RESUMO
BACKGROUND: Optimal reversal agent for direct oral anticoagulant (DOAC)-associated major bleeding has not been described. Before the approval of andexanet alfa (AA) in 2018, 4-factor prothrombin complex concentrate (4F-PCC) was recommended by major guidelines. Currently, AA is recommended as the first-line agent by most guidelines. With a paucity of literature comparing the 2 agents, there is clinical value in assessing hemostatic efficacy and safety of the 2 agents. OBJECTIVE: This study aimed to evaluate hemostatic efficacy and safety of AA and 4F-PCC in all DOAC-associated major bleedings. METHODS: A multicenter, retrospective chart review was performed of adult subjects who were admitted for a DOAC-associated major bleeding and received 4F-PCC from February 2018 to May 2019 or AA from May 2019 to September 2021. Some of the exclusion criteria included not receiving a DOAC, receiving multiple reversal agents during the same hospitalization, receiving reversal for any nonmajor bleeding indication, and not receiving the full dose of a reversal agent. The primary outcome was hemostatic efficacy 24 hours after the end of the reversal agent administration. Secondary outcomes included time to administration, hospital mortality, length of stay, need for surgery, and need for additional blood product. Safety outcome was incidence of thrombotic events. RESULTS: There were 99 subjects included in the 4F-PCC group and 84 subjects in the AA group. Hemostatic efficacy was achieved in 69 subjects (69.7%) in the 4F-PCC group and 63 subjects (75%) in the AA group (P = 0.927). In-hospital mortality was seen in 20 subjects (20.2%) in the 4F-PCC group and 10 subjects (11.9%) in the AA group. Thrombotic events were seen in 7 subjects (7.1%) in the 4F-PCC group and 6 subjects (7.1%) in the AA group. CONCLUSIONS: There were no significant differences in hemostatic efficacy, in-hospital mortality, and number of thrombotic events between 4F-PCC and AA.
RESUMO
BACKGROUND: Although minimally invasive distal pancreatectomy (MIDP) is considered a standard approach it still presents a non-negligible rate of conversion to open that is mainly related to some difficulty factors, as obesity. The aim of this study is to analyze the preoperative factors associated with conversion in obese patients with MIDP. METHODS: In this multicenter study, all obese patients who underwent MIDP at 18 international expert centers were included. The preoperative factors associated with conversion to open surgery were analyzed. RESULTS: Out of 436 patients, 91 (20.9%) underwent conversion to open, presenting higher blood loss, longer operative time and similar rate of major complications. Twenty (22%) patients received emergent conversion. At univariate analysis, the type of approach, radiological invasion of adjacent organs, preoperative enlarged lymphnodes and ASA ≥ III were significantly associated with conversion to open. At multivariate analysis, robotic approach showed a significantly lower conversion rate (14.6 % vs 27.3%, OR = 2.380, p = 0.001). ASA ≥ III (OR = 2.391, p = 0.002) and preoperative enlarged lymphnodes (OR = 3.836, p = 0.003) were also independently associated with conversion. CONCLUSION: Conversion rate is significantly lower in patients undergoing robotic approach. Radiological enlarged lymphnodes and ASA ≥ III are also associated with conversion to open. Conversion is associated with poorer perioperative outcomes, especially in case of intraoperative hemorrhage.
RESUMO
Children living in rural and migrant areas in the United States disproportionately suffer from poor oral health. Additionally, there continues to be a shortage of pediatric dentists practicing in rural/migrant areas. The purpose of this formative research study was to assess whether staff, teachers and families from rural/migrant Head Start/Early Head Start (HS/EHS) programs in California were receptive to oral health online education workshops conducted by pediatric dental residents who were assisted by bilingual (English and Spanish) community oral health workers (COHWs). Our findings suggest that partnering pediatric dental residents with bilingual COHWs to educate HS/EHS teachers, staff and parents on oral health care in rural/migrant areas could result in a rewarding experience for pediatric dentists that might lead them to practice in these communities upon graduation from their residency program. Furthermore, the positive feedback received from the teachers, staff and parents who participated in the workshops indicates they were receptive to receiving oral health information related to oral health literacy from the dental providers and COHWs. COHWs can help increase access to oral health care by serving as a bridge between families and providers by relaying information in a cultural, linguistic and sensitive manner.
Assuntos
Saúde Bucal , População Rural , Migrantes , Humanos , Saúde Bucal/educação , Educação a Distância/métodos , Intervenção Educacional Precoce , Estados Unidos , California , Pré-Escolar , CriançaRESUMO
Accelerated atherosclerosis has been identified as a complication of multiple autoimmune diseases, among which Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis stands out. We describe the case of a 60-year-old patient with a history of hypertension, diabetes mellitus, and chronic kidney disease of unknown etiology, who presented two acute coronary syndromes with only a six-month difference. Rapid progression of coronary involvement was evidenced, along with increased markers of inflammatory response, usual interstitial pneumonia on tomography, and positive anti-myeloperoxidase antibodies (anti-MPO), leading to the diagnosis of microscopic polyangiitis (MPA). In these cases, timely diagnostic suspicion is crucial, as early treatment significantly impacts the course and prognosis of the disease.
