Successful serial plasmapheresis for solar urticaria, a case report and literature review.

BACKGROUND/PURPOSE: Amidst the emergence of new therapeutic options, traditional therapeutic plasmapheresis (TPE) used in diseases involving a toxic substance in the plasma, remains a viable alternative for cases of recalcitrant solar urticaria (SU). We emphasize the importance of documenting successful experience with repeated plasmapheresis to increase awareness amongst physicians and dermatologists regarding this effective treatment option. MATERIAL AND METHOD: We reported a case of recalcitrant SU that had not responded to a combination of H1-antihistamines, immunosuppressants, omalizumab and intravenous immunoglobulin. We introduced serial TPE, which involved two consecutive days of procedures for each course was introduced. We detailed the regimen and highlighted the clinical and objective benefits observed with multiple treatments. Additionally, we compared this to other plasmapheresis regimens and their treatment responses previously reported for solar urticaria. RESULTS: Our patient underwent serial TPE, totaling 42 procedures over five years. Following the last TPE session, phototesting showed a sustained prolongation of minimal urticating doses (MUDS), which exceeded the maximum tested doses across nearly all ultraviolet (UV) and visible light ranges, with the exception of the two short ultraviolet B (UVB) wavelengths. MUDs increased to 25 from 6 mj/cm2 at 307.5± 5nm, and to 500 from 15 mj/cm2 at 320 ± 10nm, before the initial TPE. In our review, we included five articles covering eight SU patients who received TPE. Of these, the five patients with positive intradermal tests responded particularly well immediately after treatment. However, the condition relapsed within two weeks in one patient and within two months in another. In contrast, the other three patients with negative intradermal tests, showed no significant benefits from the treatment. No serious side effects from TPE were reported amongst the patients. CONCLUSIONS: This review underscores the efficacy of serial plasmapheresis procedures in treating refractory cases of SU, high3lighting the robust results observed.

[Solar urticaria and polymorphous light eruption]. / Lichturtikaria und polymorphe Lichtdermatose.

Solar urticaria is a rare idiopathic photodermatosis. According to the current knowledge its pathogenesis is most likely based on an allergic type I reaction to an autoantigen activated by ultraviolet (UV) radiation or visible light. As many of the patients suffer from severe forms of the disease, it may therefore severely impair the quality of life of those affected. In contrast, polymorphous light eruption is a very common disease, which, according to the current data, can be interpreted as a type IV allergic reaction to a photoallergen induced by UV radiation. As the skin lesions heal despite continued sun exposure, the patients' quality of life is generally not significantly impaired. These two clinically and pathogenetically very different light dermatoses have shared diagnostics by means of light provocation and an important therapeutic option (light hardening). Herein, we present an overview of the clinical picture, pathogenesis, diagnosis and available treatment options for the above-mentioned diseases.

Overexposure to ultraviolet radiation in solar urticaria.

A man in his 50s was diagnosed with solar urticaria following monochromated light testing that demonstrated exquisite photosensivity to ultraviolet (UV) A, UV B (UVB) and visible light.Treatment options for this photodermatosis are limited; UVB phototherapy is one modality that can be appropriate in some patients. This is administered at very low doses in a controlled environment to induce skin hardening.1 To self-treat his condition, the patient used a commercial sunbed on two occasions several days apart. He noted an immediate flare of solar urticaria after first use with associated dizziness. Following the second use, he felt generally unwell and was witnessed to lose consciousness and displayed jerky movements of his limbs while a passenger in a car. Investigations including a head MRI and an EEG were normal; an anoxic seizure caused by a flare of solar urticaria was later confirmed.Solar urticaria is a rare photodermatosis that is poorly understood and difficult to treat. The condition has a significant impact on the quality of life of patients. Severe cases can be associated with systemic symptoms that could be life-threatening.

Solar Urticaria: An Ambispective Study in a Long-term Follow-up Cohort with Emphasis on Therapeutic Predictors and Outcomes.

