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4.
Int Arch Allergy Immunol ; 181(1): 43-50, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31722348

RESUMO

INTRODUCTION: Although 4 mast cell mediators can be routinely measured, the results of initial testing to evaluate symptoms of mast cell activation have not been widely reported. OBJECTIVE: We examined the results of mast cell mediator tests used to assess patients with mast cell activation symptoms during a 5-year time span. METHODS: After excluding patients with alternative diagnoses, records of 108 patients were reviewed for initial mediator test results. Mediators included serum tryptase plus urinary N-methyl histamine (N-MH), leukotriene (LT)E4, and 11ß-prostaglandin (PG) F2α or 2,3-dinor-11ß-PGF2α (BPG). RESULTS: Most commonly, either a single measured elevation of 1 mediator (48.1%) or elevations of 2 (33.3%) mediators was found at baseline, during symptoms or at both time points. Elevated levels of a single mediator in order of frequency were: BPG > tryptase > LTE4 > N-MH, and for two mediators: BPG + tryptase (n = 16 cases) > BPG + LTE4 (n = 9) > BPG + N-MH (n = 6). Elevations in 3 mediators (n = 8) or 4 mediators (n = 2) were much less frequent. Monoclonal mast cell activation syndrome (n = 6), and systemic and cutaneous mastocytosis (n = 4) were also infrequent. Baseline plus symptom-associated tryptase values were obtained in only 7 patients. CONCLUSIONS: This survey suggests that elevations of 1 or 2 mediators are the most common (total 81.4% of cases) findings from initial tests for mast cell activation. Elevated levels of BPG were most commonly found both singly and in combination with other mediators, followed by the finding of elevated levels of tryptase. Baseline plus symptom-associated tryptase levels were measured in only a minority of patients.


Assuntos
Dinoprosta/urina , Leucotrieno E4/urina , Mastócitos/fisiologia , Mastocitose/imunologia , Metilistaminas/urina , Triptases/sangue , Dinoprosta/análogos & derivados , Rubor , Humanos , Inquéritos e Questionários
5.
Orthopade ; 48(12): 1042-1044, 2019 Dec.
Artigo em Alemão | MEDLINE | ID: mdl-31620827

RESUMO

Harlequin syndrome is a rare combination of symptoms, characterized by unilateral facial anhidrosis and paleness on the affected side, becoming obvious by contralateral flushing mainly during sports activity. The syndrome is mostly idiopathic, however it is also described as a complication of thoracic surgery, i.e. superior lobectomy. Here, we report on two cases of Harlequin syndrome following scoliosis surgery at the cervicothoracic junction.


Assuntos
Doenças do Sistema Nervoso Autônomo/diagnóstico , Rubor/diagnóstico , Hipo-Hidrose/diagnóstico , Escoliose/cirurgia , Adolescente , Doenças do Sistema Nervoso Autônomo/complicações , Doenças do Sistema Nervoso Autônomo/fisiopatologia , Criança , Rubor/complicações , Rubor/fisiopatologia , Humanos , Hipo-Hidrose/complicações , Hipo-Hidrose/fisiopatologia , Masculino
6.
Am J Health Syst Pharm ; 76(21): 1749-1752, 2019 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-31612928

