Long-term outcomes of intraoperative triamcinolone injection versus postoperative oral prednisolone in congenital cataract surgery / Resultados de longo prazo do uso intraoperatório de triancinolona versus oral pós-operatório de prednisolona na cirurgia de catarata congênita

ABSTRACT Purpose: To compare the long-term ocular findings of children that were operated of congenital cataract before the age of two and that received an intraoperative intracameral triamcinolone injection or used postoperative oral prednisolone to modulate ocular inflammation. Methods: All patients who had previously participated in a clinical trial that analyzed the 1-year surgical outcomes of congenital cataract surgery utilizing intracameral triamcinolone (study group) or oral prednisolone (control group) were eligible to participate in this prospective cohort research. Patients' medical records were reviewed, and the children underwent a complete ophthalmologic exam on final follow-up. Biomicroscopic findings, intraocular pressure, central corneal thickness, the need for additional surgical interventions, and findings compatible with glaucoma were the primary end measures. Results: Twenty-six eyes (26 patients) were included (study group = 11 eyes; control group = 15 eyes). The mean follow--up was 8.2 ± 1.2 years and 8.1 ± 1.7 years in the study and control groups, respectively (p=0.82). All eyes presented a centered intraocular lens. There was no statistically significant difference between the groups with regards to the presence of posterior synechia (p=0.56), intraocular pressure (p=0.49), or central corneal thickness (p=0.21). None of the eyes fulfilled the glaucoma diagnostic criteria, presented secondary visual axis obscuration, or were reoperated. Conclusion: The long--term ocular findings of children that underwent congenital cataract surgery and received an intraoperative intracameral triamcinolone injection were similar to those that used postoperative oral prednisolone to modulate ocular inflammation. This suggests that intracameral triamcinolone may substitute oral prednisolone in congenital cataract surgery, facilitating the postoperative treatment regimen and compliance.

RESUMO Objetivo: Comparar os achados oculares em longo prazo de crianças que se submeteram à cirurgia de catarata congênita antes dos dois anos de idade e receberam uma injeção intracameral de triancinolona no intraoperatório ou usaram prednisolona oral no pós-operatório para modular a inflamação ocular. Métodos: Neste estudo prospectivo de coorte, todos os pacientes que participaram de um ensaio clínico anterior, que analisou os resultados cirúrgicos de 1 ano da cirurgia de catarata congênita usando triancinolona intracameral (Grupo de Estudo) ou prednisolona oral (Grupo Controle), eram elegíveis para participar. Os prontuários médicos dos pacientes foram revisados e as crianças foram submetidas a um exame oftalmológico completo no acompanhamento final. As principais medidas de desfecho foram: achados biomicroscópicos, pressão intraocular, espessura central da córnea, a necessidade de intervenções cirúrgicas adicionais e achados compatíveis com glaucoma. Resultados: Vinte e seis olhos (26 pacientes) foram incluídos (Grupo de Estudo = 11 olhos; Grupo de Controle = 15 olhos). O seguimento médio foi de 8,2 ± 1,2 anos e 8,1 ± 1,7 anos nos Grupos de Estudo e Controle, respectivamente (p=0,82). Todos os olhos apresentavam lente intraocular centrada. Não houve diferença estatisticamente significativa entre os grupos com relação à presença de sinéquia posterior (p=0,56), pressão intraocular (p=0,49) ou espessura central da córnea (p=0,21). Nenhum dos olhos preencheu os critérios diagnósticos para glaucoma, apresentou opacificação secundária do eixo visual ou foi reoperado. Conclusão: Os achados oculares em longo prazo de crianças que se submeteram à cirurgia de catarata congênita e receberam uma injeção intracameral de triancinolona no intraoperatório foram semelhantes aos que usaram prednisolona oral no pós-operatório para modular a inflamação ocular, sugerindo que a triancinolona intracameral pode substituir a prednisolona oral na cirurgia de catarata congênita, facilitando o tratamento pós-operatório e a adesão ao mesmo.

Linfoma de células B de alto grado de malignidad con morfología blastoide durante el embarazo: reporte de un caso / High-grade malignant B-Cell lymphoma with blastoid during pregnancy: a case report

Resumen ANTECEDENTES: Durante el embarazo es más común el linfoma de Hodking que el no Hodking; afecta, en promedio, a mujeres de 30 años (18-44 años) y más. Suele diagnosticarse alrededor de las 28 semanas de embarazo y está documentado que puede llegarse al término. Los esquemas de tratamiento pueden iniciarse en el posparto inmediato o, incluso, antes. La incidencia mundial del linfoma no Hodking es de 0.8 por cada 100,000 mujeres; se desconoce la supervivencia durante el embarazo. CASO CLINICO: Paciente de 34 años, con antecedentes obstétricos de tres embarazos, una cesárea y un aborto y el embarazo actual en curso de las 29 semanas, referida de la ciudad de Colima debido a un reporte de BI-RADS 3 en el ultrasonido de mama y un nódulo mamario palpable, con evidencia de múltiples tumoraciones en la zona hepática, esplénica y peripancreática. La biopsia tomada de las zonas de la lesión reportó: linfoma de células B de alto grado de malignidad, con morfología blastoide y expresión de C-MYC y BCL2. Además, la paciente se encontró con: anemia, dolor abdominal, múltiples nódulos hepáticos y adenopatías abdominales. Se decidió la interrupción del embrazo a las 30 semanas, con la obtención de un recién nacido, sin complicaciones. Enseguida se inició el tratamiento con rituximab-etopósido-prednisolona-vincristina-ciclofosfamida-doxorrubicina (R-EPOCH) con adecuada adaptación por la paciente. CONCLUSION: Puesto que la información bibliográfica de linfoma y embarazo es escasa el caso aquí reportado es relevante por su aporte. La atención multidisciplinaria favorecerá siempre el pronóstico de las pacientes.