Solar urticaria is a rare photodermatosis with several unknown pathogenic, clinical and therapeutic aspects. This study analysed the clinical and therapeutic features of a long-term follow-up solar urticaria cohort, with a focus on omalizumab management and outcomes, and characterized omalizumab response with the use of the high-affinity immunoglobulin E (IgE) receptor (FcεRI) and the Urticaria Control Test. An observational, unicentric, ambispective study was conducted from 2007 to 2023. Solar urticaria was diagnosed in 41 patients with a median follow-up of 60 months. Thirteen patients were prescribed omalizumab, with a median treatment time of 48 months. A significant decrease in FcεRI baseline levels and subsequent median increase in Urticaria Control Test was evidenced after omalizumab prescription in all patients. Drug survival at 48 months was at 88.9%. Omalizumab stepping-down protocol led to sustained omalizumab discontinuation in only 1 patient. Median basal Urticaria Control Test was lower (p < 0.01) in patients who were prescribed omalizumab and in patients without remission. This study contributes to our knowledge of omalizumab outcomes in real-life clinical practice and highlights the pathogenic importance of IgE-mediated pathways in solar urticaria, where FcεRI emerges as a possible biomarker of omalizumab response.

Solar urticaria involves rapid mast cell STAT3 activation and neutrophil recruitment, with FcεRI as an upstream regulator.

BACKGROUND: Solar urticaria is a rare photodermatosis characterized by rapid-onset sunlight-induced urticaria, but its pathophysiology is not well understood. OBJECTIVE: We sought to define cutaneous cellular and molecular events in the evolution of solar urticaria following its initiation by solar-simulated UV radiation (SSR) and compare with healthy controls (HC). METHODS: Cutaneous biopsy specimens were taken from unexposed skin and skin exposed to a single low (physiologic) dose of SSR at 30 minutes, 3 hours, and 24 hours after exposure in 6 patients with solar urticaria and 6 HC. Biopsy specimens were assessed by immunohistochemistry and bulk RNA-sequencing analysis. RESULTS: In solar urticaria specimens, there was enrichment of several innate immune pathways, with striking early involvement of neutrophils, which was not observed in HC. Multiple proinflammatory cytokine and chemokine genes were upregulated (including IL20, IL6, and CXCL8) or identified as upstream regulators (including TNF, IL-1ß, and IFN-γ). IgE and FcεRI were identified as upstream regulators, and phosphorylated signal transducer and activator of transcription 3 expression in mast cells was increased in solar urticaria at 30 minutes and 3 hours after SSR exposure, suggesting a mechanism of mast cell activation. Clinical resolution of solar urticaria by 24 hours mirrored resolution of inflammatory gene signature profiles. Comparison with available datasets of chronic spontaneous urticaria showed transcriptomic similarities relating to immune activation, but several transcripts were identified solely in solar urticaria, including CXCL8 and CSF2/3. CONCLUSIONS: Solar urticaria is characterized by rapid signal transducer and activator of transcription 3 activation in mast cells and involvement of multiple chemotactic and innate inflammatory pathways, with FcεRI engagement indicated as an early event.

Aplausos às diretrizes para a prática clínica odontológica na atenção primária à saúde / Applause to the guidelines for clinical dental practice in primary health care

In recent important days, social media have been communication tools for the new Guidelines for the Dental Clinic that are being used and disseminated by the Ministry of Health (MS) through the Secretariat of Primary Health Care (APS). This year, more precisely in May, the Guideline for clinical dental practice in Primary Health Care: treatment in pregnant women was published. The document was previously made available, still in 2021, in public consultation, and various sectors of society and the community were aware of their considerations and suggestions. This is a relevant strategy for validating the material, as it provides opportunities for the professional health teams to look at the use of the future Guideline. For those who are unaware, the General Coordination of Oral Health of the Ministry of Health, in partnership with the GODeC (Global Observatory for Dental Care) initiative of the Federal University of Pelotas, will make available in the year 2022, 22 clinical guidelines for the qualification of the caregiver. in health oral supply in Primary Health Care by the Unified Health System (SUS)

Dias de gravidez potencialmente perdidos: um novo olhar sobre a idade gestacional / Potentially Missed Pregnancy Days: A New Look at Gestational Age