RESUMO
BACKGROUND AND OBJECTIVES: Direct-acting antivirals (DAAs) offer a high rate of hepatitis C virus (HCV) eradication. However, concerns on the risk of cancer after HCV eradication remain. Our study aimed at quantifying the incidence of cancer in patients treated with anti-HCV therapies in Catalonia (Spain) and their matched controls. METHODS: This was a population-based study using real-world data from the public healthcare system of Catalonia between 2012 and 2016. Propensity score matching was performed in patients with HCV infection treated with interferon-based therapy (IFN), sequential IFN and DAA (IFN+DAA), and DAA only (DAA) with concurrent controls. We estimated the annual incidence of overall cancer, hepatocellular carcinoma, and non-liver cancer of HCV-treated patients and their corresponding rate ratios. RESULTS: The study included 11,656 HCV-treated patients and 49,545 controls. We found statistically significant increases in the rate of overall cancer for IFN+DAA-treated (rate ratio [RR] 1.77, 95% confidence interval [CI] 1.27-2.46) and DAA-treated patients (RR 1.90, 95% CI 1.66-2.19) and in the rate of HCC for IFN-treated (RR 1.50, 95% CI 1.02-2.22), IFN+DAA-treated (RR 3.89, 95% CI 2.26-6.69), and DAA-treated patients (RR 6.45, 95% CI 4.90-8.49) compared with their corresponding controls. Moreover, DAA-treated patients with cirrhosis showed an increased rate of overall cancer versus those without cirrhosis (RR 1.92, 95% CI 1.51-2.44). CONCLUSIONS: Results showed that overall cancer and hepatocellular carcinoma incidence in Catalonia was significantly higher among HCV-treated patients compared with matched non-HCV-infected controls, and risks were higher in patients with cirrhosis. An increased awareness of the potential occurrence of uncommon malignant events and monitoring after HCV eradication therapy may benefit patients.
Direct-acting antivirals (DAAs) are effective drugs for eradicating hepatitis C virus (HCV). However, concerns about the risk of cancer after HCV eradication remain. Therefore, this study aimed to compare the incidence of cancer between patients treated with anti-HCV therapies in Catalonia (Spain) and properly matched, non-HCV-infected individuals (controls).This study was based on real-world data from the public healthcare system of Catalonia, specifically from patients with HCV infection treated with interferon-based therapy (IFN), sequential IFN and DAA (IFN+DAA), or DAA only (DAA). We calculated the incidence and rate ratios of overall cancer and hepatocellular carcinoma of HCV-treated patients.We observed that the rate of overall cancer increased in patients receiving DAA or IFN+DAA, whereas the rate of hepatocellular carcinoma increased in all groups of HCV-treated patients. Of note, DAA-treated patients with cirrhosis showed an increased rate of overall cancer versus those without cirrhosis. Thus, a close monitoring for detection of cancer in patients after HCV eradication seems reasonable, especially in those with cirrhosis.
RESUMO
OBJECTIVE: To compare multimodal structural and functional diagnostic methods in patients with systemic lupus erythematosus (SLE) treated with hydroxychloroquine, to identify the best complementary approach for detecting subclinical retinal toxicity. METHODS: A cross-sectional, unicentric study was conducted on patients with SLE treated with hydroxychloroquine. Each patient underwent a comprehensive ophthalmic evaluation, comprising structural tests (spectral-domain optical coherence tomography (SD-OCT), en face OCT, en face OCT angiography (OCTA), fundus autofluorescence (FAF)) and functional tests (automated perimetry for visual field (VF) testing, multifocal electroretinography (mfERG)). A diagnosis of macular toxicity required the presence of abnormalities in at least one structural and functional test. The Kappa Concordance Index was used to assess the concordance among the different tests in detecting potential macular toxicity-associated alterations. RESULTS: Sixty-six patients with SLE (132 eyes) were consecutively enrolled. Four (6.1%) patients developed subclinical hydroxychloroquine-induced retinal toxicity without visual acuity impairment. The proportion of abnormal results was 24% for both en face OCT and en face OCTA. Regarding functional analysis, VF was less specific than mfERG in detecting subclinical retinal toxicity (VF specificity 47.5%). En face OCT and en face OCTA structural findings showed better concordance, with a kappa index >0.8, and both identified the same cases of toxicity as FAF. CONCLUSION: Although structural OCT and VF are frequently used to screen for hydroxychloroquine-induced retinal toxicity, our findings suggest that a combination of mfERG, en face OCT and en face OCTA could improve the diagnostic accuracy for subclinical retinal damage. This study emphasises the importance of a multimodal imaging strategy to promptly detect signs of hydroxychloroquine-induced retinal toxicity.
