RESUMEN
Azacitidine is a pyrimidine nucleoside analog licensed for treatment of adult patients with myelodysplastic syndrome. Azacitidine acts as an inducer of cell differentiation by causing demethylation and re-expression of genes silenced by hypermethylation. We report a 56-year-old man with myelodysplastic syndrome who developed interstitial lung disease after azacitidine therapy. Open lung biopsy revealed a nonresolving organizing pneumonia pattern and bronchocentric granulomatous pattern suggestive of drug-induced lung injury. Treatment with steroids and discontinuation of azacitidine led to resolution of interstitial lung disease. The Naranjo adverse drug reaction probability scale score indicated that the association between azacitidine and interstitial lung disease was probable. Interstitial lung disease is a serious but uncommon side effect of this relatively safe drug. The mechanism underlying this is still unclear. The patient was subsequently treated with decitabine with no recurrence of interstitial lung disease.
Asunto(s)
Antimetabolitos Antineoplásicos/efectos adversos , Azacitidina/efectos adversos , Enfermedades Pulmonares Intersticiales/inducido químicamente , Síndromes Mielodisplásicos/tratamiento farmacológico , Antimetabolitos Antineoplásicos/uso terapéutico , Azacitidina/uso terapéutico , Humanos , Enfermedades Pulmonares Intersticiales/tratamiento farmacológico , Masculino , Persona de Mediana Edad , Esteroides/uso terapéuticoRESUMEN
Hypotension can be a manifestation of transfusion reactions, including acute hemolysis, bacterial contamination, transfusion-related acute lung injury, and anaphylaxis. In addition to hypotension, these reactions usually present with other characteristic symptoms and signs. In rare cases, hypotension is the only manifestation of a transfusion reaction. This reaction, characterized by early and abrupt onset of hypotension that resolves quickly once the transfusion is stopped, is referred to as acute hypotensive transfusion reaction (AHTR). We report a case of AHTR observed in a patient on angiotensin-converting enzyme inhibitor therapy. The Naranjo adverse drug reaction probability scale score indicated that the association between angiotensin-converting enzyme inhibitor therapy and AHTR was probable. If a patient on angiotensin-converting enzyme inhibitor therapy develops AHTR, it is important to recognize the need to switch to another class of antihypertensive medication, at least while the patient continues to require transfusion.
Asunto(s)
Inhibidores de la Enzima Convertidora de Angiotensina/efectos adversos , Antihipertensivos/efectos adversos , Incompatibilidad de Grupos Sanguíneos/complicaciones , Bradiquinina/metabolismo , Hipotensión/etiología , Reacción a la Transfusión , Anciano de 80 o más Años , Humanos , Masculino , Transfusión de Plaquetas/efectos adversosRESUMEN
Perioperative management of patients on chronic anticoagulant use involves balancing individual risk for thromboembolism and bleeding. Discontinuation of antithrombotic therapy can place patients at increased risk of thromboembolic complications, whereas continuing antithrombotic therapy can increase procedure-related bleeding risk. Temporary perioperative substitution of low-molecular weight heparin or unfractionated heparin in place of warfarin, "the bridge therapy" is often used in the periprocedural period, but the indications and timing of this is still uncertain. This review addresses the risk stratification of patients according to thromboembolic risk, indications, timing, and duration, and a practical approach to bridge therapy.
Asunto(s)
Anticoagulantes/uso terapéutico , Heparina/uso terapéutico , Atención Perioperativa/métodos , Hemorragia Posoperatoria/prevención & control , Tromboembolia/prevención & control , Warfarina/uso terapéutico , Anticoagulantes/administración & dosificación , Anticoagulantes/efectos adversos , Pérdida de Sangre Quirúrgica/prevención & control , Heparina/administración & dosificación , Humanos , Medición de Riesgo , Warfarina/administración & dosificación , Warfarina/efectos adversosRESUMEN
Treatment of heart failure involves management of risk factors and control of symptoms. Traditional management of heart failure involves the use of angiotensin converting enzyme inhibitors, angiotensin receptor blockers, beta-blockers, diuretics, aldosterone antagonists, and digitalis. Metabolic modulators are a newer class of drugs that benefit these patients by modulating cardiac metabolism without altering hemodynamics. They have the potential to relieve symptoms in patients with refractory heart failure who are already on optimal medical therapy. These drugs increase glucose metabolism at the expense of free fatty acid metabolism, thereby enhancing efficient use of oxygen. This review discusses the role of 4 metabolic modulators drugs that could potentially be used for heart failure therapy: trimetazidine, ranolazine, perhexiline, and etomoxir.
Asunto(s)
Insuficiencia Cardíaca/tratamiento farmacológico , Insuficiencia Cardíaca/metabolismo , Acetanilidas/uso terapéutico , Carnitina O-Palmitoiltransferasa/antagonistas & inhibidores , Inhibidores Enzimáticos/uso terapéutico , Compuestos Epoxi/uso terapéutico , Ácidos Grasos/metabolismo , Glucosa/metabolismo , Humanos , Mitocondrias Cardíacas/efectos de los fármacos , Mitocondrias Cardíacas/metabolismo , Miocitos Cardíacos/efectos de los fármacos , Miocitos Cardíacos/metabolismo , Perhexilina/uso terapéutico , Piperazinas/uso terapéutico , Ranolazina , Trimetazidina/uso terapéutico , Vasodilatadores/uso terapéuticoRESUMEN
Endothelin and angiotensin II are potent vasoconstrictor substances that also can exert proliferative and proinflammatory effects. Dysregulation of these systems can induce or mediate endothelial dysfunction and organ damage in systemic hypertension. Dual-acting angiotensin II and endothelin receptor blockers have been shown to reduce systemic blood pressure in animal models and in hypertensive patients. Preliminary data in smaller human studies have shown that these agents are safe and well tolerated. Larger randomized trials evaluating the efficacy and safety of these agents are underway and show potential as a new class of antihypertensives.