Abstract BACKGROUND: Hodking's lymphoma is more common during pregnancy than non-Hodking's lymphoma; it affects, on average, women aged 30 years (18-44 years) and older. It is usually diagnosed around 28 weeks of pregnancy and is documented to be carried to term. Treatment regimens can be initiated in the immediate postpartum period or even earlier. The worldwide incidence of non-Hodking's lymphoma is 0.8 per 100,000 women; survival during pregnancy is unknown. CLINICAL CASE: 34-year-old patient, with obstetric history of three pregnancies, one cesarean section and one abortion and the current pregnancy in progress at 29 weeks, referred from the city of Colima due to a report of BI-RADS 3 on breast ultrasound and a palpable breast nodule, with evidence of multiple tumors in the hepatic, splenic and peripancreatic area. Biopsy taken from the lesion areas reported: high grade malignant B-cell lymphoma, with blastoid morphology and expression of C-MYC and BCL2. In addition, the patient was found to have: anemia, abdominal pain, multiple hepatic nodules and abdominal adenopathies. It was decided to terminate the pregnancy at 30 weeks, with the delivery of an uncomplicated newborn. Rituximab-Etoposide, Prednisone, Vincristine, Cyclophosphamide, and Doxorubicin (R-EPOCH) therapy was started immediately with adequate adaptation by the patient. CONCLUSION: Since bibliographic information on lymphoma and pregnancy is scarce, the case reported here is relevant for its contribution. Multidisciplinary care will always favor the prognosis of patients.

Sensor for prednisolone detection in sports doping / Sensor para detecção de prednisolona no doping esportivo / Sensor para la detección de prednisolona en el dopaje deportivo

ABSTRACT Introduction: Prednisolone causes pro-inflammatory impulses to be inhibited and anti-inflammatory signals to be promoted. As a result, it alters how the body's immune system reacts to certain diseases. The World Anti-Doping Agency, however, has banned SNP and other glucocorticosteroids. An electrochemical sensor can be developed using a gold nanocomposite, polypyrrole nanoparticles and synthesized carbon nanotubes (Au-PPy NPs@CNTs). Objective: Develop an electrochemical sensor to detect prednisolone. Method: Au-PPy NPs@CNTs nanocomposite was chemically synthesized with a modified glassy carbon electrode (GCE) surface. Results: According to SEM data, the nanocomposite was composed of amorphous Au NPs, and PPy NPs deposited in tubes strongly entangled in a CNTs network. The wide linear range and low detection limit of the Au-PPy NPs@CNTs/GCE as prednisolone sensors were attributed to the combined catalytic performance of the Au and PPy NPs@CNTs nanostructures. Conclusion: The results of prednisolone detection in each specimen using the amperometric method indicated good accuracy. The accuracy and precision of Au-PPy NPs@CNTs/GCE for prednisolone detection were explored in blood samples from 5 young athletes aged 20-24 years who used prednisolone tablets (RSD less than 4.25%). In addition to monitoring prednisolone concentrations in athletes' serum, Au-PPy NPs@CNTs/GCE can be used as a reliable prednisolone sensor. Level of evidence II; Therapeutic studies - investigating treatment outcomes.

RESUMO Introdução: A prednisolona faz com que os impulsos pró-inflamatórios sejam inibidos e os sinais anti-inflamatórios sejam promovidos. Como resultado, ela altera a forma como o sistema imunológico do corpo reage a certas doenças. A Agência Mundial Antidoping, no entanto, proibiu o SNP e outros glucocorticoesteroides. Usando um nanocomposto de ouro, nanopartículas de polipirrol e nanotubos de carbono sintetizados (Au-PPy NPs@CNTs), um sensor eletroquímico pode ser desenvolvido. Objetivo: Desenvolver um sensor eletroquímico para detectar a prednisolona. Método: O nanocompósito Au-PPy NPs@CNTs foi sintetizado quimicamente com uma superfície de eletrodo de carbono vítreo modificado (GCE). Resultados: De acordo com dados da SEM, o nanocomposto foi descoberto como sendo composto de Au NPs e NPs de PPy amorfo, depositados em tubos fortemente emaranhados em uma rede de CNTs. O amplo alcance linear e o baixo limite de detecção do Au-PPy NPs@CNTs/GCE como sensores de prednisolona foram atribuídos ao desempenho catalítico combinado das nanoestruturas de Au e PPy NPs@CNTs. Conclusão: Os resultados da detecção de prednisolona em cada espécime usando o método de amperometria indicaram boa precisão. A precisão e a acurácia de Au-PPy NPs@CNTs/GCE para a detecção de prednisolona foram exploradas em amostras de sangue preparadas de 5 atletas jovens de 20 a 24 anos que usaram comprimidos de prednisolona (RSD inferior a 4,25%). Além de monitorar as concentrações de prednisolona no soro dos atletas, Au-PPy NPs@CNTs/GCE pode ser usado como um sensor confiável de prednisolona. Nível de evidência II; Estudos terapêuticos - investigação dos resultados do tratamento.

RESUMEN Introducción: La prednisolona hace que se inhiban los impulsos proinflamatorios y se promuevan las señales antiinflamatorias. Como resultado, altera la forma en que el sistema inmunológico del cuerpo reacciona a ciertas enfermedades. Sin embargo, la Agencia Mundial Antidopaje ha prohibido el SNP y otros glucocorticosteroides. Utilizando un nanocompuesto de oro, nanopartículas de polipirrol y nanotubos de carbono sintetizados (Au-PPy NPs@CNTs), se puede desarrollar un sensor electroquímico. Objetivo: Desarrollar un sensor electroquímico para detectar la prednisolona. Método: Se sintetizó químicamente el nanocompuesto Au-PPy NPs@CNTs con una superficie de electrodo de carbono vítreo (GCE) modificada. Resultados: Según los datos del SEM, se comprobó que el nanocompuesto estaba compuesto de Au NPs y NPs de PP amorfo y depositados en tubos fuertemente enredados en una red de CNTs. El amplio rango lineal y el bajo límite de detección de Au-PPy NPs@CNTs/GCE como sensores de prednisolona se atribuyeron al rendimiento catalítico combinado de las nanoestructuras de Au y PPy NPs@CNTs. Conclusión: Los resultados de la detección de prednisolona en cada muestra mediante el método amperométrico indicaron una buena precisión. Se exploró la exactitud y precisión de las Au-PPy NPs@CNTs/GCE para la detección de prednisolona en muestras de sangre preparadas a partir de 5 jóvenes atletas de entre 20 y 24 años de edad que utilizaban tabletas de prednisolona (RSD inferior al 4,25%). Además de controlar las concentraciones de prednisolona en el suero de los deportistas, Au-PPy NPs@CNTs/GCE puede utilizarse como un sensor fiable de prednisolona. Nivel de evidencia II; Estudios terapéuticos - investigación de los resultados del tratamiento.