Assuntos
Antirreumáticos , Lúpus Eritematoso Sistêmico , Humanos , Hidroxicloroquina/efeitos adversos , Antirreumáticos/efeitos adversos , Estudos Transversais , Angiofluoresceinografia/métodos , Lúpus Eritematoso Sistêmico/diagnóstico por imagem , Fundo de Olho , Imagem MultimodalRESUMO
Impulse control disorders and their consequences display variability among individuals, indicating potential involvement of environmental and genetic factors. In this retrospective study, we analyzed a cohort of Parkinson's disease patients treated with dopamine agonists and investigated the influence of the dopamine D4 receptor gene polymorphism, DRD4 7R+, which is linked to psychiatric disorders, impulsive traits, and addictive behaviors. We found that DRD4 7R+ is a significant genetic risk factor associated with the severity of ICD.
Assuntos
Transtornos Disruptivos, de Controle do Impulso e da Conduta , Agonistas de Dopamina , Doença de Parkinson , Receptores de Dopamina D4 , Humanos , Doença de Parkinson/tratamento farmacológico , Doença de Parkinson/genética , Receptores de Dopamina D4/genética , Transtornos Disruptivos, de Controle do Impulso e da Conduta/genética , Transtornos Disruptivos, de Controle do Impulso e da Conduta/induzido quimicamente , Masculino , Agonistas de Dopamina/efeitos adversos , Agonistas de Dopamina/farmacologia , Agonistas de Dopamina/administração & dosagem , Pessoa de Meia-Idade , Feminino , Idoso , Estudos Retrospectivos , Polimorfismo GenéticoRESUMO
Colorectal cancer is a widespread neoplasia with high ratios of chemoresistance. Phytochemicals in plant-based extracts could be useful to treat colorectal cancer, and/or reduce chemoresistance. Methanolic extract of avocado mesocarp (MEAM) has demonstrated antitumoral properties, depending on the fruit ripening stage (RS). The aim of this study was to analyze the effects of methanolic extracts of "Hass" avocado fruit at different RS on cytotoxicity, antioxidative, anti-inflammatory, anti-invasive, cell cycle, and epithelial-mesenchymal transition inhibition in colorectal adenocarcinoma cell line HT29. The MEAM showed an increasing concentration of total phenolic compounds as the RS progressed, which was correlated with antioxidant capacity measured by the Ferric Reducing Antioxidant Power assay but not with the 2.2-diphenyl-1-picrylhydrazyl assay. The specific phenolic compounds of MEAM were determined by high-performance liquid chromatography, and it was found that concentrations of epicatechin decreased while concentrations of chlorogenic acid increased as the RS progressed. The HT29 cell line was treated with MEAM for 48 h, and all MEAM had a cytotoxic effect, reported by MTT assay, nevertheless, the strongest effect was associated with the presence of chlorogenic acid. MEAM induced apoptosis and cell cycle arrest in phase G0/G1, reported by flow cytometry. Moreover, MEAM inhibited cell migration evidenced by the wound healing assay. On the other hand, MEAM significantly reduced expression of mRNA of tumor necrosis factor-alpha and cyclooxygenase 2. These effects comprise important inhibition of some hallmarks of cancer. This, in turn, may provide interesting guidelines for developing antitumoral intervention agents.
Assuntos
Antineoplásicos , Neoplasias Colorretais , Persea , Humanos , Frutas/química , Antioxidantes/metabolismo , Persea/química , Metanol , Ácido Clorogênico/análise , Extratos Vegetais/química , Células HT29 , Neoplasias Colorretais/tratamento farmacológicoRESUMO
ATP is actively maintained at high concentrations in cancerous tissues, where it promotes a malignant phenotype through P2 receptors. In this study, we first evaluated the effect of extracellular ATP depletion with apyrase in SKOV-3, a cell line derived from metastatic ovarian carcinoma. We observed a decrease in cell migration and an increase in transepithelial electrical resistance and cell markers, suggesting a role in maintaining a mesenchymal phenotype. To identify the P2 receptor that mediated the effects of ATP, we compared the transcript levels of some P2 receptors and found that P2RX7 is three-fold higher in SKOV-3 cells than in a healthy cell line, namely HOSE6-3 (from human ovarian surface epithelium). Through bioinformatic analysis, we identified a higher expression of the P2RX7 transcript in metastatic tissues than in primary tumors; thus, P2X7 seems to be a promising effector for the malignant phenotype. Subsequently, we demonstrated the presence and functionality of the P2X7 receptor in SKOV-3 cells and showed through pharmacological approaches that its activity promotes cell migration and contributes to maintaining a mesenchymal phenotype. P2X7 activation using BzATP increased cell migration and abolished E-cadherin expression. On the other hand, a series of P2X7 receptor antagonists (A438079, BBG and OxATP) decreased cell migration. We used a CRISPR-based knock-out system directed to P2RX7. According to the results of our wound-healing assay, SKOV3-P2X7KO cells lacked receptor-mediated calcium mobilization and decreased migration. Altogether, these data let us propose that P2X7 receptor is a regulator for cancer cell migration and thus a potential drug target.