RESUMO

PURPOSE: The options for immunotherapy treatment are limited for treatment of hepatocellular carcinoma. In this case study, we report a case of successful alternation of one PD-1 inhibitor for another after a hypersensitivity reaction. SUMMARY: Nivolumab (Opdivo, Bristol-Myers Squibb) has been Food and Drug Administration (FDA) approved for a variety of malignancies, including a recent approval for hepatocellular carcinoma (HCC). Infusion-related reactions occur in less than 1% of patients, and although such reactions are rare, recognition of infusion-related reactions induced by nivolumab is an important aspect of its usage. The PD-1 checkpoint inhibitor pembrolizumab is also FDA approved for subsequent-line therapy in treatment of HCC. Thus far, approximately 0.2% of patients experienced severe infusion-related reaction in studies using pembrolizumab. A 70-year-old male with HCC had an infusion reaction to nivolumab that presented as facial flushing, dyspnea, and back pain. The patient received prompt administration of diphenhydramine and hydrocortisone, which led to the amelioration of symptoms and allowed the patient to complete his immunotherapy treatment. For the third dose of nivolumab, the patient received premedications prior to treatment, including diphenhydramine, hydrocortisone, and famotidine. During his infusion, the patient experienced facial flushing, coughing, chest tightness, and an itchy throat. The patient again received diphenhydramine and hydrocortisone to treat infusion-related symptoms and his therapy was discontinued. Because of the nivolumab infusion-related reaction, nivolumab was discontinued, and the patient was started on pembrolizumab. The patient tolerated pembrolizumab without any subsequent infusion-related reactions. Prompt recognition and attention to immunotherapy infusion-related reactions could potentially prevent the fatal complication of anaphylaxis with immune checkpoint inhibitors. In this report, we describe the successful transition from one anti-PD-1 therapy to another for continued immunotherapy treatment without any subsequent infusion reactions. CONCLUSION: A patient with HCC was successfully treated with pembrolizumab after experiencing adverse effects with nivolumab.


Assuntos
Anticorpos Monoclonais Humanizados/administração & dosagem , Antineoplásicos Imunológicos/administração & dosagem , Carcinoma Hepatocelular/tratamento farmacológico , Hipersensibilidade a Drogas/etiologia , Neoplasias Hepáticas/tratamento farmacológico , Nivolumabe/efeitos adversos , Idoso , Antineoplásicos Imunológicos/efeitos adversos , Carcinoma Hepatocelular/imunologia , Tosse/induzido quimicamente , Tosse/imunologia , Tosse/prevenção & controle , Hipersensibilidade a Drogas/imunologia , Hipersensibilidade a Drogas/prevenção & controle , Substituição de Medicamentos , Rubor/induzido quimicamente , Rubor/imunologia , Rubor/prevenção & controle , Humanos , Infusões Intravenosas/efeitos adversos , Neoplasias Hepáticas/imunologia , Masculino , Nivolumabe/administração & dosagem , Receptor de Morte Celular Programada 1/antagonistas & inibidores , Receptor de Morte Celular Programada 1/imunologia
7.
Pan Afr Med J ; 33: 141, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31558939

RESUMO

Harlequin's syndrome is a rare dysautonomic syndrome of the face characterized by sweating with flush of one side and anhidrosis of the contralateral side. Mostly idiopathic although several secondary cases have been reported in the literature, the purpose of the treatment is mainly aesthetic and functional. We report the case of a patient having harlequin syndrome in its idiopathic form with a literature review.


Assuntos
Doenças do Sistema Nervoso Autônomo/diagnóstico , Rubor/diagnóstico , Hipo-Hidrose/diagnóstico , Doenças do Sistema Nervoso Autônomo/fisiopatologia , Face , Rubor/fisiopatologia , Humanos , Hipo-Hidrose/fisiopatologia , Masculino , Adulto Jovem
8.
Auton Neurosci ; 220: 102559, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31331696

RESUMO

Pure autonomic failure (PAF) is a progressive syndrome of neurogenic orthostatic hypotension, widespread anhidrosis, urinary retention, and constipation without other neurologic manifestations. It is generally considered a peripheral ganglionic synucleinopathy. Natural history studies have described risk factors for the conversion of PAF to Parkinson's disease, multiple system atrophy, or dementia with Lewy bodies, yet the early stages of PAF are not well characterized. We present a patient with unilateral anhidrosis, contralateral facial flushing and hyperhidrosis consistent with Harlequin syndrome that, over 6 years, progressed to PAF, suggesting that PAF may present with focal autonomic impairment prior to generalized autonomic failure.


Assuntos
Doenças do Sistema Nervoso Autônomo/diagnóstico , Progressão da Doença , Rubor/diagnóstico , Hipo-Hidrose/diagnóstico , Insuficiência Autonômica Pura/diagnóstico , Doenças do Sistema Nervoso Autônomo/complicações , Feminino , Rubor/complicações , Humanos , Hipo-Hidrose/complicações , Pessoa de Meia-Idade , Insuficiência Autonômica Pura/complicações
9.
J Stroke Cerebrovasc Dis ; 28(9): e127-e128, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31301985

RESUMO

Harlequin syndrome is a disorder of the autonomic nervous system. It clinically presents as a distinct line of hemifacial sympathetic denervation. We describe a case of Harlequin syndrome with co-existing central first-order Horner syndrome in the setting of a large thalamic hemorrhage with intraventricular extension.