Introdução: Estudos que visam elucidar os fatores associados à idade gestacional (IG) utilizam intervalos semanais ou categorias estabelecidas. A análise utilizando a variável IG em dias pode apresentar um avanço no conhecimento sobre os seus fatores associados e desfechos, principalmente utilizando o conceito de dias de gravidez potencialmente perdidos (DGPP). Objetivo: Analisar os fatores associados aos DGPP e os principais desfechos perinatais associados aos DGPP. Método: Estudo de coorte histórica, utilizando os dados da pesquisa Nascer no Brasil: Inquérito Nacional sobre o Parto e Nascimento, realizada de 2011 a 2012, referentes à Região Sudeste. Os possíveis fatores associados foram avaliados individualmente e aqueles que foram considerados elegíveis foram avaliados por meio de regressão linear múltipla. Coeficientes de correlação ponto bisserial foram calculados para os principais desfechos perinatais. Resultados: Apenas 10% dos RN não perderam dias de gravidez entre os que tiveram financiamento privado para o nascimento, enquanto essa proporção foi três vezes maior entre os que tiveram financiamento público. Apenas 20% das mulheres que receberam cesárea tiveram filhos sem nenhum DGPP, enquanto 30% das mulheres que tiveram parto normal deram à luz RN sem DGPP. As variáveis que permaneceram independentemente associadas à DGPP após regressão linear múltipla foram: Fonte de financiamento da assistência ao parto privada ( 3,48), Síndromes hipertensivas na Gravidez ( 3,02), Apresentação fetal não cefálica ( 2,27), Nascimento por cesárea sem trabalho de parto ( 1,49), Cor da pele branca ou amarela ( 0,73), Idade em anos ( 0,05), IMC ( -0,06) e Anos de estudo ( -0,08). Para cada DGPP, houve um aumento estatisticamente significativo (p-valor < 0,05) de 18% na internação em UTI, 14% na necessidade de oxigênio após nascimento, 12% na necessidade de fototerapia, 10% na ocorrência de desconforto respiratório, 8% na ocorrência de óbito perinatal e 7% na ocorrência da Doença da Membrana Hialina, além de uma diminuição de 16% na ocorrência de Aleitamento Materno Exclusivo no momento da alta. Conclusão: A utilização do conceito de DGPP permitiu obter mais clareza para analisar os fatores associados ao encurtamento da gravidez, bem como seus principais desfechos perinatais, indicando o quanto os fatores de assistência podem ter maior peso se comparados aos fatores fisiológicos.

Introduction: Studies aims to elucidate factors associated with gestational age (GA) use weekly intervals or established categories. The analysis using the GA variable in days may present an advance in the knowledge about its associated factors and outcomes, mainly using the concept of Potentially Missed Pregnancy Days (PMPD). Objective: To analyze the factors associated with PMPD and the main perinatal outcomes associated with PMPD. Methods: Historical cohort study, using data from the survey "Birth in Brazil: National Inquiry into labor and Birth, conducted from 2011 to 2012, referring to the Southeast Region. The possible associated factors were evaluated individually and those that were considered eligible were evaluated through multiple linear regression. Bisserial point correlation coefficients were calculated for the main perinatal outcomes. Results: Only 10% of newborns did not lose days of gestation among those who had private funding for their birth, while this proportion was three times higher among those who had public funding. Only 20% of women who received cesarean section had children without any PMPD, while 30% of women who had normal birth gave birth to RN without PMPD. The variables that remained independently associated to the PMPD after multiple linear regression were: Private funding for birth care ( 3.48), Hypertensive syndromes during pregnancy ( 3.02), Non-cephalic fetal presentation ( 2.27), Cesarean birth without labor ( 1.49), white or yellow skin color ( 0.73), age in years ( 0,05), BMI ( -0,06) and years of study ( -0.08). For each PMPD, there was a statistically significant increase (p-value <0.05) of 18% in ICU admission, 14% in the need for oxygen after birth, 12% in the need for phototherapy, 10% in the occurrence of respiratory discomfort, 8% in the occurrence of perinatal death and 7% in the occurrence of Hyaline Membrane Disease, in addition to a 16% decrease in the occurrence of Exclusive Breastfeeding on discharge. Conclusion: The use of the DGPP concept allowed more clarity to analyze the factors associated with the shortening of gestation, as well as its main perinatal outcomes, indicating how much the care factors may have greater weight when compared to the physiological factors.

Eventos adversos a medicamentos em idosos de unidades de terapia intensiva / Adverse drug events in the elderly of intensive care units