Assuntos
Trifosfato de Adenosina , Movimento Celular , Neoplasias Ovarianas , Receptores Purinérgicos P2X7 , Humanos , Receptores Purinérgicos P2X7/metabolismo , Receptores Purinérgicos P2X7/genética , Neoplasias Ovarianas/patologia , Neoplasias Ovarianas/metabolismo , Neoplasias Ovarianas/genética , Feminino , Trifosfato de Adenosina/metabolismo , Linhagem Celular Tumoral , Transição Epitelial-Mesenquimal/genética , Regulação Neoplásica da Expressão GênicaRESUMO
OBJECTIVE: To develop updated guidelines for the pharmacological management of rheumatoid arthritis (RA). METHODS: A group of experts representative of different geographical regions and various medical services catering to the Mexican population with RA was formed. Questions based on Population, Intervention, Comparison, and Outcome (PICO) were developed, deemed clinically relevant. These questions were answered based on the results of a recent systematic literature review (SLR), and the evidence's validity was assessed using the GRADE system, considered a standard for these purposes. Subsequently, the expert group reached consensus on the direction and strength of recommendations through a multi-stage voting process. RESULTS: The updated guidelines for RA treatment stratify various therapeutic options, including different classes of DMARDs (conventional, biologicals, and JAK inhibitors), as well as NSAIDs, glucocorticoids, and analgesics. By consensus, it establishes the use of these in different subpopulations of interest among RA patients and addresses aspects related to vaccination, COVID-19, surgery, pregnancy and lactation, and others. CONCLUSIONS: This update of the Mexican guidelines for the pharmacological treatment of RA provides reference points for evidence-based decision-making, recommending patient participation in joint decision-making to achieve the greatest benefit for our patients. It also establishes recommendations for managing a variety of relevant conditions affecting our patients.
Assuntos
Antirreumáticos , Artrite Reumatoide , Artrite Reumatoide/tratamento farmacológico , Humanos , México , Antirreumáticos/uso terapêutico , Glucocorticoides/uso terapêutico , Feminino , Anti-Inflamatórios não Esteroides/uso terapêutico , Gravidez , Analgésicos/uso terapêuticoRESUMO
BACKGROUND: Retrospective studies support that mean perfusion pressure (MPP) deficit in cardiac surgery patients is associated with a higher incidence of acute kidney injury (CS-AKI). The aim of our study was to apply an algorithm based on MPP in the postoperative period to determine whether management with an individualized target reduces the incidence of CS-AKI. METHODS: Randomized controlled trial of patients undergoing cardiac surgery with extracorporeal circulation. Adult patients submitted to valve replacement and/or bypass surgery with a high risk of CS-AKI evaluated by a Leicester score >30 were randomized to follow a target MPP of >75% of the calculated baseline or a standard hemodynamic management during the first postoperative 24 h. RESULTS: Ninety-eight patients with an eGFR of 54 mL/min were included. There were no differences in MAP and MPP in the first 24 h between the randomized groups, although a higher use of noradrenaline was found in the intervention arm (38.78 vs. 63.27, p = 0.026). The percentage of time with MPP < 75% of measured baseline was similar in both groups (10 vs. 12.7%, p = 0.811). MAP during surgery was higher in the intervention group (73 vs. 77 mmHg, p = 0.008). The global incidence of CS-AKI was 36.7%, being 38.6% in the intervention group and 34.6% in the control group (p = 0.40). There were no differences in extrarenal complications between groups as well. CONCLUSION: An individualized hemodynamic management based on MPP compared to standard treatment in cardiac surgery patients was safe but did not reduce the incidence of CS-AKI in our study.
