ABSTRACT
Abstract Objective: To provide guidelines on the coronavirus disease 2019 (COVID-19) vaccination in patients with immune-mediated rheumatic diseases (IMRD) to rheumatologists considering specific scenarios of the daily practice based on the shared-making decision (SMD) process. Methods: A task force was constituted by 24 rheumatologists (panel members), with clinical and research expertise in immunizations and infectious diseases in immunocompromised patients, endorsed by the Brazilian Society of Rheumatology (BSR), to develop guidelines for COVID-19 vaccination in patients with IMRD. A consensus was built through the Delphi method and involved four rounds of anonymous voting, where five options were used to determine the level of agreement (LOA), based on the Likert Scale: (1) strongly disagree; (2) disagree, (3) neither agree nor disagree (neutral); (4) agree; and (5) strongly agree. Nineteen questions were addressed and discussed via teleconference to formulate the answers. In order to identify the relevant data on COVID-19 vaccines, a search with standardized descriptors and synonyms was performed on September 10th, 2021, of the MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, ClinicalTrials.gov, and LILACS to identify studies of interest. We used the Newcastle-Ottawa Scale to assess the quality of nonrandomized studies. Results: All the nineteen questions-answers (Q&A) were approved by the BSR Task Force with more than 80% of panelists voting options 4—agree—and 5—strongly agree—, and a consensus was reached. These Guidelines were focused in SMD on the most appropriate timing for IMRD patients to get vaccinated to reach the adequate covid-19 vaccination response. Conclusion: These guidelines were developed by a BSR Task Force with a high LOA among panelists, based on the literature review of published studies and expert opinion for COVID-19 vaccination in IMRD patients. Noteworthy, in the pandemic period, up to the time of the review and the consensus process for this document, high-quality evidence was scarce. Thus, it is not a substitute for clinical judgment.
ABSTRACT
Anafilaxia é uma reação de hipersensibilidade potencialmente grave, mediada por imunoglobulinas E e G, após exposição a antígeno em pessoas previamente sensibilizadas. As manifestações clínicas que provoca são multissitêmicas e inespecíficas, o que dificulta o seu diagnostico, podendo evoluir para colapso cardiovascular e insuficiência respiratória. O choque anafilático é distributivo, com importante componente hipovolêmico. A suspeição clínica imediata é fundamental, pois tem impacto no sucesso do tratamento. Este artigo objetiva rever o tema, ressaltando não apenas os sinais e sintomas clínicos e medicamentos usados, como também correlacionar a fisiopatologia com o tratamento e enfatizar a importância da prevenção adequada de novos episódios, para redução da sua incidência e morbidade.
Anaphylaxis is a potentially serious hypersensitivity reaction mediated by E and G-types immunoglobulin after exposition to antigen in previously sensitized people. It is hard to diagnose, as its clinical manifestations are unspecific and multisystemic. It can, however, progress to cardiovascular collapse and respiratory insufficiency. The anaphylactic shock is distributive, with an important hypovolemic component. Immediate clinical suspicion is crucial for treatment success. This paper aims to provide a review of the topic and highlight not only the drugs and clinical signals and symptoms, but also correlate physiopathology and treatment. It also aims to emphasize the importance of appropriate prevention of new events in order to reduce incidence and morbidity.
Subject(s)
Humans , Anaphylaxis/diagnosis , Anaphylaxis/etiology , Anaphylaxis/therapy , Diagnosis, Differential , Epinephrine/therapeutic use , HypersensitivityABSTRACT
Esta revisão discute o estado atual da fisiopatologia e do tratamento do infarto agudo do miocárdio relacionado ao uso de cocaína. O abuso de drogas ilícitas, em especial, da cocaína é cada vez mais frequente, com o aumento consequente da quantidade de consultas de emergências relacionadas a suas complicações, incluindo o infarto do miocárdio. Os principais mecanismos fisiopatológicos que contribuem de forma aguda ou crônica para causar o infarto relacionado ao uso de cocaína são: vasoespasmo, aterosclerose, trombogenese mediada por aumento dos níveis de fatores pró-trombóticos associada com a elevação da agregação plaquetária, aumento da demanda de oxigênio pelo miocárdio. O tratamento do infarto agudo do miocárdio relacionado ao uso de cocaína é semelhante ao do infarto na população em geral, com ácido acetilsalicílico, nitratos e oxigênio. As diferenças estão no uso de benzodiazepínicos e na contraindicação do uso de beta-bloqueadores. Existe controvérsia quanto ao uso do labetalol e da terapia trombolítica. Está sob investigação o uso de novos medicamentos como a fentolamina para reverter os efeitos de vasoconstrição e dos inibidores plaquetários para evitar a progressão do trombo.
This article aims to review current pillars of the pathophysiology and treatment of acute myocardial infarction related to cocaine use. Cocaine use has become increasingly frequent, and consequently the number of medical emergencies has increased related to its complications, including myocardial infarction. Four seems to be the pathophysiological mechanisms that contribute acutely or chronically, to cause infarction related to cocaine use: vasospasm, atherosclerosis, thrombus formation mediated by increased levels of prothrombotic factors and increased platelet aggregation, and increased demand for myocardial oxygen. The cocaine related infarction treatment is similar to infarction in general population with aspirine, nitrates and oxigen therapy. The differences are based on the use of benzodiazepines and the non indication of beta blockers, in the first case. Labetalol and trombolitic therapy use are controversial. The patophisiology knowledgement plays an important role in the introduction of new medications specific to cocaine related infarction, like phentolamine and platelets inhibitors.
Subject(s)
Humans , Myocardial Infarction/physiopathology , Myocardial Infarction/drug therapy , Cocaine-Related Disorders/complications , Aspirin/therapeutic use , Phentolamine/therapeutic use , Labetalol/adverse effects , Nitroglycerin/therapeutic useABSTRACT
O tétano é doença adquirida do sistema nervoso central pela contaminação de feridaspelo bacilo Gram positivo Clostridium tetani, presente em fezes de animais, solo, poeirae objetos enferrujados. O tétano, apesar de passível de imunoprevenção, ainda persistenos países em desenvolvimento, devido à cobertura vacinal incompleta e ao tratamentoinadequado de lesões traumáticas. Este trabalho descreve a evolução de pacienteatendido no Hospital Risoleta Tolentino Neves, com manifestações clínicas de tétano,caso em que a adequada abordagem terapêutica garantiu a cura. Alerta para a persistênciado tétano como doença grave e para a importância da observação do esquemavacinal e da correta abordagem de feridas.
Tetanus is a central nervous system disease, acquired by contamination of wounds by Clostridium tetani, a Gram positive bacillus present in animal feces, soil, dust and rusty objects. Although vaccine-preventable, the disease persists in developing countries, due to incomplete vaccine-coverage and inadequate treatment of traumatic injuries. This paper describes a case of a patient treated at Hospital Risoleta Tolentino Neves, with typi-cal clinical manifestations of tetanus, in whom the institution of an appropriate treatment contributed effectively to his healing. This case report highlights the persistence of tetanus in Brazilian context and aims to draw attention to the importance of observation of the immunization schedule and the correct approach to wound treatment.