Asunto(s)
Antagonistas de Receptores de Angiotensina/farmacología , Antihipertensivos/farmacología , Antagonistas de los Receptores de Endotelina , Hipertensión/tratamiento farmacológico , Vasoconstrictores/farmacología , Antagonistas de Receptores de Angiotensina/efectos adversos , Antagonistas de Receptores de Angiotensina/uso terapéutico , Animales , Antihipertensivos/efectos adversos , Antihipertensivos/uso terapéutico , Presión Sanguínea/efectos de los fármacos , Humanos , Hipertensión/epidemiología , Hipertensión/fisiopatología , Receptores de Endotelina/metabolismo , Vasoconstrictores/efectos adversos , Vasoconstrictores/farmacocinética , Vasoconstrictores/uso terapéuticoRESUMEN
BACKGROUND: Dyspnea is a common symptom in a patient with valvular heart disease. The mechanism underlying this disease is still uncertain. Respiratory muscle weakness has been proposed to be one of the mechanisms underlying dyspnea in heart failure, but this has not been adequately studied in valvular heart disease. METHODS: We prospectively studied 20 patients with rheumatic mitral valve stenosis who were candidates for percutaneous balloon mitral valvotomy. Respiratory muscle strength assessment by maximal static inspiratory mouth pressure and maximal static expiratory mouth pressure was done on all patients at baseline and at 1 week after the procedure. The severity of dyspnea in study participants was also studied by the 6-min walk test and visual analog scale. RESULTS: Balloon valvotomy was followed by a significant improvement in the 6-min walking distance (from 219 +/- 30.15 to 237.55 +/- 32.25 m, P < 0.001), visual analog scale as a measure of dyspnea (from 60.95 +/- 12.16 to 44.4 +/- 13.71 mm, P < 0.001), inspiratory muscle strength (from 51.9 +/- 10.28 to 56.55 +/- 11.87 cmH2O, P < 0.001) and expiratory muscle strength (from 62.15 +/- 19.68 to 67.20 +/- 21.91 cmH2O, P < 0.001). CONCLUSION: Improvement in dyspnea in mitral stenosis after balloon valvotomy is associated with significant improvement in respiratory muscle strength.
Asunto(s)
Cateterismo , Disnea/fisiopatología , Estenosis de la Válvula Mitral/fisiopatología , Fuerza Muscular , Músculos Respiratorios/fisiopatología , Adulto , Disnea/etiología , Disnea/terapia , Femenino , Humanos , Masculino , Estenosis de la Válvula Mitral/complicaciones , Estenosis de la Válvula Mitral/terapia , Estudios Prospectivos , Cardiopatía Reumática/complicaciones , Cardiopatía Reumática/terapia , Adulto JovenRESUMEN
BACKGROUND: Dyspnea is a common symptom in a patient with valvular heart disease. The mechanism underlying this is still uncertain. METHODS: We prospectively studied 20 patients with rheumatic mitral valve stenosis who were candidates for percutaneous balloon mitral valvotomy. Assessment of airway hyper-reactivity by histamine challenge test was done on all patients at baseline and at 1 week after the procedure. The provocative concentration of histamine solution required producing a 20% fall in forced expiratory volume in 1 second (FEV(1)) (PC20) was recorded as a measure of airway hyper-reactivity. The severity of dyspnea in study subjects was also studied by the 6-minute-walk test and visual analog scale. RESULTS: After balloon valvotomy, a significant improvement was seen in the six minute walking distance (219+/-30.15 to 237.55+/-32.25; p < 0.001), visual analog scale as a measure of dyspnea (60.95+/-12.16 to 44.4+/-13.71; p < 0.001) and airway hyper-reactivity (PC20; 5.69+/-6.01 mg/ml to 10.16+/-7.93; p < 0.001). CONCLUSIONS: Improvement in dyspnea in mitral stenosis after balloon valvotomy is associated with significant improvement in airway hyper-reactivity.
Asunto(s)
Cateterismo/métodos , Disnea/terapia , Estenosis de la Válvula Mitral/terapia , Cardiopatía Reumática/terapia , Adulto , Hiperreactividad Bronquial/diagnóstico , Hiperreactividad Bronquial/etiología , Hiperreactividad Bronquial/terapia , Pruebas de Provocación Bronquial , Disnea/etiología , Femenino , Volumen Espiratorio Forzado , Histamina , Humanos , Masculino , Estudios Prospectivos , Índice de Severidad de la Enfermedad , Resultado del Tratamiento , Caminata , Adulto JovenAsunto(s)
Colecistitis/etiología , Gangrena/etiología , Hafnia alvei/patogenicidad , Anciano , Colecistitis/diagnóstico , Colecistitis/tratamiento farmacológico , Colecistitis/patología , Gangrena/tratamiento farmacológico , Gangrena/patología , Hafnia alvei/aislamiento & purificación , Humanos , MasculinoRESUMEN
A middle-aged woman presented with insidious onset swelling of bilateral lacrimal and parotid glands. Mikulicz syndrome is a symptom complex caused by a variety of systemic disorders like lymphoma, sarcoidosis, amyloidosis, human immunodeficiency virus infection, tuberculosis, etc. Biopsy from her lacrimal glands revealed mantle cell lymphoma. Although involvement of salivary and lacrimal glands as a part of generalized lymphomatous involvement is not uncommon, Mikulicz syndrome as a presenting manifestation of a lymphoma is very rare.