RESUMO
A Carta de Maceió foi elaborada com base nas discussões do 3º Fórum SUS da Associação Brasileira de Alergia e Imunologia (ASBAI). O documento destaca os desafios e propostas para aprimorar a assistência a pacientes com doenças imunoalérgicas no Sistema Único de Saúde (SUS) do Brasil. Tais condições, frequentemente crônicas e debilitantes, afetam milhões de brasileiros e exigem uma abordagem integrada, desde a atenção primária à saúde até a atenção especializada. Foram discutidos a necessidade de aprimorar a gestão de referência e contrarreferência, a urgência na superação da carência de especialistas e o desafio representado pelo limitado acesso tanto a diagnóstico quanto a tratamento adequados. As doenças raras, incluindo os erros inatos da imunidade (EII), apresentam um desafio adicional, exigindo acesso a tecnologias de alto custo para diagnóstico e tratamento e cuidado multidisciplinar. Do fórum emergiram propostas como o financiamento adequado da saúde, o fortalecimento do diagnóstico precoce, a gestão integrada de cuidados, a educação continuada dos profissionais de saúde e a implementação de telemedicina. Essas ações visam um sistema de saúde mais inclusivo, eficiente e humanizado, atendendo às necessidades dos pacientes com doenças imunoalérgicas.
The Maceió Charter was based on discussions held at the 3rd Unified Health System Forum (Fórum SUS) of the Brazilian Association of Allergy and Immunology (ASBAI). This document highlights challenges and proposals to improve care for patients with immune and allergic diseases within the Brazilian Unified Health System (SUS). Such conditions, often chronic and debilitating, affect millions of Brazilians and require an integrated approach from primary health through to specialty care. The need for improved management of referrals and counter-referrals, the urgency of overcoming the shortage of specialists, and the challenge represented by limited access to proper diagnosis and treatment alike were discussed. Rare diseases, including inborn errors of immunity (IEI), pose an additional challenge, requiring access to high-cost technologies for diagnosis and treatment as well as multidisciplinary care. Several proposals emerged from the Forum, such as securing sufficient funding for health, strengthening early diagnosis, integrating management, continuing education for health professionals, and implementation of telemedicine. These proposed interventions seek a more inclusive, efficient, and humanized healthcare system which meets the needs of patients with immune and allergic diseases.
Assuntos
HumanosRESUMO
En el marco de los 40 años de la docencia médica en Cienfuegos, este artículo constituye un pequeño, pero sincero, homenaje para sus fundadores. El primer grupo de alumnos de 3er año de la carrera de Medicina, llegó en septiembre de 1980 al Hospital Dr. Gustavo Aldereguía Lima, de Cienfuegos. En este trabajo se hace una relatoría de los primeros trabajadores de la Unidad Docente, que radicó donde se encuentra hoy la oficina del Consejo Científico, la distribución de los alumnos y profesores por salas, la ubicación de los primeros albergues, las primeras actividades científicas, hoy Fórum Científico Estudiantil, el Movimiento de alumnos ayudantes, actividades extracurriculares: la primera actividad por el día de la mujer, las primeras celebraciones por el día del Educador, el primer chequeo de emulación de los tres centros de educación superior de la provincia, el inicio de las manifestaciones de la cultura, entre otros aspectos, anécdotas y comentarios.
Within the framework of 40 years of medical teaching in Cienfuegos, this article constitutes a small, but sincere, tribute to its founders. The first group of 3rd year Medicine students arrived in September 1980 at the Dr. Gustavo Aldereguía Lima Hospital in Cienfuegos. In this work, a report is made of the first workers of the Teaching Unit, which was located where the office of the Scientific Council is today, the distribution of students and teachers by rooms, the location of the first hostels, the first scientific activities, today the Student Scientific Forum, the Movement of student assistants, extracurricular activities: the first activity for Women's Day, the first celebrations for Educator's Day, the first emulation check of the three higher education centers in the province, the beginning of the manifestations of culture, among other aspects, anecdotes and comments.
RESUMO
Introdução: O teste de provocação oral (TPO) com alimentos é o padrão ouro para avaliação diagnóstica e de aquisição de tolerância em pacientes com alergia alimentar (AA). Exige, no entanto, equipe especializada e local apropriado para execução, uma vez que reações alérgicas, incluindo anafilaxia, podem acontecer. Foi recém-incorporado como procedimento reconhecido pelo Sistema Único de Saúde e pela Agência Nacional de Saúde, mas apenas no contexto da alergia ao leite de vaca para pacientes com até 24 meses de vida. Pouco se sabe sobre sua disponibilidade/execução no território brasileiro. Objetivos: Explorar o perfil de realização de TPO com alimentos em âmbito nacional, bem como as limitações para a sua não realização. Métodos: Inquérito virtual foi disponibilizado por e-mail aos 2.500 sócios cadastrados na Associação Brasileira de Alergia e Imunologia questionando sobre a prática de TPO, formação do profissional, limitações para sua não realização e possíveis soluções para sua execução. Resultados: Foram obtidas 290 respostas (11,6% dos associados), sendo a maioria deles proveniente da Região Sudeste (56,1%). Realizam TPO 54,5% (158/290) dos associados, 62% destes mais de 5 TPOs/mês, principalmente para leite e ovo. A execução de TPO na atualidade, majoritariamente na rede privada, esteve associada à prática do procedimento durante a especialização. Falta de recurso e ambiente apropriados são as maiores limitações para a não realização do TPO. Conclusões: Apesar do viés de seleção inerente à metodologia empregada do estudo, este inquérito pioneiro em território nacional tem importância por esclarecer e discutir a realização do TPO no âmbito do Brasil. Certamente este procedimento ainda é insuficientemente realizado no Brasil.