Introdução: Eventos adversos a medicamentos (EAM) representam um importante problema de saúde pública, sendo associados à morbimortalidade, maior taxa de permanência hospitalar e elevação de custos. Os idosos e os pacientes de unidade de terapia intensiva (UTI) são grupos de risco para a ocorrência desses eventos. O uso de rastreadores, que representam situações indicativas de potenciais EAM, simplifica a detecção de EAM por meio do screening sistemático de prontuários, possibilitando a mensuração da taxa dessas adversidades continuamente e permitindo avançar na prática de segurança do paciente crítico. Objetivo: Analisar os eventos adversos a medicamentos e fatores associados em pacientes idosos de UTI. Método: Coorte retrospectiva conduzida com idosos internados em UTI do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo. A amostra consecutiva foi composta por prontuários de idosos, hospitalizados por no mínimo 24 horas para tratamento clínico ou cirúrgico e que tenham recebido pelo menos um medicamento. Os pacientes foram acompanhados da internação até a saída da UTI por alta ou óbito. Para a identificação dos EAM utilizou-se o instrumento do Institute for Healthcare Improvement (IHI) adaptado para a realidade local, que inclui rastreadores medicamentosos, bioquímicos e clínicos. Foram coletadas variáveis demográfico-clínicas, relativas ao regime terapêutico, exames laboratoriais, intervenções durante a internação e sinais/sintomas clínicos. A variável dependente foi a ocorrência de EAM. Os dados foram analisados por meio dos testes Qui-quadrado, Exato de Fisher, Correlação de Pearson e regressão logística multivariada, com significância de p0,05. Resultados: A incidência de pacientes com EAM foi 22,3% e o número de EAM por 100 pacientes foi 32,3, média de 1,4 EAM. A amostra foi composta predominantemente por homens (54,6%), idosos jovens (68,8%), internados para procedimentos clínicos (67,4%) e sujeitos a polifarmácia (70,6%). Sangramento (21,7%), injúria renal aguda (20%), hipotensão (18,3%), náusea/vômito (15%) e hipoglicemia (13,3%) foram os EAM mais frequentes. Identificou-se correlação positiva entre EAM e as variáveis comorbidades (r=0,189), tempo de internação (r=0,288) e número de medicamentos prescritos (r=0,282). Os fatores de risco para EAM em UTI foram ventilação mecânica (OR= 2,614; IC95% 1,393 4,906; p= 0,003), injúria renal aguda (OR= 3,794; IC95% 1,688 8,527; p=0,001) e diabetes mellitus (OR= 3,280; IC 95% 1,703 6,315; p= 0,000). Conclusão: A ocorrência dos EAM mostrou-se correlacionada positivamente com atributos que são muito característicos de idosos admitidos em UTI, aspecto que pode servir de alerta aos profissionais que realizam o monitoramento desses eventos.

Introduction: Adverse drug events (ADE) represent an important public health problem, being associated with morbidity and mortality, a higher hospital stay rate and higher costs. The elderly and intensive care patients (ICU) are at risk groups for the occurrence of these events. The use of trackers, which represent situations indicative of potential ADE, simplifies the detection of ADE through the systematic screening of medical records, making it possible to measure the rate of these adversities continuously and to advance in the practice of critical patient safety. Objective: To analyze adverse drug events and associated factors in elderly ICU patients. Method: Retrospective cohort conducted with elderly patients admitted to ICU at Hospital das Clínicas, Medical School, University of São Paulo. The consecutive sample consisted of records of the elderly, hospitalized for at least 24 hours for clinical or surgical treatment and who received at least one medication. Patients were followed up for ICU discharge or discharge. The Institute for Healthcare Improvement (IHI) instrument adapted to the local reality, which includes drug, biochemical and clinical trackers, was used to identify the ADE. Demographic and clinical variables related to the therapeutic regimen and laboratory tests, therapeutic interventions during hospitalization, clinical signs and symptoms were collected. The dependent variable was the occurrence of ADE. Data were analyzed using the Chi-square test, Fisher's exact test, Pearson's correlation and multivariate logistic regression, with significance of p0.05. Results: The incidence of ADE patients was 22.3% and the number of ADE per 100 patients was 32.3, a mean of 1.4 ADE. Men (54.6%), young adults (68.8%), hospitalized for clinical procedures (67.4%) and polypharmacy (70.6%). Bleeding (21.7%), acute renal injury (20%), hypotension (18.3%), nausea / vomiting (15%) and hypoglycaemia (13.3%) were the most frequent events. A positive correlation between EAM and comorbidities (r = 0.189), length of hospital stay (r = 0.288), and number of drugs prescribed (r=0.282) were identified. The risk factors for EAM in the ICU were mechanical ventilation (OR= 2,614; IC95%, 1,393 4,906; p= 0,003), acute renal injury (OR= 3,794; IC95% 1,688 8,527; p=0,001) and diabetes mellitus (OR= 3,280; IC 95% 1,703 6, 315; p= 0,000). Conclusion: The occurrence of ADE was positively correlated with attributes that are very characteristic of the elderly admitted to the ICU, an aspect that can serve as an alert to the professionals who perform the monitoring of these events.