Síndrome DRESS secundária ao uso de alopurinol: um relato de caso / DRESS syndrome secondary to the use of allopurinol: a case report

A Síndrome de DRESS (do inglês, Drug Rash with Eosinophilia and Systemic Symptoms) é uma patologia rara que consiste em uma severa reação medicamentosa mediada por células T. O presente relato de caso retrata uma paciente do sexo feminino, 59 anos, que apresentou icterícia, febre não termometrada, acolia, colúria, mialgia, placas hipercrômicas e lesões pruriginosas. Referiu uso recente de alopurinol, paracetamol e nimesulida, apresentando melhora importante e espontânea após a suspensão das medicações. A extensão do tempo de exposição ao medicamento agressor ocasiona um maior período de internação e risco de mortalidade. Além disso, os dados restritos sobre a Síndrome de DRESS impõe desafios ao seu diagnóstico. Sendo assim, este estudo busca destacar a importância do diagnóstico clínico precoce, a suspensão do medicamento agressor e a instituição da terapêutica adequada para um prognóstico favorável

The Drug Rash with Eosinophilia and Systemic Symptoms (DRESS) Syndrome is a rare pathology that consists of a severe drug reaction mediated by T cells. The present case report depicts a female patient, 59 years old, who presented jaundice, non thermometered fever, acholia, choluria, myalgia, hyperchromic plaques and pruritic lesions. She mentioned recent use of allopurinol, paracetamol and nimesulide, showing significant and spontaneous improvement after discontinuation of medications. The extension of time of exposure to the offending drug causes a longer period of hospitalization and risk of mortality. In addition, the restricted data on DRESS Syndrome poses challenges to its diagnosis. Therefore, this study seeks to highlight the importance of early clinical diagnosis, suspension of the offending drug and the institution of appropriate therapy for a favorable prognosis

Efficacy of ursodeoxycholic acid combined with prednisolone and immunosuppressant triple therapy in the treatment of refractory primary biliary cholangitis.

BACKGROUND AND AIM: To explore the efficacy treatment regimen in refractory PBC. METHODS: Triple treatment including ursodeoxycholic acid, prednisolone and immunosuppressant was prescribed to 47 refractory patients. Biochemistries, immune parameters, non-invasive liver fibrosis assessments were measured during follow-up. RESULTS: Triple therapy resulted in significant decrease in ALP, GGT, ALT, AST, TBIL, ALB, IgG, IgM, APRI, FIB-4 and S-INDEX. The biochemical cumulative normalization rates of ALP and other biochemical parameters were higher in long-term follow-up. Poor outcome was observed in patients with lower ALB, higher TBIL, PT, sp100 positivity and advanced liver pathology at baseline. Osteoporosis and bone fracture were observed in 15% patients. CONCLUSIONS: Triple therapy is associated with marked decrease and normalization of ALP and other parameters. ALB, TBIL, PT, sp100 and pathology were related with poor outcome. Osteoporosis should be closely monitored.

Paracoccidiodomicosis suprarrenal / Adrenal paracoccidioidomycosis

La insuficiencia suprarrenal primaria es un defecto en la producción de glucocorticoides, mineralocorticoides y andrógenos sexuales. Los pacientes afectados por esta condición se caracterizan por concentraciones bajas de cortisol y deficiencia de aldosterona con hiponatremia e hiperpotasemia concomitantes. La etiología más común es el desarrollo de anticuerpos contra la enzima 21 hidroxilasa. Otra causa importante de la insuficiencia suprarrenal primaria son las enfermedades infecciosas, en especial en los países de bajos ingresos. Entre las causas infecciosas que se han descrito se encuentran: Mycobacterium tuberculosis, el complejo de Mycobacterium avium, Neisseria meningitidis, Pseudomonas aeruginosa, Haemophilus influenzae, citomegalovirus, Pneumocystis jirovecii, Histoplasma capsulatum, Blastomyces dermatiditis, Cryptococcus neoformans, Cocciodiodes immitis, Nocardia spp. y Paracoccidioides brasiliensis. En este artículo se presenta la imagen de la tomografía de un paciente que presentó falla suprarrenal, con masas en las glándulas suprarrenales, cuya biopsia permitió establecer el diagnóstico final de paracoccidioidomicosis.

Primary adrenal insufficiency is a defect in glucocorticoid, mineralocorticoid and sexual androgens production. Patients with this disorder have low cortisol levels and aldosterone deficiency with concomitant hyponatremia and hyperkalemia. The most common etiology of this disease is the production of antibodies against the enzyme 21 hydroxylase. Another common cause, particularly in low income countries, are infectious diseases. Several micro-organisms have been reported as a causal agent in adrenal insufficiency including Mycobacterium tuberculosis, Mycobacterium avium complex, Neisseria meningitidis, Pseudomonas aeruginosa, Haemophilus influenzae, cytomegalovirus, Pneumocystis jirovecii, Histoplasma capsulatum, Blastomyces dermatiditis, Cryptococcus neoformans, Cocciodiodes immitis, Nocardia spp. and Paracoccidioides brasiliensis. In this article, we present the computerized tomography and the adrenal biopsy of a patient with adrenal insufficiency. The final diagnosis was paracoccidioidomycosis.

