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1.
Wiad Lek ; 73(4): 818-822, 2020.
Artigo em Polonês | MEDLINE | ID: mdl-32731724

RESUMO

The orbital pseudo-tumor is an orbital inflammatory disease of unknown origin that can affect all the anatomical structures that make up the orbit. The diagnosis is based on the assessment of clinical symptoms, imaging tests and the exclusion of other possible causes. Glucocorticosteroids are used for treatment, but other immunosuppressants as well as biological treatments can be used. The aim of the study is to present, based on the literature review, the current state of knowledge about pathogenesis, symptoms, differential diagnosis, and treatment of the orbital pseudotumor.


Assuntos
Pseudotumor Orbitário , Diagnóstico Diferencial , Humanos , Imunossupressores , Órbita , Tomografia Computadorizada por Raios X
2.
Medicine (Baltimore) ; 99(27): e21056, 2020 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-32629733

RESUMO

Primary nephrotic syndrome (PNS) is one of the most common primary glomerular diseases in children. Patients complicated nephrotic syndrome with pancreatic lesions are rarely reported, and the clinical manifestations in children are atypical. This study has observed the incidence, clinical types, and prognosis of acute pancreatitis (AP) in children with primary nephrotic syndrome, and analyzed its related factors, early diagnosis, and treatment.Seven children with PNS and AP in Shanghai Children's Hospital from January 2015 to December 2017 were reviewed. The clinical data including age, height, weight, body mass index (BMI), diet, biliary tract disease, PNS durations, drugs, proteinuria, creatinine, glucose, glycated hemoglobin, amylase and lipase, albumin, cholesterol, triglyceride, ultrasound, computerized tomography (CT), renal pathology and estimated glomerular filtration rate (eGFR) were retrospectively analyzed. All patients were followed for >2 years.Ten in 589 patients with PNS were detected pancreatic lesions by abdominal ultrasound. Seven were diagnosed as AP, which the incidence was 1.2%. Only 1 of 7 patients had elevated serum amylase. Lesions of pancreas were found by ultrasound and/or enhanced CT. Four of 7 patients had been treated with tacrolimus. All patients with AP were improved after octreotide acetate injection and supportive treatment. Only 1 patient suffered recurrent AP during the relapse of PNS 10 months later.AP in children with PNS is not common, and the clinical manifestations are not typical. Abdominal ultrasound and enhanced CT are of high value in diagnosis. The adverse effects of tacrolimus should be concerned. Early diagnosis and timely treatment can be helpful for a prognosis.


Assuntos
Rim/patologia , Síndrome Nefrótica/complicações , Síndrome Nefrótica/metabolismo , Pancreatite/metabolismo , Adolescente , Criança , Pré-Escolar , China/epidemiologia , Feminino , Fármacos Gastrointestinais/administração & dosagem , Fármacos Gastrointestinais/uso terapêutico , Humanos , Imunossupressores/efeitos adversos , Imunossupressores/uso terapêutico , Incidência , Masculino , Síndrome Nefrótica/diagnóstico por imagem , Síndrome Nefrótica/fisiopatologia , Octreotida/administração & dosagem , Octreotida/uso terapêutico , Pancreatite/diagnóstico por imagem , Pancreatite/tratamento farmacológico , Pancreatite/epidemiologia , Prognóstico , Recidiva , Estudos Retrospectivos , Tacrolimo/efeitos adversos , Tacrolimo/uso terapêutico
3.
BMJ Case Rep ; 13(7)2020 Jul 20.
Artigo em Inglês | MEDLINE | ID: mdl-32690572

RESUMO

Kidney transplant recipients have been reported at a particularly high risk of severe COVID-19 illness due to chronic immunosuppression and coexisting conditions. Yet, here we describe a remarkably mild case of COVID-19 in a 62-year-old female who had a kidney transplantation 10 years earlier due to autosomal dominant polycystic kidney disease. The patient was admitted for 1 day; immunosuppressive therapy with tacrolimus and low-dose prednisolone was continued; and the patient recovered successfully without the use of antiviral agents or oxygen therapy. The case demonstrates that kidney transplant recipients are not necessarily severely affected by COVID-19. Withdrawal of immunosuppressive therapy could be associated with poorer outcomes and should not be implemented thoughtlessly.


