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1.
Ann Hematol ; 96(5): 879-880, 2017 May.
Artículo en Inglés | MEDLINE | ID: mdl-28213751

Asunto(s)
Anticuerpos Monoclonales Humanizados/efectos adversos , Inmunosupresores/efectos adversos , Infecciones Meningocócicas/fisiopatología , Neisseria meningitidis Serogrupo W-135/inmunología , Infecciones Oportunistas/fisiopatología , Microangiopatías Trombóticas/complicaciones , Síndrome de Waterhouse-Friderichsen/etiología , Lesión Renal Aguda/complicaciones , Lesión Renal Aguda/etiología , Lesión Renal Aguda/inmunología , Lesión Renal Aguda/terapia , Adulto , Antibacterianos/uso terapéutico , Anticuerpos Monoclonales Humanizados/uso terapéutico , Ciprofloxacina/uso terapéutico , Terapia Combinada , Coagulación Intravascular Diseminada/complicaciones , Coagulación Intravascular Diseminada/etiología , Coagulación Intravascular Diseminada/terapia , Humanos , Huésped Inmunocomprometido , Inmunosupresores/uso terapéutico , Unidades de Cuidados Intensivos , Lupus Eritematoso Sistémico/complicaciones , Lupus Eritematoso Sistémico/tratamiento farmacológico , Lupus Eritematoso Sistémico/inmunología , Lupus Eritematoso Sistémico/fisiopatología , Masculino , Infecciones Meningocócicas/complicaciones , Infecciones Meningocócicas/tratamiento farmacológico , Infecciones Meningocócicas/microbiología , Neisseria meningitidis Serogrupo W-135/efectos de los fármacos , Neisseria meningitidis Serogrupo W-135/aislamiento & purificación , Infecciones Oportunistas/complicaciones , Infecciones Oportunistas/tratamiento farmacológico , Infecciones Oportunistas/microbiología , Síndrome Respiratorio Agudo Grave/complicaciones , Síndrome Respiratorio Agudo Grave/etiología , Síndrome Respiratorio Agudo Grave/inmunología , Síndrome Respiratorio Agudo Grave/terapia , Choque Séptico/complicaciones , Choque Séptico/etiología , Choque Séptico/inmunología , Choque Séptico/terapia , Microangiopatías Trombóticas/etiología , Microangiopatías Trombóticas/inmunología , Microangiopatías Trombóticas/prevención & control , Resultado del Tratamiento , Síndrome de Waterhouse-Friderichsen/inmunología , Síndrome de Waterhouse-Friderichsen/microbiología , Síndrome de Waterhouse-Friderichsen/prevención & control , Adulto Joven
2.
Med Hypotheses ; 71(2): 298-301, 2008 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-18448259

RESUMEN

Severe Acute Respiratory Syndrome (SARS) outbreak in 2002-03 caused morbidity in over 8000 individuals and mortality in 744 in 29 countries. Lymphopenia along with neutrophilia was a feature of SARS, as it is in respiratory syncytial virus (RSV) and Ebola infections, to name a few. Direct infestation of lymphocytes, neutrophils and macrophages by SARS coronavirus (CoV) has been debated as a cause of lymphopenia, but there is no convincing data. Lymphopenia can be caused by glucocorticoids, and thus any debilitating condition has the potential to induce lymphopenia via stress mechanism involving the hypothalamic-pituitary-adrenal axis. Cortisol levels are elevated in patients with RSV and Ebola, and cortisol was higher in SARS patients with lymphopenia before any steroid therapy. Glucocorticoids also down-regulate the production of proinflammatory lymphokines. Because of the insidious presentation, SARS was treated with antibacterial, antiviral and supra-physiological doses of glucocorticoids. Treatment with glucocorticoids complicated the issue regarding lymphopenia, and certainly calls into question the status of lymphokines and their prognostic implications in SARS.