Assuntos
Doenças do Sistema Nervoso Autônomo/etiologia , Rubor/etiologia , Síndrome de Horner/etiologia , Hipo-Hidrose/etiologia , Hemorragias Intracranianas/complicações , Tálamo/irrigação sanguínea , Doenças do Sistema Nervoso Autônomo/diagnóstico , Doenças do Sistema Nervoso Autônomo/fisiopatologia , Feminino , Rubor/diagnóstico , Rubor/fisiopatologia , Síndrome de Horner/diagnóstico , Síndrome de Horner/fisiopatologia , Humanos , Hipo-Hidrose/diagnóstico , Hipo-Hidrose/fisiopatologia , Hemorragias Intracranianas/diagnóstico , Hemorragias Intracranianas/fisiopatologia , Pessoa de Meia-Idade
10.
Artigo em Inglês | MEDLINE | ID: mdl-31146355

RESUMO

Asians are more susceptible to alcohol flush syndrome and its associated health risks because they are genetically predisposed towards it. Guided by the theory of planned behaviour, this research examined the psychosocial factors associated with moderate alcohol consumption, in order to inform the development of a health campaign targeting young Asian "flushers" in Singapore. We employed a mixed-method design comprising an online survey and focus group discussions. The survey results identified perceived behavioural control as the most salient belief associated with moderate drinking intentions, particularly for Asian flushers. Although Asian flushers had more positive attitudes towards, and perceived behavioural control about drinking in moderation, they were more likely to consider that their peers disapprove of such a practice, compared to non-flushers. Additionally, Asian flushers did not consider themselves as having a higher risk of long-term health effects from alcohol consumption than non-Flushers despite their actual high-risk status. Focus group findings suggest that young Asian flushers have poor knowledge of, and skills associated with moderate drinking, in addition to feeling self-imposed social pressure. The study findings provide practical insights into bridging the information gap on Asian flush and promoting Asian flushers' drinking in moderation.


Assuntos
Consumo de Bebidas Alcoólicas/psicologia , Grupo com Ancestrais do Continente Asiático/psicologia , Rubor/psicologia , Conhecimentos, Atitudes e Prática em Saúde , Adulto , Feminino , Rubor/genética , Grupos Focais , Predisposição Genética para Doença , Humanos , Intenção , Masculino , Motivação , Singapura , Inquéritos e Questionários , Adulto Jovem
13.
Kaohsiung J Med Sci ; 35(6): 341-349, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31001924

RESUMO

This study examines the effects of environmental hazards, including tobacco, alcohol/alcohol flush response, areca nut, and Helicobacter pylori (H pylori) infection on upper digestive diseases. This is a multi-hospital-based endoscopy-survey cross-sectional study. Subjects were received upper endoscopies in outpatient clinics at four hospitals in Taiwan between 2008 and 2013. Biopsy-based methods or urea breath test were used confirm the status of H pylori infection. In total, 8135 subjects were analyzed. Higher cumulative amounts of alcohol consumption were at higher risk of Barrett's esophagus and esophageal squamous cell carcinoma (ESCC), higher cumulative amounts of tobacco consumption were at higher risk of peptic ulcer, and higher cumulative amounts of areca nut consumption were at higher risk of duodenitis. Alcohol flush response was significant risk for reflux esophagitis and Barrett's esophagus (adjusted odds ratio [aOR] = 1.18 and 1.32, 95% confidence interval [CI] = 1.07-1.31 and 1.06-1.65, respectively). H pylori infection was inversely associated with ESCC risk (aOR = 0.20, 95% CI = 0.10-0.40). In addition, H pylori infection was consistently and significantly risk factors for gastrointestinal diseases, including peptic ulcer, gastric adenocarcinoma, and duodenitis (aOR = 5.51, 1.84, and 2.10, 95% CI = 4.85-6.26, 1.03-3.26, and 1.71-2.56, respectively). Besides the cumulative risk of alcohol, tobacco, and areca nut for Barrett's esophagus, ESCC, and peptic ulcer, respectively, presence of facial flushing was the significant risk for reflux esophagitis and Barrett's esophagus. H pylori infection was positively associated with peptic ulcer, gastric adenocarcinoma, and duodenitis, but inversely associated with ESCC.