Clinical and laboratory data in pediatric autoimmune hepatitis: study from referral center in Iran / Datos clínicos y de laboratorio en hepatitis autoinmune pediátrica: estudio del centro de referencia en Irán

ABSTARCT Background : Autoimmune hepatitis (AIH) is an auto-inflammatory liver disease of children and adults, affecting patients of any age, sex, race or ethnicity, with more prevalence in females. Objective : The aim of this study was to evaluate clinical manifestation, laboratory findings, and outcome of children with autoimmune hepatitis. Materials and methods : We evaluated 86 patients treated and followed with final diagnosis of AIH between years 2010 to 2018. Physical findings (including jaundice, hepatomegaly, splenomegaly and encephalopathy), liver enzymes, liver histology and autoantibodies (including ANA, Anti LKM-1 and ASMA) were extracted from medical files. Then the patients were followed for their final outcome (including response to medical treatment or successful treatment withdrawal, liver transplantation or death). Results : Among 86 patients with AIH with mean age 9.10±4.36 years old, 66.27% were females. Jaundice (75.6%) and hepatomegaly (46.5%) were the most frequent physical findings, followed by splenomegaly (32.6%) and encephalopathy (17.4%). Aminotransferases including AST and ALT were elevated at least 3 times more than upper limit of normal in most of the patients (61.6% and 55.81%, respectively). Autoantibodies were available in 53 of 86 patients, 24.5% had AIH-1, 3.8% had AIH-II and 67.9% were seronegative. Medical treatment including prednisolone and azathioprine was started for patients, 53 of 86 cases (61.6%) had remission and 11 of 86 (13.7%) tolerated medication withdrawal successfully. Among all cases, 26 (30.2%) patients needed liver transplantation. Mortality rate was 9 among 86 cases (10.5%). Conclusion : Jaundice and hepatomegaly was the most frequent clinical findings. Mortality rate was 10.5%.

RESUMEN Antecedentes : La hepatitis autoinmune (AIH) es una enfermedad hepática autoinflamatoria de niños y adultos, que afecta a pacientes de cualquier edad, sexo, raza u origen étnico, con mayor prevalencia en las mujeres. Objetivo : El objetivo de este estudio fue evaluar la manifestación clínica, los hallazgos de laboratorio y el resultado de los niños con hepatitis autoinmune. Materiales y métodos : Evaluamos 86 pacientes tratados y seguidos con el diagnóstico final de AIH entre los años 2010 a 2018. Los hallazgos físicos (incluyendo ictericia, hepatomegalia, esplenomegalia y encefalopatía), enzimas hepáticas, histología hepática y autoanticuerpos (incluidos ANA, Anti LKM-1 y ASMA) se extrajeron de las historias médicas. Luego, los pacientes fueron seguidos para su resultado final (incluida la respuesta al tratamiento médico o la retirada exitosa del tratamiento, el trasplante de hígado o la muerte). Resultados : Entre 86 pacientes con AIH con una edad media de 9,10 ± 4,36 años, el 66,27% eran mujeres. La ictericia (75,6%) y la hepatomegalia (46,5%) fueron los hallazgos físicos más frecuentes, seguidos de esplenomegalia (32,6%) y encefalopatía (17,4%). Las aminotransferasas que incluyen AST y ALT se elevaron al menos 3 veces más que el límite superior de la normalidad en la mayoría de los pacientes (61,6% y 55,81%, respectivamente). Los autoanticuerpos estaban disponibles en 53 de 86 pacientes, 24,5% tenían AIH-1, 3,8% tenían AIH-II y 67,9% eran seronegativos. Se inició tratamiento médico que incluyó prednisolona y azatioprina, 53 de 86 casos (61,6%) tuvieron remisión y 11 de 86 (13,7%) toleraron el retiro de medicamentos con éxito. Entre todos los casos, 26 (30,2%) pacientes necesitaron un trasplante de hígado. La tasa de mortalidad fue de 9 entre 86 casos (10,5%). Conclusión : la ictericia y la hepatomegalia fueron los hallazgos clínicos más frecuentes. La tasa de mortalidad fue del 10,5%.

Effect of prednisolone on linear growth in children with nephrotic syndrome / Efeito da prednisolona sobre o crescimento linear em crianças com síndromenefrótica

Abstract Objective This study aims at determining the relationship between prednisolone cumulative dose and linear growth in pre-pubertal children with idiopathic nephrotic syndrome. Method This cross-sectional study was conducted on all children with idiopathic nephrotic syndrome registered to the pediatric nephrology department at the main referral children's hospital in Southwestern Iran. Inclusion criteria included age (males <12 years; females <10 years), >6 months of use, and the minimum prednisolone cumulative dose of 152 mg/kg. The exclusion criteria were individuals who had entered puberty or had other diseases affecting linear growth. Based on the prednisolone cumulative dose of ≥550 mg/kg (four or more relapses), the children were divided into two groups. All data regarding age, height, and weight at disease onset and the last visit, bone age, and the parents' height were collected. Secondary variables including mid-parental target height and predicted adult height were also calculated. Height data were compared between the different rates of relapse. Results A total of 97 children (68% male) were enrolled. Their post-treatment mean height Z-score was less than that obtained before treatment (−0.584 vs. −0.158; p = 0.001). Subjects with higher prednisolone cumulative doses were found to have more reduction in height Z-score (p = 0.001). Post-treatment height prediction also showed less growth potential compared to pre-treatment target height (p = 0.006). Thirty-three children (34.4%) had four or more relapses, among whom more mean-height Z-score decreases were found compared to those with less-frequent relapses (−0.84 vs. −0.28; p = 0.04). Conclusion This study showed the negative effect of cumulative dosages of prednisolone on linear growth, which was greater in children with four or more relapses.

Resumo Objetivo Determinar a relação entre a dose cumulativa de prednisolona e o crescimento linear em crianças pré-púberes com síndrome nefrótica idiopática. Método Estudo transversal conduzido em todas as crianças com síndrome nefrótica idiopática registradas no departamento de nefrologia pediátrica no principal hospital infantil para encaminhamento no sudoeste do Irã. Os critérios de inclusão incluíram idade (meninos < 12 anos; meninas < 10 anos), > 6 meses e a dose cumulativa de prednisolona mínima de 152 mg/kg. Os critérios de exclusão foram indivíduos que entraram na puberdade ou tinham outras doenças que afetam o crescimento linear. Com base na dose cumulativa de prednisolona de ≥ 550 mg/kg (≥ 4 recidivas), as crianças foram divididas em dois grupos. Foram coletados todos os dados relacionados a idade, estatura e peso no início da doença e na última visita, idade óssea e estatura dos pais. Também foram calculadas as variáveis secundárias, inclusive estatura-alvo e estatura adulta prevista. Os dados de estatura foram comparados entre as diferentes taxas de recidivas. Resultados Foram inscritas 97 crianças (68% do sexo masculino). Seu escore z de estatura média pós-tratamento foi inferior ao obtido antes do tratamento (−0,584 em comparação com −0,158; p = 0,001). Os indivíduos com maiores doses cumulativas de prednisolona mostraram maior redução no escore z para estatura (p = 0,001). A estatura pós-tratamento também foi preditiva de menor potencial de crescimento em comparação com a estatura-alvo pré-tratamento (p = 0,006); 33 crianças (34,4%) apresentaram ≥ 4 recidivas, entre as quais foram encontradas mais reduções médias no escore z para estatura em comparação com as recidivas menos frequentes (−0,84 em comparação com −0,28; p = 0,04). Conclusão Este estudo mostrou o efeito negativo das doses cumulativas de prednisolona sobre o crescimento linear, que foi maior em crianças com ≥ 4 recidivas.