Assuntos
Infecções por Coronavirus/diagnóstico , Imunossupressão/efeitos adversos , Transplante de Rim/efeitos adversos , Pneumonia Viral/diagnóstico , Transplantados/estatística & dados numéricos , Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/tratamento farmacológico , Infecções por Coronavirus/virologia , Feminino , Glucocorticoides/uso terapêutico , Hospitalização , Humanos , Imunossupressores/uso terapêutico , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/tratamento farmacológico , Pneumonia Viral/virologia , Prednisolona/uso terapêutico , Tacrolimo/uso terapêutico , Resultado do Tratamento
5.
J Immunother Cancer ; 8(2)2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32611687

RESUMO

The present review summarizes up-to-date evidence addressing the frequently discussed clinical controversies regarding the use of immune checkpoint inhibitors (ICIs) in cancer patients with viral infections, including AIDS, hepatitis B and C, progressive multifocal leukoencephalopathy, influenza, and COVID-19. In detail, we provide available information on (1) safety regarding the risk of new infections, (2) effects on the outcome of pre-existing infections, (3) whether immunosuppressive drugs used to treat ICI-related adverse events affect the risk of infection or virulence of pre-existing infections, (4) whether the use of vaccines in ICI-treated patients is considered safe, and (5) whether there are beneficial effects of ICIs that even qualify them as a therapeutic approach for these viral infections.


Assuntos
Imunossupressores/uso terapêutico , Neoplasias/complicações , Viroses/terapia , Betacoronavirus , Infecções por Coronavirus/complicações , Infecções por Coronavirus/tratamento farmacológico , Infecções por Coronavirus/imunologia , Infecções por Coronavirus/terapia , Hepatite B/complicações , Hepatite B/tratamento farmacológico , Hepatite B/imunologia , Hepatite B/terapia , Hepatite C/complicações , Hepatite C/tratamento farmacológico , Hepatite C/imunologia , Hepatite C/terapia , Humanos , Influenza Humana/complicações , Influenza Humana/tratamento farmacológico , Influenza Humana/imunologia , Influenza Humana/terapia , Pandemias , Pneumonia Viral/complicações , Pneumonia Viral/tratamento farmacológico , Pneumonia Viral/imunologia , Pneumonia Viral/terapia , Viroses/complicações , Viroses/tratamento farmacológico , Viroses/imunologia
6.
J Immunother Cancer ; 8(2)2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32699182

RESUMO

Pneumonitis is a rare but serious adverse event caused by cancer immunotherapy. The diagnosis between COVID-19-induced pneumonia and immunotherapy-induced pneumonitis may be challenging in the era of COVID-19 outbreak. Some clinical symptoms and radiological findings of pneumonitis can be attributed to the coronavirus infection as well as to an immune-related adverse event. Identifying the exact cause of a pneumonitis in patients on treatment with immunotherapy is crucial to promptly start the most appropriate treatment. The proper management of immune checkpoint inhibitors for the risk of pneumonia must take into account a series of parameters. Accurate attention should be payed to symptoms like cough, fever and dyspnea during immunotherapy.


Assuntos
Antineoplásicos Imunológicos/efeitos adversos , Infecções por Coronavirus/diagnóstico , Neoplasias/tratamento farmacológico , Pneumonia Viral/diagnóstico , Pneumonia/induzido quimicamente , Pneumonia/diagnóstico , Betacoronavirus , Antígeno CTLA-4/antagonistas & inibidores , Técnicas de Laboratório Clínico , Infecções por Coronavirus/imunologia , Infecções por Coronavirus/terapia , Diagnóstico Diferencial , Reações Falso-Negativas , Glucocorticoides/uso terapêutico , Humanos , Imunossupressores/uso terapêutico , Pulmão/diagnóstico por imagem , Pandemias , Pneumonia/tratamento farmacológico , Pneumonia/imunologia , Pneumonia Viral/imunologia , Pneumonia Viral/terapia , Receptor de Morte Celular Programada 1/antagonistas & inibidores , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Tomografia Computadorizada por Raios X
7.
Rev Gastroenterol Mex ; 85(3): 312-320, 2020.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-32620315

RESUMO

The coronavirus disease 2019 (COVID-19) is caused by the severe acute respiratory syndrome coronavirus2 (SARS-CoV-2) virus. COVID-19 affected more than 6million persons worldwide in fewer than 4 months, after the report of the first cases in China in December 2019. The relation of the disease caused by SARS-Cov-2 to immunosuppressive treatment used in different gastrointestinal disorders is uncertain, resulting in debate with regard to suspending immunosuppressive therapy to improve infection outcome. Said suspension implies the inherent risk for graft rejection or autoimmune disease exacerbation that can potentially worsen the course of the infection. Based on the presently available evidence, a treatment stance has been established for patients with gastrointestinal diseases that require immunosuppressive therapy.