Assuntos
Adenocarcinoma/diagnóstico , Esôfago de Barrett/diagnóstico , Neoplasias Esofágicas/diagnóstico , Carcinoma de Células Escamosas do Esôfago/diagnóstico , Infecções por Helicobacter/diagnóstico , Úlcera Péptica/diagnóstico , Neoplasias Gástricas/diagnóstico , Adenocarcinoma/etiologia , Adenocarcinoma/microbiologia , Adenocarcinoma/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Consumo de Bebidas Alcoólicas/efeitos adversos , Areca/química , Esôfago de Barrett/etiologia , Esôfago de Barrett/microbiologia , Esôfago de Barrett/patologia , Estudos Transversais , Duodenite/diagnóstico , Duodenite/etiologia , Duodenite/microbiologia , Duodenite/patologia , Endoscopia do Sistema Digestório , Neoplasias Esofágicas/etiologia , Neoplasias Esofágicas/microbiologia , Neoplasias Esofágicas/patologia , Carcinoma de Células Escamosas do Esôfago/etiologia , Carcinoma de Células Escamosas do Esôfago/microbiologia , Carcinoma de Células Escamosas do Esôfago/patologia , Feminino , Rubor/complicações , Rubor/fisiopatologia , Trato Gastrointestinal/efeitos dos fármacos , Trato Gastrointestinal/patologia , Infecções por Helicobacter/etiologia , Infecções por Helicobacter/microbiologia , Infecções por Helicobacter/patologia , Helicobacter pylori/patogenicidade , Helicobacter pylori/fisiologia , Humanos , Masculino , Pessoa de Meia-Idade , Nozes/química , Úlcera Péptica/etiologia , Úlcera Péptica/microbiologia , Úlcera Péptica/patologia , Fatores de Risco , Neoplasias Gástricas/etiologia , Neoplasias Gástricas/microbiologia , Neoplasias Gástricas/patologia , Taiwan , Uso de Tabaco/efeitos adversos
18.
Rev Esp Quimioter ; 32(2): 178-182, 2019 Apr.
Artigo em Espanhol | MEDLINE | ID: mdl-30834736

RESUMO

OBJECTIVE: To describe the clinical-epidemiological characteristics of a series of suspected systemic adverse reactions registered with the 23 serotype pneumococcal polysaccharide vaccine (PNEUMOVAX23®). Calculate the cumulative incidence of the reaction and know if similar and/or compatible cases have been described in the scientific literature or in pharmacovigilance. METHODS: Observational and retrospective study realized between 01/12/2015 and 30/09/2017 in the Vaccines Unit of an autonomic reference hospital. We calculated the cumulative incidence of the adverse reaction for that vaccine. The common pharmacovigilance database (FEDRA) was consulted. RESULTS: Nine systemic adverse reactions were recorded (flushing + bronchospasm + SatO2<95%). The cumulative incidence was 1.036%. The outcome was recovered/resolved for everyone. No similar and/or compatible cases were found. CONCLUSIONS: The reactions described do not appear in the PNEUMOVAX23® data sheet. Epidemiologically, no causal relationship can be established between the symptoms and the variables studied. This study could be the basis for more detailed research that could modify the vaccine data sheet.


Assuntos
Espasmo Brônquico/induzido quimicamente , Espasmo Brônquico/epidemiologia , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/epidemiologia , Rubor/induzido quimicamente , Rubor/epidemiologia , Vacinas Pneumocócicas/efeitos adversos , Adolescente , Adulto , Idoso , Criança , Bases de Dados Factuais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Farmacovigilância , Estudos Retrospectivos , Espanha/epidemiologia , Adulto Jovem
19.
Artigo em Inglês | MEDLINE | ID: mdl-30642132