Incidence of cystoid macular edema following routine cataract surgery using NSAIDs alone or with corticosteroids / Incidência de edema macular cistóide após cirurgia de catarata de rotina com a utilização de AINEs isoladamente ou com corticosteroides

ABSTRACT Purpose: To evaluate the rate of cystoid macular edema development among cataract surgery patients on four different therapeutic regimens. Methods: The present study is a retrospective analysis of 5,380 eyes following uncomplicated phacoemulsification at Wake Forest University. The study period went from July 2007 to December 2012. Patients received one of four regimens, as follows: postoperative generic ketorolac 0.4% and prednisolone 1%, postoperative name-brand ketorolac 0.45% and prednisolone 1%, postoperative bromfenac 0.09% and prednisolone 1%, preoperative and postoperative bromfenac 0.09% alone. A statistical analysis was performed to assess the differences in rate of cystoid macular edema development among the four different therapeutic regimens. The diagnosis of cystoid macular edema required worsening of vision and evidence of increased macular thickness on optical coherence tomography. Results: The overall rate of cystoid macular edema was 0.82%. Treatment by postoperative generic ketorolac 0.45% and prednisolone 1% demonstrated the highest rate of cystoid macular edema development (2.20% of the cases). Postoperative name-brand ketorolac 0.45% and prednisolone 1% exhibited intermediate rates of cystoid macular edema development (0.90% of the cases). Postoperative administration of bromfenac 0.09% and prednisolone 1% exhibited intermediate rates of cystoid macular edema development (0.44% of the cases). Preoperative and postoperative bromfenac 0.09% alone resulted in the lowest rate of cystoid macular edema development (0.09% of the cases). The rate of cystoid macular edema was significantly lower when bromfenac was used alone vs. either regimen where ketorolac and prednisolone were used (OR 0.043, 95% CI 0.002 to 0.312; p<0.001). Conclusions: Post-cataract surgery cystoid macular edema developed less frequently following topical non-steroidal anti-inflammatory drugs regimen compared to the other therapies evaluated. Bromfenac, without corticosteroids, achieved lower rates of cystoid macular edema vs. various combinations of non-ste­roidal anti-inflammatory drugs with corticosteroids.

RESUMO Objetivo: Avaliar a taxa de desenvolvimento do edema macular cistóide em pacientes submetidos à cirurgia de catarata em quatro esquemas terapêuticos diferentes. Métodos: O presente estudo é uma análise retrospectiva de 5.380 olhos após facoemulsificação não complicada na Wake Forest University. O período do estudo foi entre julho de 2007 e dezembro de 2012. Os pacientes receberam um dos quatro esquemas: cetorolaco genérico pós-operatório 0,4% e prednisolona 1%, cetorolaco 0,45% pós-operatório e prednisolona 1%, bromfenac 0,09% e a prednisolona 1% pós-operatório, bromfenaco 0,09% no pré-operatório e isoladamente no pós-operatório. Uma análise estatística foi realizada para avaliar as diferenças na taxa de desenvolvimento do edema macular cistóide entre os quatro diferentes regimes terapêuticos. O diagnóstico de edema macular cistóide exigiu uma piora da visão e uma evidência de aumento da espessura macular na tomografia de coerência óptica. Resultados: A taxa global de edema macular cistóide foi de 0,82%. O tratamento com cetorolaco genérico pós-operatório 0,45% e prednisolona 1% demonstrou a maior taxa de desenvolvimento de edema macular cistóide (2,20% dos casos). O cetorolaco 0,45% e a prednisolona 1% no pós-operatório exibiram taxas intermediárias de desenvolvimento de edema macular cistóide (0,90% dos casos). A administração de bromofenac 0,09% e de prednisolona 1% no pós-operatório apresentou taxas interme­diárias de desenvolvimento de edema macular cistóide (0,44% dos casos). O bromfenac 0,09% no pré e pós-operatório isoladamente resultou na menor taxa de desenvolvimento de edema macular cistóide (0,09% dos casos). A taxa de edema macular cistóide foi significativamente menor quando o bromfenac foi utilizado isoladamente em relação ao esquema onde cetorolaco e a prednisolona foram usados (OR 0,043, 95% CI 0,002 a 0,312; p<0,001). Conclusões: O edema macular cistóide pós-cirurgia de catarata desenvolveu-se com menor frequência após o tratamento tópico de medicamentos anti-inflamatórios não esteroidais, comparado às outras terapias avaliadas. Bromfenac, sem corticosteróides, alcançou taxas mais baixas de edema macular cistóide vs. Várias combinações em comparação com as várias combinações de drogas anti-inflamatórias não esteroidais com corticosteróides.

Effect of prednisolone on linear growth in children with nephrotic syndrome.

OBJECTIVE: This study aims at determining the relationship between prednisolone cumulative dose and linear growth in pre-pubertal children with idiopathic nephrotic syndrome. METHOD: This cross-sectional study was conducted on all children with idiopathic nephrotic syndrome registered to the pediatric nephrology department at the main referral children's hospital in Southwestern Iran. Inclusion criteria included age (males <12 years; females <10 years), >6 months of use, and the minimum prednisolone cumulative dose of 152mg/kg. The exclusion criteria were individuals who had entered puberty or had other diseases affecting linear growth. Based on the prednisolone cumulative dose of ≥550mg/kg (four or more relapses), the children were divided into two groups. All data regarding age, height, and weight at disease onset and the last visit, bone age, and the parents' height were collected. Secondary variables including mid-parental target height and predicted adult height were also calculated. Height data were compared between the different rates of relapse. RESULTS: A total of 97 children (68% male) were enrolled. Their post-treatment mean height Z-score was less than that obtained before treatment (-0.584 vs. -0.158; p=0.001). Subjects with higher prednisolone cumulative doses were found to have more reduction in height Z-score (p=0.001). Post-treatment height prediction also showed less growth potential compared to pre-treatment target height (p=0.006). Thirty-three children (34.4%) had four or more relapses, among whom more mean-height Z-score decreases were found compared to those with less-frequent relapses (-0.84 vs. -0.28; p=0.04). CONCLUSION: This study showed the negative effect of cumulative dosages of prednisolone on linear growth, which was greater in children with four or more relapses.