Background: Oral food challenge (OFC), the gold standard for diagnosing food allergy and determining tolerance levels, requires specialized staff and appropriate conditions since anaphylaxis may occur. In 2022, OFC was officially recognized in Brazilian public and private health systems, although only for milk allergy in children up to 24 months of age. Little is known about OFC practices in Brazil. Objectives: To explore OFC practices, barriers, and solutions among Brazilian allergists and immunologists. Methods: A survey was e-mailed to 2500 associates of the Brazilian Association of Allergy and Immunology regarding OFC practices, training experiences, barriers to this procedure, and workable solutions. Results: A total of 290 associates responded (11.6%), more than a half of whom (56.15) practiced in the southeast region: 158 (54.5%) reported performing OFC, of whom 62% performed > 5 procedures each month, mostly for cow milk and hen egg. OFCs were mostly performed in private practice and were associated with specialized training. Lack of an appropriate setting was seen as the main barrier to performing the procedure. Conclusions: Although this study's methodology involves intrinsic biases, this is the first exploration of OFC practice in Brazil. OFCs are still underperformed nationwide.
Assuntos
Humanos , Sociedades Médicas , Brasil , Técnicas e Procedimentos DiagnósticosRESUMO
A polinose é uma doença comum dos países de clima temperado, onde as estações do ano são bem definidas. Apresenta-se clinicamente como rinoconjuntivite e/ou asma sazonal ou perene com exacerbação na primavera. No Brasil, há relatos de casos de polinose por polens de gramíneas que são os principais causadores dessa patologia, principalmente na Região Sul, apesar do clima subtropical. A expansão da população e desmatamento com crescente urbanização de áreas florestais são alguns dos responsáveis pelo aumento de casos em vários locais do país. Neste relato de caso, descrevemos um caso de polinose por polens de gramínea em um paciente militar que morou em países da Europa e que atualmente reside em uma zona de mata nativa no Rio de Janeiro, RJ, Brasil. Apesar de a polinose não ser uma doença encontrada no RJ, este diagnóstico não deve ser excluído em pacientes com conjuntivite/rinoconjuntivite sazonal, principalmente quando têm uma história pregressa de morar vários anos fora país.
Pollinosis is a common disease in temperate countries, which have well-defined seasons. It presents clinically as rhinoconjunctivitis and/or seasonal or perennial asthma that is exacerbated in spring. In Brazil, cases of pollinosis due to grass pollens have been reported, especially in the south, despite its subtropical climate. The expansion of the population and deforestation, including increasing urbanization of forest areas, are contributing to the rise in cases in various regions of the country. This case report describes a case of pollinosis due to grass pollens in a military patient who lived in Europe and currently resides in a region of native forest in Rio de Janeiro metropolitan area. Although pollinosis is not found in the state of Rio de Janeiro, this diagnosis should not be excluded in patients with seasonal conjunctivitis/ rhinoconjunctivitis, especially when they have lived outside the country for several years.
Assuntos
Humanos , Masculino , Idoso , Testes Cutâneos , Imunoglobulina ERESUMO
ABSTRACT HTLV-1 is a retrovirus that has an impact on human health due to its T-lymphocyte tropism. It occurs worldwide, but is more prevalent in tropical regions. Although most infected individuals will remain asymptomatic, the infection may manifest with complications such as uveitis, myelopathy, and leukemia, among others. The diagnosis is a chieved by the detection of anti-HTLV antibodies and a confirmatory test (Western Blot or proviral load). Although there is no specific treatment, medical treatments are aimed towards the management of secondary diseases. Three cases are described of pediatric patients diagnosed with HTLV-1 infection and associated autoimmune manifestations.
RESUMEN El virus linfotrópico humano de células T tipo I (HTLV-1) es un retrovirus que causa impacto en la salud del ser humano debido al tropismo para infectar a linfocitos T. Está distribuido mundialmente, pero es más prevalente en regiones tropicales. La mayoría de las personas afectadas permanecen asintomáticas, sin embargo, al manifestarse puede causar complicaciones como uveítis, mielopatía y leucemia, entre otras. Su diagnóstico se hace mediante la determinación de anticuerpos anti-HTLV y prueba confirmatoria (Western Blot o carga proviral). No tiene tratamiento específico, las medidas están dirigidas a la prevención y el manejo de las afecciones secundarias. Se describen tres pacientes en edad pediátrica con diagnóstico de infección por HTLV-1 y manifestaciones autoinmunes.