Assuntos
Infecções por Coronavirus/complicações , Imunossupressores/efeitos adversos , Imunossupressores/uso terapêutico , Hepatopatias/tratamento farmacológico , Pancreatopatias/tratamento farmacológico , Pandemias , Pneumonia Viral/complicações , Humanos , Hepatopatias/complicações , Transplante de Fígado , Transplante de Pâncreas , Pancreatopatias/complicações
8.
Bone Joint J ; 102-B(7_Supple_B): 11-19, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32600194

RESUMO

AIMS: Failure of irrigation and debridement (I&D) for prosthetic joint infection (PJI) is influenced by numerous host, surgical, and pathogen-related factors. We aimed to develop and validate a practical, easy-to-use tool based on machine learning that may accurately predict outcome following I&D surgery taking into account the influence of numerous factors. METHODS: This was an international, multicentre retrospective study of 1,174 revision total hip (THA) and knee arthroplasties (TKA) undergoing I&D for PJI between January 2005 and December 2017. PJI was defined using the Musculoskeletal Infection Society (MSIS) criteria. A total of 52 variables including demographics, comorbidities, and clinical and laboratory findings were evaluated using random forest machine learning analysis. The algorithm was then verified through cross-validation. RESULTS: Of the 1,174 patients that were included in the study, 405 patients (34.5%) failed treatment. Using random forest analysis, an algorithm that provides the probability for failure for each specific patient was created. By order of importance, the ten most important variables associated with failure of I&D were serum CRP levels, positive blood cultures, indication for index arthroplasty other than osteoarthritis, not exchanging the modular components, use of immunosuppressive medication, late acute (haematogenous) infections, methicillin-resistant Staphylococcus aureus infection, overlying skin infection, polymicrobial infection, and older age. The algorithm had good discriminatory capability (area under the curve = 0.74). Cross-validation showed similar probabilities comparing predicted and observed failures indicating high accuracy of the model. CONCLUSION: This is the first study in the orthopaedic literature to use machine learning as a tool for predicting outcomes following I&D surgery. The developed algorithm provides the medical profession with a tool that can be employed in clinical decision-making and improve patient care. Future studies should aid in further validating this tool on additional cohorts. Cite this article: Bone Joint J 2020;102-B(7 Supple B):11-19.


Assuntos
Desbridamento , Prótese de Quadril/efeitos adversos , Prótese do Joelho/efeitos adversos , Infecções Relacionadas à Prótese/terapia , Irrigação Terapêutica , Falha de Tratamento , Fatores Etários , Idoso , Algoritmos , Artroplastia de Quadril/efeitos adversos , Artroplastia de Quadril/métodos , Artroplastia do Joelho/efeitos adversos , Artroplastia do Joelho/métodos , Proteína C-Reativa/análise , Feminino , Infecções por Bactérias Gram-Negativas/terapia , Infecções por Bactérias Gram-Positivas/terapia , Humanos , Imunossupressores/efeitos adversos , Aprendizado de Máquina , Masculino , Infecções Relacionadas à Prótese/microbiologia , Estudos Retrospectivos , Dermatopatias Bacterianas/complicações
9.
Medicine (Baltimore) ; 99(28): e20829, 2020 Jul 10.
Artigo em Inglês | MEDLINE | ID: mdl-32664077

RESUMO

INTRODUCTION: Anabolic steroids are widely administered to patients with aplastic anemia (AA) and are associated with numerous medical complications. To assist with future diagnoses, we report about a young boy with multiple hepatocellular adenomas (HAs) induced by long-term use of anabolic androgenic steroids (AAS) for AA and present a related literature review. PATIENT CONCERN: A 15-year-old boy who was diagnosed with AA in 2011 had been treated with stanozolol (6 mg per day) and ciclosporin A (120-150 mg per day) for almost 4 years. He presented with epigastric pain and fever, and abdominal computed tomography showed a lesion of heterogenous density measuring 13.5 × 13.0 × 8.0 cm in the left hepatic lobe, which was initially misdiagnosed as a liver abscess. DIAGNOSIS: The patient went into hemorrhagic shock twice after invasive manipulation that aimed at diagnosis and was finally diagnosed with HA using fine needle aspiration. INTERVENTIONS: The patient discontinued AAS and only reserved ciclosporin A for AA treatment. OUTCOMES: Follow-up abdominal computed tomography performed 4 years after AAS discontinuation showed obvious regression of the hepatic lesions. CONCLUSION: It is of great importance for hematologists to completely understand that the long-term use of AAS may cause HA, which carries a great risk of hemorrhage and malignant transformation.