Estudo comparativo do uso da minociclina sistêmica versus corticoterapia sistêmica no tratamento de vitiligo em atividade / Comparative study on the use of systemic minocycline versus systemic corticosteroid therapy in the treatment of active vitiligo

Introdução: Vitiligo é uma doença cutânea adquirida crônica, que evolui com despigmentação. O controle da atividade da doença é um desafio terapêutico. Os corticosteroides sistêmicos, em uso diário ou sob a forma de pulsos, constituem o tratamento mais utilizado para a doença. Objetivo: Avaliar o efeito da minociclina no controle sobre a atividade do vitiligo em comparação ao corticosteroide. Métodos: Ensaio clínico randomizado com 16 pacientes com vitiligo vulgar em atividade, distribuídos em dois grupos: Grupo MINO - minociclina 100mg/dia, via oral, por três meses; e Grupo CORT - prednisolona 0,3mg/kg/dia, via oral, por dois meses e 0,15mg/ kg/dia no terceiro mês. Os pacientes foram avaliados antes e depois do tratamento por: registros fotográficos e avaliação das pontuações obtidas pelo escore VIDA (escore de atividade da doença vitiligo). Resultados: De acordo com os registros fotográficos, houve controle da atividade do vitiligo em 100% dos pacientes do Grupo MINO em comparação a 60% do Grupo CORT. Na comparação para o escore VIDA, notou-se diferença estatisticamente significante para ambos os grupos; porém, constatou-se que a redução foi maior no Grupo MINO, evidenciando maior efetividade da minociclina no controle da atividade do vitiligo. Conclusões: Este estudo demonstrou a eficácia da minociclina no controle do vitiligo em atividade em comparação a um esquema de corticoterapia sistêmica. Estudos adicionais devem ser realizados para confirmar sua eficácia.

Introduction: Vitiligo is a chronic acquired skin disease, which evolves with depigmentation. The control of disease activity is a therapeutic challenge. Systemic corticosteroids, in daily use or in pulse doses, are the most used treatment for the disease. Objective: To evaluate the effect of minocycline on the control over vitiligo activity compared with the corticosteroid therapy. Methods: Randomized clinical trial with 16 active vitiligo vulgaris patients, divided into two groups: MINO group: minocycline 100mg/day, orally, for three months; and CORT group: prednisolone 0.3mg/kg/day, orally, for two months, and 0.15 mg/kg/day in the third month. The patients were evaluated before and after the treatment by photographic records and evaluation of the scores obtained by the VIDA score (vitiligo disease activity score). Results: According to the photographic records, there was control of vitiligo activity in 100% of patients in the MINO group compared with 60% in the CORT group. In the comparison using the VIDA score, we noticed a statistically significant difference for both groups; however, we found that the reduction was greater in the MINO group, evidencing more effectiveness of minocycline in controlling the vitiligo activity. Conclusion: This study demonstrated the efficacy of minocycline in the control of active vitiligo compared with a systemic corticosteroid regimen. Additional studies should be performed to confirm its efficacy.

Alteraciones endocrinas asociadas al uso medicamentos en el Programa Distrital de Farmacovigilancia de Bogotá durante el periodo 2012 a 2016 / Medication-use related endocrine disruption reported to the local pharmacovigilance program in Bogota, during 2012- 2016 / Alterações endócrinas associadas ao uso de medicamentos no Programa Distrital de Vigilância farmacológica em Bogotá no período 2012-2016

Objetivos. Conocer las reacciones adversas tipo endocrino asociado al uso de medicamentos y reportado al Programa Distrital de Farmacovigilancia de Bogotá durante el periodo 2012 a 2016. Materiales y métodos. Los reportes analizados corresponden al periodo del 1º de enero de 2012 al 31 de diciembre de 2016 del Programa Distrital de Farmacovigilancia. Su análisis se hizo mediante algoritmos de causalidad y por tipo de evento. Resultados. Se analizaron 85 reportes. Uno de ellos relacionado con una sospecha de problema de calidad del medicamento, los otros 84 relaciona-dos con reacciones adversas sobre los cuales se centró la investigación. De los 84 reportes, 36 (42,9 %) corresponden a reacciones adversas a medicamento tipo A y 26 (31 %) a reportes de reacciones adversas a medicamentos de tipo fallo terapéutico. Los principales efectos secundarios a los medicamentos fueron el aumento de los niveles de hormona paratiroidea por uso de cinacalcet en 27 (34,1 %) reportes, seguidas por el síndrome de Cushing relacionado con la administración de prednisolona en 12 (14,1 %), bocio por uso de adalimumab en 12 (14,1 %), hiperprolactinemia por el uso de risperidona en 10 (11,8 %) e hipotiroidismo inducido por amiodarona en 3 (3,4 %). Conclusiones. El desarrollo de estos estudios permite conocer las principales reacciones adversas que se presentan durante el uso habitual de los medicamentos, así como su perfil de seguridad.

Objective. Becoming familiar with medication-use related endocrine disruption reported to the local pharmacovigilance program in Bogotá during 2012-2016.Tools and methods. Analyzed reports are dated between January 1st, 2012 and December 31st, 2016 and were gathered from the Pharmacovigilance Program in Bogotá. The analysis of the said reports was conducted through causality algorithms and event type.Results. Out of 87 analyzed reports, two were not included in the study due to lack of information for its classification in one case and, medication-related problems in another case. 36 reports (42.9 %) were found to have adverse reaction to type A medications, while 26 reports (34.1%) were found to have medication related problem type therapeutic failure. The main medication related problems were associated to the use of Cinacalcet with increased levels of parathormone in 27 out of 87 analyzed reports in this study. Other medication related problems found were: Cushing Syndrome, associated with the use of prednisolone in 12 reports; Goiter associated to the use of adalimumab in 12 reports; Hyperprolactinemia associated to the use of Risperidone in 10 reports and, Hypothyroidism associated to the use of Amiodarone in 3 reports. Conclusions: Carrying out such studies allows for the understanding of the main medication-use problems that are shown during common use of medications, as well as their safety profile.