Assuntos
Humanos , Lactente , Criança , Vírus Oncogênicos , Retroviridae , Vírus , Vírus Linfotrópico T Tipo 1 Humano , Doenças Inflamatórias Intestinais , Doença de Crohn , Doenças do Sistema Digestório , GastroenteropatiasRESUMO
Abstract Objective To summarize the available evidence of TAP Block in efficacy in laparoscopic or robotic hysterectomy. Data Sources We searched databases and gray literature for randomized controlled trials in which transversus abdominis plane (TAP) block was compared with placebo or with no treatment in patients who underwent laparoscopic or robot-assisted hysterectomy. Method of Study Selection Two researchers independently evaluated the eligibility of the selected articles. Tabulation, Integration, and Results Seven studies were selected, involving 518 patients. Early postoperative pain showed a difference in the mean mean difference (MD): - 1.17 (95% confidence interval [CI]: - 1.87-0.46) in pain scale scores (I2=68%), which was statistically significant in favor of using TAP block, but without clinical relevance; late postoperative pain: DM 0.001 (95%CI: - 0.43-0.44; I2=69%); opioid requirement: DM 0.36 (95%CI: - 0.94-1.68; I2=80%); and incidence of nausea and vomiting with a difference of 95%CI=- 0.11 (- 0.215-0.006) in favor of TAP. Conclusion With moderate strength of evidence, due to the high heterogeneity and imbalance in baseline characteristics among studies, the results indicate that TAP block should not be considered as a clinically relevant analgesic technique to improve postoperative pain in laparoscopic or robotic hysterectomy, despite statistical significance in early postoperative pain scale scores. Clinical Trial Number and Registry: PROSPERO ID - CRD42018103573.
Resumo Objetivo Resumir as evidências disponíveis sobre a eficácia do bloqueio TAP em histerectomia laparoscópica ou robótica. Fontes de Dados Pesquisamos bancos de dados e literatura cinza por ensaios clínicos randomizados nos quais o bloqueio do plano transverso do abdome (TAP na sigla em inglês) foi comparado com placebo ou com nenhum tratamento em pacientes que foram submetidos a histerectomia laparoscópica ou assistida por robô. Métodos de Seleção de Estudos Dois pesquisadores avaliaram independentemente a elegibilidade dos artigos selecionados. Tabulação, Integração e Resultados Sete estudos foram selecionados envolvendo 518 pacientes. A dor pós-operatória precoce apresentou diferença nasmédias (DM) de: -1 17 (intervalo de confiança [IC] de 95%: - 1 87-0 46) nos escores da escala de dor (I2=68%) o que foi estatisticamente significativo a favor do uso do bloqueio TAP mas sem relevância clínica; dor pós-operatória tardia: DM 0001 (IC95%: - 043-044; I2=69%); necessidade de opioides: DM0 36 (95%CI: - 0 94-168; I2=80%); e incidência de náuseas e vômitos com diferença de 95% CI=- 011 (- 0215-0006) a favor do TAP. Conclusão Com moderada força de evidência devido à alta heterogeneidade e ao desequilíbrio nas características basais entre os estudos os resultados indicam que o bloqueio do TAP não deve ser considerado como uma técnica analgésica clinicamente relevante para melhorar a dor pós-operatória em histerectomia laparoscópica ou robótica apesar da significância estatística nas pontuações da escala de dor pósoperatória inicial. Número e Registro do Ensaio Clínico: PROSPERO ID - CRD42018103573.
Assuntos
Dor Pós-Operatória/prevenção & controle , Laparoscopia/métodos , Procedimentos Cirúrgicos Robóticos/métodos , Analgésicos Opioides/uso terapêutico , Dor Pós-Operatória/tratamento farmacológico , Robótica , Músculos Abdominais , Histerectomia/métodosRESUMO
Nas últimas décadas observa-se aumento na prevalência mundial de alergia alimentar, que já acomete aproximadamente 6% das crianças, atribuído à interação entre fatores genéticos, ambientais e alterações na resposta imunológica e pode envolver reações mediadas por IgE, não mediadas e mistas. As formas não IgE mediadas decorrem de reação de hipersensibilidade tardia, mediada por linfócitos T e afetam prioritariamente o trato gastrointestinal, como a Síndrome da enterocolite induzida por proteína alimentar (FPIES), Síndrome da proctocolite alérgica induzida por proteína alimentar (FPIAP), Síndrome da enteropatia induzida por proteína alimentar (FPE) e doença celíaca. As características destas reações podem ser diferenciadas por sua apresentação clínica, gravidade, idade de início e história natural. Entre as reações alérgicas aos alimentos não IgE mediadas, a proctocolite alérgica é a mais frequente. Geralmente ocorre no primeiro ano de vida e apresenta excelente prognóstico. Embora costume ter um curso benigno, traz grande preocupação aos cuidadores por frequentemente cursar com quadro de hematoquezia exigindo diagnóstico diferencial adequado. O conhecimento e manejo da proctocolite alérgica é de suma importância para a prática médica em Alergia e Imunologia. Seu diagnóstico é baseado na história clínica seguindo-se dieta de exclusão, especialmente do leite de vaca, com subsequente provocação oral, que geralmente pode ser realizada no domicílio. O diagnóstico preciso é importante, para se evitar dietas de exclusão desnecessárias. Nesta revisão foram utilizados artigos publicados nos últimos anos, com busca realizada através da base PubMed envolvendo revisões, diagnóstico e tratamento de alergias não IgE mediadas, com foco em proctocolite alérgica.