Assuntos
Adenoma de Células Hepáticas/induzido quimicamente , Anemia Aplástica/complicações , Neoplasias Hepáticas/patologia , Estanozolol/efeitos adversos , Congêneres da Testosterona/efeitos adversos , Dor Abdominal/etiologia , Adenoma de Células Hepáticas/patologia , Adolescente , Adulto , Assistência ao Convalescente , Idoso , Anemia Aplástica/tratamento farmacológico , Biópsia por Agulha Fina/métodos , Ciclosporina/uso terapêutico , Erros de Diagnóstico , Feminino , Febre/etiologia , Humanos , Imunossupressores/uso terapêutico , Abscesso Hepático/diagnóstico por imagem , Neoplasias Hepáticas/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Choque Hemorrágico/diagnóstico , Choque Hemorrágico/etiologia , Estanozolol/uso terapêutico , Congêneres da Testosterona/uso terapêutico , Tomografia Computadorizada por Raios X/métodos
10.
Nat Commun ; 11(1): 3774, 2020 07 24.
Artigo em Inglês | MEDLINE | ID: mdl-32709909

RESUMO

Immune-mediated inflammatory diseases (IMIDs) of the joints, gut and skin are treated with inhibitors of inflammatory cytokines. These cytokines are involved in the pathogenesis of coronavirus disease 2019 (COVID-19). Investigating anti-SARS-CoV-2 antibody responses in IMIDs we observe a reduced incidence of SARS-CoV-2 seroconversion in IMID patients treated with cytokine inhibitors compared to patients receiving no such inhibitors and two healthy control populations, despite similar social exposure. Hence, cytokine inhibitors seem to at least partially protect from SARS-CoV-2 infection.


Assuntos
Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/imunologia , Citocinas/antagonistas & inibidores , Doenças do Sistema Imunitário/tratamento farmacológico , Pneumonia Viral/epidemiologia , Pneumonia Viral/imunologia , Soroconversão , Adulto , Anticorpos Antivirais/sangue , Feminino , Humanos , Imunoglobulina G/sangue , Imunossupressores/administração & dosagem , Masculino , Pessoa de Meia-Idade , Pandemias , Prevalência , Risco
11.
S Afr Med J ; 110(2): 159-166, 2020 Jan 29.
Artigo em Inglês | MEDLINE | ID: mdl-32657689