Asunto(s)
Linfopenia/complicaciones , Síndrome Respiratorio Agudo Grave/sangre , Síndrome Respiratorio Agudo Grave/complicaciones , Citocinas/metabolismo , Glucocorticoides/uso terapéutico , Humanos , Hidrocortisona/metabolismo , Hipotálamo/metabolismo , Sistema Inmunológico , Linfocitos/metabolismo , Linfocinas/metabolismo , Linfopenia/etiología , Linfopenia/virología , Modelos Biológicos , Modelos Teóricos , Sistema Hipófiso-Suprarrenal/metabolismo , Pronóstico , Síndrome Respiratorio Agudo Grave/tratamiento farmacológico
3.
Chang Gung Med J ; 31(6): 546-53, 2008.
Artículo en Inglés | MEDLINE | ID: mdl-19241893

RESUMEN

BACKGROUND: There are no treatment guidelines for hip necrosis in severe acute respiratory syndrome (SARS) patients. A new regimen of cocktail therapy that consists of extracorporeal shockwave therapy (ESWT), hyperbaric oxygen therapy (HBO) and oral alendronate was utilized in four patients with eight hips. This study evaluated the outcomes of cocktail therapy with a 4-year followup. METHODS: There were 3 women and 1 man with an average age of 26 +/- 3.8 years. Each hip was treated with 6000 impulses of ESWT at 0.62 mJ/mm2 energy flux density in a single session. Each patient received HBO treatment for 100 sessions and oral alendronate for one year. The evaluations included pain score and Harris hip score, radiographs and magnetic resonance imaging (MRI) of the affected hips. RESULTS: At the 4-year follow-up, significant improvements in pain score and Harris hip score were observed in all cases (p < 0.001). All patients returned to work as healthcare providers. None required surgical intervention including hip replacement. MRI showed a trend of reduction in bone marrow edema and the size of the lesion, but no changes in the stage of the lesion. CONCLUSION: Cocktail therapy seems promising in delaying the disease progression of SARS-associated femoral head necrosis in the short-term.


Asunto(s)
Alendronato/uso terapéutico , Necrosis de la Cabeza Femoral/terapia , Ondas de Choque de Alta Energía/uso terapéutico , Oxigenoterapia Hiperbárica , Síndrome Respiratorio Agudo Grave/complicaciones , Adulto , Femenino , Necrosis de la Cabeza Femoral/diagnóstico por imagen , Humanos , Imagen por Resonancia Magnética , Masculino , Radiografía
6.
Zhonghua Yi Xue Za Zhi ; 83(11): 897-901, 2003 Jun 10.
Artículo en Chino | MEDLINE | ID: mdl-12899786

RESUMEN

OBJECTIVE: To investigate the clinical manifestations, treatment, and outcome of severe acute respiratory syndrome (SARS). METHODS: The clinical data of 108 SARS in-patients were analyzed. RESULTS: Among the 108 cases, 35 males (32.4%) and 73 females (67.6%), aged 37 +/- 9 (range 13 approximately 83 years), most were white-collar workers, medical workers accounting for 28.7%. 87.0% had a definite contact history. 20.4% were complicated by other internal diseases. The main clinical manifestations included fever, cough, pectoralgia, chest distress, headache, etc. Involvement of multiple organs was often. The incubation period was 2 approximately 14 days. The course included early stage, progressive stage, climax, and convalescence. Mild type accounted for 4.6%, common type 39.8%, severe type 20.4%, and extremely severe type 35.2%. At the early stage, white blood cell count, lymphocyte count and ratio of lymphocyte, proalbumin, transferring, CD(3)(+), CD(4)(+), CD(8)(+) cell count were remarkably decreased, and C-reactive protein, alpha-acid glycoprotein, and alpha(2)-globulin were remarkably increased. X-ray chest film showed solitary or multiple local exudative changes, mostly in pulmonary lower field. During the progressive stage the hyaline or consolidation images were enlarged. High solution CT showed solitary or multiple cotton wadding like images and ground glass-like or consolidation images. Hypoxemia was common. At the progressive stage application of adrenocortical hormones and non-invasive mechanical ventilation helped stop the progress of disease. Ninety-four cases were discharged, 14 cases died. Traditional Chinese medicine (TCM) regards SARS as one of epidemic febrile diseases. Treatment by combination of TCM and Western medicine was effective. CONCLUSION: SARS mainly affects youth and people in their prime of life. It has its own characteristic clinical manifestations. The classification system of 5 types and 4 stages helps judge the condition. Treatment by combination of TCM and Western medicine is encouraged.