Objetivo. O objetivo do artigo é conhecer as alterações endócrinas associadas ao uso de medicamentos reportadas pelo Programa Distrital de Vigilância farmacológica em Bogotá. Materiais e métodos. Os reportes analisados correspondem ao período de janeiro de 2012 a dezembro 2016 e a analise foi realizada com algoritmos de causalidade e por tipo de evento. Resultados. Foram analisados 87 reportes, embora no final dois deles foram desconsiderados, um por corresponder a um problema relacionado com o medicamento e o outro por falta de informações para classifica-lo. Encontraram-se 36 (42%) de reportes associados a reações adversas perante os medicamentos tipo A e 26 (31%) de reportes de RAM tipo falho terapêutico. As principais RAM foram por uso de cinacalcet com aumento dos níveis de parathormona em 27 reportes (34%), seguidas de Síndrome de Cushing relacionado com prednisolona em 12 reportes (14,1%), bócio por uso de adalimumab em outros 12 re-portes, hiperprolactinemia por uso de risperidona em 10 casos (11,8%) e hipotiroidismo induzido por amiodarona em 3 casos. Conclusoes. O desenvolvimento destes estudos, permite conhecer as principais reações adversas causadas pelo uso habitual dos medicamentos mesmo como seu perfil de segurança.

Tiroiditis y pancreatitis como presentación simultánea en una paciente con nefritis lúpica. Reporte de caso / Thyroiditis and pancreatitis as a simultaneous presentation in a patient with lupus nephritis. Case report

RESUMEN El lupus eritematoso sistémico se puede presentar con un amplio espectro de síntomas que en algunas ocasiones pueden enmascarar complicaciones graves asociadas a la misma enfermedad. Dentro de estas la pancreatitis es una causa poco común, y sin embargo de alta mortalidad, especialmente en pacientes con un tratamiento no oportuno. Reportamos el caso de una paciente que cursa con lupus eritematoso sistémico con compromiso renal y de sistema nervioso central, de reciente aparición, que se asocia a la aparición de pancreatitis y tiroiditis, presentando evolución satisfactoria con esquema terapéutico de ciclofosfamida y prednisolona.

ABSTRACT Systemic lupus erythematosus can present with a broad spectrum of symptoms that on some occasions may mask serious complications associated with the same disease. Within these, pancreatitis is an uncommon but high-mortality cause, especially in patients with non-oportune treatment. We report the case of a patient with systemic lupus eryt-hematosus with recent renal and central nervous system involvement that is associated with the onset of pancreatitis and thyroiditis. A satisfactory outcome was obtained with a cyclophosphamide and prednisolone therapeutic regimen.

Association between desloratadine and prednisolone in the treatment of children with acute symptoms of allergic rhinitis: a double-blind, randomized and controlled clinical trial / Associação entre desloratadina e prednisolona no tratamento de crianças com sintomas agudos de rinite alérgica: ensaio clínico duplo-cego, randomizado e controlado

Abstract Introduction: A combination of antihistamines and oral corticosteroids is often used to treat acute symptoms of allergic rhinitis. Objective: To evaluate safety and efficacy of desloratadine plus prednisolone in the treatment of acute symptoms of children (2-12 years) with allergic rhinitis, and to compare it to dexchlorpheniramine plus betamethasone. Methods: Children with moderate/severe persistent allergic rhinitis and symptomatic (nasal symptoms score [0-12] ≥ 6) were allocated in a double-blind, randomized fashion to receive dexchlorpheniramine plus betamethasone (n = 105; three daily doses) or desloratadine plus prednisolone (n = 105; single dose followed by two of placebo) for 7 days. At the beginning and end of the evaluation, the following were obtained: nasal symptoms score, extra nasal symptoms score, peak nasal inspiratory flow, blood biochemistry, and electrocardiogram. Ninety-six children of the dexchlorpheniramine plus betamethasone group and 98 of the desloratadine plus prednisolone group completed the protocol. Results: The two groups were similar regarding initial and final nasal symptoms scores, extra nasal symptoms scores and peak nasal inspiratory flow. A drop of 76.4% and 79.1% for nasal symptoms score, 86.0% and 79.2% for extra nasal symptoms score, as well as an increase of 25.2% and 24.3% for peak nasal inspiratory flow occurred for those treated with desloratadine plus prednisolone and dexchlorpheniramine plus betamethasone, respectively. There were no significant changes in blood chemistry. Sinus tachycardia was the most frequent electrocardiogram change, but with no clinical significance. Drowsiness was reported significantly more often among those of dexchlorpheniramine plus betamethasone group (17.14% × 8.57%, respectively). Conclusion: The desloratadine plus prednisolone combination was able to effectively control acute symptoms of rhinitis in children, improving symptoms and nasal function. Compared to the dexchlorpheniramine plus betamethasone combination, it showed similar clinical action, but with a lower incidence of adverse events and higher dosing convenience.