RESUMO

BACKGROUND: Tacrolimus forms the cornerstone for immunosuppression in solid-organ transplantation. It has a narrow therapeutic window with wide inter- and intra-patient variability (IPV). Cytochrome P-450 3A5 (CYP3A5) is the main enzyme involved in tacrolimus metabolism, and rs776746A>G is the most frequently studied polymorphism in the CYP3A5 gene. The rs776746A>G (i.e. CYP3A5*3) single-nucleotide polymorphism in CYP3A5 alters tacrolimus predose trough concentration (C0) and may also affect IPV, which may lead to immune- and/or drug-mediated allograft injury. CYP3A5*3 may result in absent (*3/*3), partial (*1/*3) or normal (*1/*1) CYP3A5 expression. The effect of CYP3A5*3 on tacrolimus exposure and variability has not been examined in South African (SA) transplant recipients. OBJECTIVES: To determine the frequencies and effect of CYP3A5 and adenosine triphosphate-binding cassette subfamily B member 1 (ABCB1) polymorphisms on tacrolimus C0/dose ratios in different ethnic groups attending a tertiary renal transplant clinic in SA, and other factors that may explain inter- and IPV in tacrolimus C0. METHODS: All consenting stable renal transplant recipients on tacrolimus at the Livingstone Hospital Renal Unit in Port Elizabeth, SA, were included. Tacrolimus concentrations were obtained using a microparticle enzyme immunoassay method (ARCHITECT analyser, Abbott Laboratories). Polymerase chain reaction/restriction fragment length polymorphism was used to genotype for CYP3A5*3 and *6 allelic variants. RESULTS: There were 43 participants (35% black African, 44% mixed ancestry and 21% white), with a mean age of 44.5 years, median duration post-transplant of 47 months and median (interquartile range) creatinine and estimated glomerular filtration rate levels of 118 (92 - 140) µmol/L and 62 (49 - 76) mL/min at study inclusion. The mean tacrolimus C0 in the study was 6.7 ng/mL, with no difference across the different ethnic groups. However, the mean total daily dose of tacrolimus required was 9.1 mg (0.12 mg/kg), 7.2 mg (0.09 mg/kg) and 4.3 mg (0.06 mg/kg) in black, mixed-ancestry and white patients, respectively (p=0.017). The frequencies for CYP3A5 expressors (i.e. CYP3A5*1/*1 + CYP3A5*1/*3 genotypes) were 72%, 100%, 76% and 12% for all patients combined and black, mixed-ancestry and white patients, respectively. The frequencies for CYP3A5 non-expressors (i.e. CYP3A5*3/*3 genotypes) were 0%, 24% and 88% among the black, mixed-ancestry and white patients, respectively. None of the patients carried the CYP3A5*6 allele. CYP3A5*1/*1 and CYP3A5*1/*3 genotype carriers required a two-fold increase in dose compared with the non-expressor genotype carriers, CYP3A5*3/*3 (p<0.05). CYP3A5*3/*3 carriers also demonstrated higher IPV than CYP3A5*1/*1 and *1/*3 carriers (18.1% v. 14.2%; p=0.125). CONCLUSIONS: Compared with global transplant populations, SA renal transplant recipients demonstrated a very high rate of CYP3A5 expression, with a significant impact on tacrolimus pharmacokinetics. Genetic variation in CYP3A5 expression affects tacrolimus dosing requirements, and knowing the CYP3A5 genotype of transplant patients may allow better dose prediction compared with current standard dosing recommendations in a multi-ethnic population. Overall, black African patients required higher doses of tacrolimus than their white counterparts. While further prospective studies are needed to better evaluate dosing algorithms, it would appear that the starting dose of tacrolimus should be higher in black and mixed-race patients.


Assuntos
Citocromo P-450 CYP3A/genética , Imunossupressores/administração & dosagem , Transplante de Rim/métodos , Tacrolimo/administração & dosagem , Adulto , Estudos de Coortes , Grupos de Populações Continentais/genética , Relação Dose-Resposta a Droga , Feminino , Variação Genética , Genótipo , Humanos , Imunossupressores/farmacocinética , Masculino , Pessoa de Meia-Idade , Polimorfismo de Nucleotídeo Único , Estudos Retrospectivos , África do Sul , Tacrolimo/farmacocinética
12.
Isr Med Assoc J ; 7(22): 349-353, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32692495

RESUMO

BACKGROUND: Belimumab was the first biological drug approved for the treatment of systemic lupus erythematosus (SLE) patients. Phase II/III randomized controlled trials and real-life studies identified patients with musculoskeletal involvement as best responders. OBJECTIVES: To evaluate the effectiveness of belimumab in SLE-related joint involvement. METHODS: The cohort comprised SLE patients receiving belimumab for musculoskeletal indications. Belimumab was intravenously administrated according to protocols; all the patients were evaluated at baseline (T0) and after 3 (T1), 6 (T2), and 12 (T3) months. We assessed joint activity by disease activity score 28, simple disease activity index (SDAI), clinical disease activity index (CDAI), and swollen tender ratio. Each patient underwent musculoskeletal ultrasound of 34 joints to assess synovial effusion synovial hypertrophy, and power Doppler; by using a semi-quantitative scale (0-3) we obtained the total inflammatory score (0-216). RESULTS: We evaluated 20 patients (males/females 1/19, median age 45 years [interquartile range (IQR) 12], median disease duration 144 months [IQR 144]). CDAI and SDAI significantly decreased at T1 (P = 0.02 and P = 0.01 respectively) and this improvement was maintained at the following time-points (CDAI: T2 P = 0.008, T3 P = 0.004; SDAI: T2 P = 0.006, T3 P = 0.01). A significant reduction of median ultrasound score was identified at T1 (T0 20.5 [IQR 13.5] vs. T1 7.5 [IQR 4.7], P < 0.001), and maintained at T2 (7.0 [IQR 5], P < 0.0001), and T3 (7.0 [IQR 9.0], P < 0.0001). CONCLUSIONS: Belimumab induces a sustained improvement of ultrasound-detected inflammatory status at the articular level.