Asunto(s)
Síndrome Respiratorio Agudo Grave/terapia , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Causas de Muerte , Femenino , Humanos , Masculino , Persona de Mediana Edad , Radiografía Torácica , Síndrome Respiratorio Agudo Grave/complicaciones , Síndrome Respiratorio Agudo Grave/diagnóstico por imagen , Subgrupos de Linfocitos T/inmunología
7.
Zhonghua Er Ke Za Zhi ; 41(6): 408-12, 2003 Jun.
Artículo en Chino | MEDLINE | ID: mdl-14748989

RESUMEN

OBJECTIVE: Since the outbreak of a highly contagious new pneumonia, atypical pneumonia or severe acute respiratory syndrome (SARS) occurred in Guangzhou area, 33 children with this syndrome were treated in the authors' hospital. The present study aimed to understand clinical characteristics and prognosis of pediatric SARS patients in Guangzhou area. METHODS: Clinical manifestations, laboratory and radiologic findings, therapeutic approaches and prognosis of the 33 children with SARS in Guangzhou area were analyzed. RESULTS: Of the 33 cases, 17 were males and 16 were females. The age was between 3 months to 13 years, and 3 - 12 years old patients accounted for 82%. Five (15%) cases had an evident history of contacting SARS patient before the symptoms occurred. Another 5 (15%) cases had a history that contacts of these patients (family members or friends) developed fever and/or cough later. The most common symptoms in this cohort were fever (100%) and cough (91%). Most of the cases had high fever, higher than 39 degrees C. Near half of the cases had nonproductive cough. The initial blood cells count showed that total white blood cell (WBC) count was (2.5 - 9.7) x 10(9)/L. In 22 (67%) cases the WBC count was < 5.0 x 10(9)/L, and in 10 (30%) WBC was (5.0 - 7.0) x 10(9)/L, in 18 cases most of the WBC were lymphocyte count. Chest radiograph showed patchy infiltrates, in 15 cases the changes were unilateral, and in 18 were bilateral. The radiologic changes developed fast, in some cases the changes progressed from one side to both sides. The opacity was absorbed slowly, significant absorption took in average two weeks. Elevated ALT was found in 3 cases and elevated CK-MB in 2 cases. Treatment included isolation, good ventilation of the ward, bed rest, supportive regimens, low volume oxygen inhalation, use of Chinese traditional medicine, antibiotics to prevent bacterial infection, and anti-inflammation therapy. All the patients recovered and discharged from hospital after a mean period of 10.0 +/- 3.8 days. CONCLUSION: SARS in children may have its own characteristics. The main clinical manifestations were high fever and cough while no severe toxic symptoms, nor respiratory failure was seen; few symptoms or signs suggesting involvement of systems other than respiratory system were seen. Chest radiograph showed uni- or bilateral asymmetric air-space infiltrates which could worsen quickly and were absorbed slowly. Though there were severe changes in the lung, the patients might not have corresponding symptoms or signs. The total white blood cell count in peripheral blood did not increase. All the patients studied had a favorable outcome after the combined treatment.


Asunto(s)
Síndrome Respiratorio Agudo Grave/diagnóstico , Síndrome Respiratorio Agudo Grave/terapia , Adolescente , Antibacterianos/uso terapéutico , Reposo en Cama , Niño , Preescolar , China , Estudios de Cohortes , Tos/complicaciones , Femenino , Fiebre/complicaciones , Humanos , Lactante , Tiempo de Internación , Pulmón/efectos de los fármacos , Pulmón/microbiología , Pulmón/patología , Masculino , Pronóstico , Síndrome Respiratorio Agudo Grave/complicaciones , Resultado del Tratamiento
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