Assistência a negros e não negros nos centros de atenção psicossocial em álcool e outras drogas nos estados do Amapá, Minas Gerais e São Paulo: um estudo comparativo / Assistence to black and non-black people users of the Psychosocial Care Center for Alcohol and Drugs in the states of Amapa, Minas Gerais and Sao Paulo: a comparative study

O movimento de Reforma Psiquiátrica trouxe a necessidade de reestruturar os serviços de assistência em saúde mental e para tal a avaliação torna-se prioritária para prestar uma assistência integral e humanizada. Diante desse contexto e considerando que a população brasileira é constituída em sua maioria por negros (pretos e pardos), é fundamental que todas as pesquisas em saúde tenham um recorte racial, a começar pela inserção do quesito raça cor. Desta forma identificando o perfil e as peculiaridades dessa população, garantindo assim a qualidade da assistência com a utilização dos dados encontrados no processo de avaliação. Estudo de caráter descritivo, exploratório e transversal, teve como objetivo: comparar variáveis sociodemográficas relacionadas ao cuidado recebido dos usuários atendidos em CAPSad nos estados AP, MG e SP quanto ao quesito raça/cor. Foram entrevistados 707 usuários atendidos em CAPSad nos estados AP, MG e SP Para o presente estudo foram utilizados: os seguintes instrumentos um questionário de dados sociodemográficos, a Escala de Satisfação SATIS-BR e a Escala de Avaliação da Percepção de Mudança (EMP). Este estudo constatou as seguintes características de variáveis sociodemográficas: predominância da população masculina (57,3%), que se autodeclararam negros (59,4%), solteiros (59,0%), com faixa etária média de 44 anos, sendo o emprego a principal fonte de renda (31,7%) e com renda familiar de até 2 salários mínimos (71,1%). Quanto à escolaridade, apesar de 94,3% saberem ler, a maioria (38,8%) tinham apenas o ensino fundamental incompleto, e somente 5,1% da amostra deste estudo apresentavam nível superior completo ou acima. Os resultados apontaram que sobre o tempo de permanência no serviço os não negros tem 1,7 mais chances de ficarem mais de 6 meses no CAPSad que os negros, controlado os efeitos de alfabetização, escolaridade e renda. Sobre internação os não negros tem 1,6 mais chances de terem sido internados antes do tratamento no CAPS ad que os negros, controlado os efeitos de alfabetização, escolaridade e renda, sobre a visita domiciliar os negros tem 2,4 mais chances de receberem visita que os não negros, controlados os efeitos de alfabetização, escolaridade e renda. Identificou também que negros e não negros estão igualmente satisfeitos e com a mesma percepção de mudança.

The psychiatric reform movement resulted in the restructuring process of metal health services, which aims to provide integral and humanized assistance, prioritizing the evaluation. Given this context and considering that the population in Brazil is made up mostly of black and pardo people, it is essential that every health research consider all the racial aspects, starting with race color. Therefore, it is possible to identify the profile and peculiarities of a certain population, guaranteeing the quality of assistance services offered through the data obtained in the evaluation process. The study made with descriptive, explanatory and transversal aspects, had as a goal to compare sociodemographic variants related to the care offered to the user of Psychosocial Care Center for Alcohol and Drugs (CAPSad), in the states of Amapa (AP), Minas Gerais (MG) and Sao Paulo (SP), considering race/color. 707 users of CAPSad were interviewed in the states of AP, MG and SP. In the study the following instruments were used: a socio demographic questionnaire, the Satisfaction Scale (SATIS-BR), the Scale of Perceived Change (EMP). The sociodemographic variants were characterized by: a larger male population (57,3%), which (59,4%) is self-denominated black, (59,0%) single, with the majority being in the 44 years old range, with the job as main source of income (31,7%), and with a family income equivalent to two times the value of the Brazilian minimum wage (71,1%). As for schooling, while 94,3% can read, the majority (38,8%) didnt complete their basic education, and only 5,1% graduated from college. The results revealed that 1,7 of non-black participants are more likely to be more than 6 months in the CAPSad than the black participants, where the effects of literacy, schooling and income are under control. About hospitalization, non-black participants have 1,6 more chances of being hospitalized before the treatment at the CAPSad than the black participants, where the effects of literacy, schooling and income are under control. About homecare visits (VD), the black participants have 2,4 more change to receive VD than the non-black participants, where the effects of literacy, schooling and income are under control. It was determined that black participants and non-black participants are equally satisfied and have the same perception of change.