Assuntos
Anticorpos Monoclonais Humanizados/administração & dosagem , Imunossupressores/administração & dosagem , Lúpus Eritematoso Sistêmico/tratamento farmacológico , Doenças Musculoesqueléticas/tratamento farmacológico , Adulto , Estudos de Coortes , Feminino , Seguimentos , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Doenças Musculoesqueléticas/diagnóstico por imagem , Doenças Musculoesqueléticas/etiologia , Índice de Gravidade de Doença , Sinovite/tratamento farmacológico , Resultado do Tratamento , Ultrassonografia
15.
EBioMedicine ; 56: 102822, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32535547

RESUMO

Immunosuppression and immunomodulation are valuable therapeutic approaches for managing neuroimmunological diseases. In times of the Coronavirus disease 2019 (COVID-19) pandemic, clinicians must deal with the question of whether immunotherapy should currently be initiated or discontinued in neurological patients. Uncertainty exists especially because different national medical associations publish different recommendations on the extent to which immunotherapies must be continued, monitored, or possibly switched during the current pandemic. Based on the most recently available data both about the novel coronavirus and the approved immunotherapies for neurological diseases, we provide an updated overview that includes current treatment strategies and the associated COVID-19 risk, but also the potential of immunotherapies to treat COVID-19.


Assuntos
Infecções por Coronavirus/patologia , Imunoterapia , Doenças do Sistema Nervoso/terapia , Pneumonia Viral/patologia , Anticorpos Monoclonais/uso terapêutico , Betacoronavirus/isolamento & purificação , Betacoronavirus/fisiologia , Proteínas do Sistema Complemento/metabolismo , Infecções por Coronavirus/complicações , Infecções por Coronavirus/virologia , Humanos , Imunidade Ativa , Imunossupressores/uso terapêutico , Doenças do Sistema Nervoso/complicações , Pandemias , Pneumonia Viral/complicações , Pneumonia Viral/virologia , Vacinação
16.
Ann Hematol ; 99(7): 1485-1491, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32488602

RESUMO

No agreement had been reached on the treatment of patients with pure red cell aplasia (PRCA) secondary to indolent malignancies. Data was collected from patients with acquired PRCA from May, 2014 to May, 2018 in Peking Union Medical College Hospital. Tumor-associated PRCA and primary PRCA patients were matched at a ratio of 1:2 with compatible baseline characteristics. All patients had been treated with CsA or sirolimus for at least 6 months with the efficacy and adverse events recorded. Twelve tumor-associated PRCA patients (3 thymoma, 8 lymphoproliferative disorders, and 1 smoldering multiple myeloma) with stable underling disease and 24 acquired primary PRCA patients were selected. 83.3% tumor-associated PRCA patients and 100% primary PRCA patients (P = 0.436) responded to immunosuppression therapy (IST) at a median of 2.5 and 3.5 months (P = 0.137), respectively. No different was found in side effects. The ORR at the end of a median of 21.5-month follow-up was 75% and 70.8% (P = 0.795), respectively. No tumor progression was reported except one secondary patient had lymphoma relapse after 2 years of IST and was given chemotherapy again. These results suggested IST had similar effect, safety on patients with tumor-associated, and primary PRCA patients when the tumors were stable.


Assuntos
Imunossupressão , Imunossupressores/uso terapêutico , Neoplasias/complicações , Aplasia Pura de Série Vermelha/tratamento farmacológico , Aplasia Pura de Série Vermelha/etiologia , Adulto , Idoso , Estudos de Casos e Controles , Feminino , Humanos , Imunossupressão/efeitos adversos , Imunossupressão/métodos , Linfoma/complicações , Linfoma/tratamento farmacológico , Linfoma/patologia , Transtornos Linfoproliferativos , Masculino , Análise por Pareamento , Pessoa de Meia-Idade , Neoplasias/tratamento farmacológico , Neoplasias/patologia , Timoma/complicações , Timoma/tratamento farmacológico , Timoma/patologia , Neoplasias do Timo/complicações , Neoplasias do Timo/tratamento farmacológico , Neoplasias do Timo/patologia , Resultado do Tratamento
17.
J Neuroimmunol ; 345: 577282, 2020 08 15.
Artigo em Inglês | MEDLINE | ID: mdl-32505908

RESUMO

A multiple sclerosis patient infected by SARS-CoV-2 during fingolimod therapy was hospitalized with moderate clinical features, and recovered in 15 days. High levels of CCL5 and CCL10 chemokines and of antibody-secreting B cells were detected, while the levels other B- and T-cell subsets were comparable to that of appropriate controls. However, CD4+ and CD8+ cells were oligoclonally expanded and prone to apoptosis when stimulated in vitro. This study suggests that fingolimod-immunosuppressed patients, despite the low circulating lymphocytes, may rapidly expand antibody-secreting cells and mount an effective immune response that favors COVID-19 recovery after drug discontinuation.