An increase in the worldwide prevalence of food allergies has been observed in the past decades, currently affecting 6% of children. This increase has been associated with the interaction between genetic, environmental, and immune response factors and can be observed in IgE, non-IgE, and mixed mediated reactions. Non-IgE mediated food allergies result from delayed-type hypersensitivity and mostly affect the gastrointestinal tract, such as food protein-induced enterocolitis syndrome (FPIES), food protein-induced allergic proctocolitis (FPIAP), food protein-induced enteropathy (FPE), and celiac disease. These reactions can be differentiated by their clinical presentation, severity, age at onset, and natural history. Among non-IgE-mediated allergic reactions to food, allergic proctocolitis is the most frequent. It usually develops in the first year of life and has excellent prognosis. Although it has a benign course, allergic proctocolitis is challenging for health care professionals because it often presents with hematochezia, requiring an accurate differential diagnosis. Knowledge and management of allergic proctocolitis is of paramount importance for medical practice in allergy and immunology. Its diagnosis is based on clinical history followed by elimination diet, especially cow's milk, with subsequent oral food challenge, which may usually be performed at home. Accurate diagnosis is important to avoid unnecessary elimination diets. For this review, PubMed database was searched for recently published literature reviews and studies on the diagnosis and treatment of non- IgE mediated allergies, with a focus on allergic proctocolitis.
Assuntos
Humanos , Recém-Nascido , Lactente , Pré-Escolar , Criança , Proctocolite , Hipersensibilidade Alimentar , Terapêutica , Imunoglobulina E , Linfócitos T , Doença Celíaca , Prevalência , Hipersensibilidade a Leite , PubMed , Trato Gastrointestinal , Diagnóstico Diferencial , Alergia e Imunologia , Hemorragia GastrointestinalRESUMO
O Sistema Único de Saúde (SUS) abrange todos os níveis de atenção à saúde e garante acesso integral, universal e gratuito para toda a população brasileira. As transições demográfica e epidemiológica observadas nas últimas décadas trouxeram um cenário de maior prevalência das doenças imunoalérgicas. Nesse contexto, a implementação de políticas de saúde voltadas à assistência à saúde dessa população tornou-se um desafio. Com o objetivo de discutir a atenção à saúde dos pacientes com doenças alérgicas e imunológicas no Brasil, a Associação Brasileira de Alergia e Imunologia (ASBAI) realizou em 26 de agosto de 2022, na cidade de São Paulo, o Fórum sobre a Assistência a Pacientes com Doenças Imunoalérgicas no SUS. O evento foi estruturado no formato de painéis e contou com a participação de membros da ASBAI e representantes da gestão pública federal, do Ministério Público, de sociedade de pacientes e profissionais de saúde de diversos serviços com experiência em programas e projetos bem sucedidos na assistência a pacientes com doenças imunoalérgicas. Após a discussão, concluiu-se que ainda existem muitas necessidades não atendidas em relação à atenção à saúde da população com doenças alérgicas e imunológicas no Brasil. A ASBAI tem trabalhado no sentido de contribuir para organizar, implantar e manter a assistência a estes pacientes no âmbito do SUS.
The Brazilian Unified Health System covers all levels of health care and guarantees full, universal and free access for the entire population. The demographic and epidemiological transitions observed in recent decades have led to a higher prevalence of allergic diseases. In this context, implementing health policies to benefit these patients has become a challenge. To discuss health care for patients with allergic and immunological diseases in Brazil, the Brazilian Association of Allergy and Immunology (ASBAI) held a forum in São Paulo on August 26, 2022 called "Treating Patients with Allergic Diseases in the Unified Health System". The event's panels included members of ASBAI, representatives of the federal government, the attorney general's office, patients, and health professionals from various services with experience in successful programs for patients with allergic diseases. It was concluded that there are still many unmet health care needs for Brazilians with allergic and immunological diseases. ASBAI is contributing to the organization, implementation, and maintenance of care for these patients within the scope of the Unified Health System.