RESUMO

Alcohol consumption among individuals who experience a flushing response (reddening of the face, nausea, dizziness, headache, anxiety, and increased heartbeat) can result in serious health problems. However, studies on reasons for drinking among flushers, especially in the college context, are limited. Thus, this study investigated the association between primary reason for drinking and alcohol use among a nationally representative sample of current, former, and never flushing college students. The aim was to measure whether college students with current or former experience of facial flushing have different primary reasons for drinking compared to students with no experience of facial flushing. We surveyed and analyzed the data of 4590 students in a nationally representative sample of 82 colleges in South Korea. Multiple regression analysis was used to identify the association between primary reason for drinking and alcohol intake. Alcohol intake was measured using the Alcohol Use Disorders Identification Test (AUDIT). Among 1537 current (33.5%), 152 former (3.3%), and 2901 (63.2%) never flushers, mean AUDIT scores were 7.715 ± 5.434, 11.039 ± 6.405, and 10.465 ± 5.779, respectively. Current flushers had significantly higher AUDIT scores when drinking for pleasure (ß = 2.696, p < 0.0001) or stress/depression (ß = 2.578, p < 0.0001). Primary reasons for drinking were not associated with alcohol intake for former flushers. Never flushers had significantly higher AUDIT scores when drinking for pleasure (ß = 2.696, p < 0.0001), stress/depression (ß = 2.578, p < 0.0001), or boredom (ß = 0.740, p = 0.029) than peer pressure. Our results suggest that former and never flushers consume higher amounts of alcohol on average than never flushers. For current flushers, drinking for pleasure or stress/depression may increase alcohol intake, while for never flushers, drinking for pleasure, stress/depression, as well as boredom may have the same effect.


Assuntos
Consumo de Bebidas Alcoólicas/epidemiologia , Rubor/epidemiologia , Estudantes/psicologia , Adolescente , Feminino , Humanos , Masculino , Análise Multivariada , República da Coreia/epidemiologia , Inquéritos e Questionários , Universidades , Adulto Jovem
20.
Cir Esp ; 97(4): 196-202, 2019 Apr.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-30685056

RESUMO

INTRODUCTION: Division of the thoracic sympathetic chain is the standard treatment for severe palmar and/or axillary hyperhidrosis and facial flushing. Clipping is an alternative option which allows the block to be reverted in cases of intolerable compensatory sweating. METHODS: This is a prospective study performed to assess: a) results of clipping of the thoracic sympathetic chain in patients with palmar and/or axillary hyperhidrosis and facial flushing; and b) to determine the improvement obtained after removal of the clip in patients with unbearable compensatory sweating. We included 299 patients (598 procedures) diagnosed with palmar hyperhidrosis (n=110), palmar and/or axillary hyperhidrosis (n=78), axillary hyperhidrosis (n=35), and facial flushing (n=76), who underwent videothoracoscopic clipping between 2007 and 2015. RESULTS: 128 men and 171 women were treated, with mean age of 28 years. A total of 290 patients (97.0%) were discharged within 24hours. The procedure was effective in 92.3% (99.1% in palmar hyperhidrosis, 96,1% in palmar and/or axillary hyperhidrosis, 74.3% in axillary hyperhidrosis, and 86.8% in facial flushing). Nine patients (3%) presented minor complications. Compensatory sweating developed in 137 patients (45.8%): moderate in 113 (37.8%), severe in 16 (5.3%) and unbearable in 8 (2.7%). The clip was removed in these 8 patients; symptoms improved in 5 (62.8%), with sustained effect on hyperhidrosis in 4 of them. CONCLUSIONS: Clipping of the thoracic sympathetic chain is an effective and safe procedure. If incapacitating compensatory sweating develops, this technique allows the clips to be removed with reversion of symptoms in a considerable number of patients.


Assuntos
Rubor/cirurgia , Hiperidrose/cirurgia , Instrumentos Cirúrgicos/efeitos adversos , Simpatectomia/efeitos adversos , Adulto , Axila/inervação , Axila/fisiopatologia , Face/inervação , Face/fisiopatologia , Feminino , Mãos/inervação , Mãos/fisiopatologia , Humanos , Hiperidrose/diagnóstico , Masculino , Estudos Prospectivos , Doenças das Glândulas Sudoríparas/fisiopatologia , Simpatectomia/métodos , Cirurgia Torácica Vídeoassistida/métodos , Resultado do Tratamento
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