Assuntos
Infecções por Coronavirus/complicações , Infecções por Coronavirus/imunologia , Hospedeiro Imunocomprometido , Esclerose Múltipla Recidivante-Remitente/imunologia , Esclerose Múltipla Recidivante-Remitente/virologia , Pneumonia Viral/complicações , Pneumonia Viral/imunologia , Betacoronavirus , Feminino , Cloridrato de Fingolimode/uso terapêutico , Humanos , Imunossupressores/uso terapêutico , Pessoa de Meia-Idade , Esclerose Múltipla Recidivante-Remitente/tratamento farmacológico , Pandemias
19.
J Neuromuscul Dis ; 7(3): 361-364, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32508329

RESUMO

This is a brief report of a patient who has refractory Myasthenia Gravis, on multiple long-term immunosuppressive therapies and contracted COVID-19 during this 2020 pandemic. She was quarantined for total of 14 days and recovered successfully without any complications (no myasthenia exacerbation or crisis, no COVID-19 related complications), with no changes to her immunosuppressive therapy. Treatment of MG patients with COVID-19 needs to be tailored to individual patient.


Assuntos
Betacoronavirus , Infecções por Coronavirus/complicações , Imunossupressores/uso terapêutico , Miastenia Gravis/tratamento farmacológico , Pneumonia Viral/complicações , Adulto , Doença Crônica , Feminino , Humanos , Miastenia Gravis/complicações , Pandemias , Medicina de Precisão/métodos , Fatores de Risco , Resultado do Tratamento
20.
Neurologia ; 35(6): 357-362, 2020.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-32591152

RESUMO

INTRODUCTION: The COVID-19 pandemic is changing approaches to diagnosis, treatment, and care provision in multiple sclerosis (MS). During both the initial and peak phases of the epidemic, the administration of disease-modifying drugs, typically immunosuppressants administered in pulses, was suspended due to the uncertainty about their impact on SARS-CoV-2 infection, mainly in contagious asymptomatic/presymptomatic patients. The purpose of this study is to present a safety algorithm enabling patients to resume pulse immunosuppressive therapy (PIT) during the easing of lockdown measures. METHODS: We developed a safety algorithm based on our clinical experience with MS and the available published evidence; the algorithm assists in the detection of contagious asymptomatic/presymptomatic cases and of patients with mild symptoms of SARS-CoV-2 infection with a view to withdrawing PIT in these patients and preventing new infections at day hospitals. RESULTS: We developed a clinical/microbiological screening algorithm consisting of a symptom checklist, applied during a teleconsultation 48hours before the scheduled session of PIT, and PCR testing for SARS-CoV-2 in nasopharyngeal exudate 24hours before the procedure. CONCLUSION: The application of our safety algorithm presents a favourable risk-benefit ratio despite the fact that the actual proportion of asymptomatic and presymptomatic individuals is unknown. Systematic PCR testing, which provides the highest sensitivity for detecting presymptomatic cases, combined with early detection of symptoms of SARS-CoV-2 infection may reduce infections and improve detection of high-risk patients before they receive PIT.


Assuntos
Algoritmos , Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/prevenção & controle , Imunossupressores/administração & dosagem , Esclerose Múltipla/tratamento farmacológico , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Assistência Ambulatorial , Doenças Assintomáticas , Lista de Checagem , Técnicas de Laboratório Clínico , Contraindicações de Medicamentos , Infecções por Coronavirus/diagnóstico , Suscetibilidade a Doenças , Humanos , Hospedeiro Imunocomprometido , Imunossupressores/efeitos adversos , Imunossupressores/uso terapêutico , Programas de Rastreamento/métodos , Nasofaringe/virologia , Pneumonia Viral/diagnóstico , Reação em Cadeia da Polimerase , Pulsoterapia , Quarentena , Medição de Risco , Avaliação de Sintomas , Telemedicina
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