Resumo Introdução: A associação entre anti-histamínicos e corticosteroides orais é frequentemente empregada no tratamento de sintomas agudos de rinite alérgica. Objetivo: Avaliar a segurança e eficácia da associação desloratadina + prednisolona no tratamento de sintomas agudos de crianças (2-12 anos) com rinite alérgica e compará-las com as da associação dexclorfeniramina + betametasona. Método: Crianças com rinite alérgica persistente moderada/grave e sintomáticas (escore de sintomas nasais [0-12] ≥ 6) foram alocadas de modo duplo-cego e randômico para receber dexclorfeniramina + betametasona (n = 105; três doses diárias) ou desloratadina + prednisolona (n = 105; dose única seguida por duas de placebo) por 7 dias. No início e no fim da avaliação foram obtidos: escore de sintomas nasais, escore de sintomas extranasais, pico de fluxo inspiratório nasal, bioquímica sanguínea e eletrocardiograma. Do total, 96 crianças do grupo dexclorfeniramina + betametasona e 98 do grupo desloratadina + prednisolona concluíram o protocolo. Resultados: Os dois grupos foram iguais com relação ao escore de sintomas nasais, escore de sintomas nasais extranasais e pico de fluxo inspiratório nasal iniciais e finais. Observou-se queda de 76,4% e 79,1% nos escores para escore de sintomas nasais, de 86,0% e 79,2% para escore de sintomas extranasais, assim como incremento de 25,2% e de 24,3% para o pico de fluxo inspiratório nasal para os grupos desloratadina + prednisolona e dexclorfeniramina + betametasona, respectivamente. Não houve alterações significativas da bioquímica sanguínea. Taquicardia sinusal foi a alteração do eletrocardiograma mais encontrada, mas sem significância clínica. Sonolência foi significantemente mais referida entre os tratados com dexclorfeniramina + betametasona do que entre os desloratadina + prednisolona (8,57% × 17,14%, respectivamente). Conclusão: A associação desloratadina + prednisolona foi capaz de controlar efetivamente os sintomas agudos de rinite em crianças, melhorou sintomas e a função nasal. Na comparação com a associação dexclorfeniramina + betametasona, demonstrou ação clínica semelhante, mas com menor incidência de eventos adversos e maior comodidade posológica.

Association between desloratadine and prednisolone in the treatment of children with acute symptoms of allergic rhinitis: a double-blind, randomized and controlled clinical trial.

INTRODUCTION: A combination of antihistamines and oral corticosteroids is often used to treat acute symptoms of allergic rhinitis. OBJECTIVE: To evaluate safety and efficacy of desloratadine plus prednisolone in the treatment of acute symptoms of children (2-12 years) with allergic rhinitis, and to compare it to dexchlorpheniramine plus betamethasone. METHODS: Children with moderate/severe persistent allergic rhinitis and symptomatic (nasal symptoms score [0-12]≥6) were allocated in a double-blind, randomized fashion to receive dexchlorpheniramine plus betamethasone (n=105; three daily doses) or desloratadine plus prednisolone (n=105; single dose followed by two of placebo) for 7 days. At the beginning and end of the evaluation, the following were obtained: nasal symptoms score, extra nasal symptoms score, peak nasal inspiratory flow, blood biochemistry, and electrocardiogram. Ninety-six children of the dexchlorpheniramine plus betamethasone group and 98 of the desloratadine plus prednisolone group completed the protocol. RESULTS: The two groups were similar regarding initial and final nasal symptoms scores, extra nasal symptoms scores and peak nasal inspiratory flow. A drop of 76.4% and 79.1% for nasal symptoms score, 86.0% and 79.2% for extra nasal symptoms score, as well as an increase of 25.2% and 24.3% for peak nasal inspiratory flow occurred for those treated with desloratadine plus prednisolone and dexchlorpheniramine plus betamethasone, respectively. There were no significant changes in blood chemistry. Sinus tachycardia was the most frequent electrocardiogram change, but with no clinical significance. Drowsiness was reported significantly more often among those of dexchlorpheniramine plus betamethasone group (17.14%×8.57%, respectively). CONCLUSION: The desloratadine plus prednisolone combination was able to effectively control acute symptoms of rhinitis in children, improving symptoms and nasal function. Compared to the dexchlorpheniramine plus betamethasone combination, it showed similar clinical action, but with a lower incidence of adverse events and higher dosing convenience.

Características y manejo de la uveítis en el paciente con espondiloartropatías / Characteristics and management of uveitis associated to the spondiloarthropaties

La inflamación de los contenidos intraoculares o uveítis afectará a alrededor de un tercio de los pacientes con espondiloartropatías, especialmente a aquéllos con espondilitis anquilosante. La uveítis típica será unilateral, aguda y autolimitada, afectando los componentes de la úvea anterior: iris y cuerpo ciliar. Pese a ser muy sintomáticas se asocian a bajo riesgo de pérdida visual permanente. Su tratamiento es tópico, en base a corticoides y midriáticos. La terapia inmunosupresora y con menor frecuencia los biológicos, están reservados para los infrecuentes casos crónicos. Es posible reducir la frecuencia e intensidad de las recidivas con metotrexato o sulfasalazina, pero la evidencia que sostiene esta indicación es pobre.

The inflammatory disease affecting the intraocular contents we know as uveitis will affect around one every three patients with spondyloarthropaties, in particular those presenting ankylosing spondylitis. The typical uveitis attack will be unilateral, acute and self-limited, affecting the components of the anterior uvea; this is iris and ciliary body. Despite being very symptomatic, their associated risk of permanent vision loss is low. Treatment is based on topical therapy with corticosteroids and mydriatic eye drops. Systemic immunosuppressive therapy and rarely biologic agents are reserved for the infrequent chronic cases. The use of methotrexate and sulfadiazine could possibly reduce the frequency and intensity of uveitis recurrencies, but evidence supporting this practice is poor.

Ronda clínica y epidemiológica Club de revistas: journal club / Ronda clínica e epidemiológica / Clinical and epidemiological round: Clube de revistas

En esta nueva edición de Ronda Clínica y Epidemiológica analizamos cinco estudios que consideramos importantes para la actualidad de la práctica clínica. El estudio RENALRIPC en el cual Zarbock y colaboradores sugieren que el acondicionamiento isquémico remoto previo a cirugía cardiovascular reduce el riesgo de presentar lesión renal aguda. El estudio CAP-START en el que Postma y colaboradores muestran que el uso de monoterapia con betalactámicos no es inferior a la combinación de estos con macrólidos o a las fluoroquinolonas para prevenir mortalidad a 90 días en pacientes con neumonía adquirida en la comunidad. El estudio STOPAH revela que ni la pentoxifilina ni la prednisolona parecen tener efecto significativo en la mortalidad a 28 días de los pacientes con hepatitis alcohólica grave. Andersson y colaboradores presentan un estudio en el cual se evidencia que postergar al menos 3 minutos el pinzamiento del cordón umbilical al nacimiento puede significar un mejor desarrollo cognitivo a los 4 años de edad, en comparación con el pinzamiento temprano. Finalizamos con una nota de prensa del Instituto de Alergias y Enfermedades Infecciosas de Estados Unidos sobre el estudio START, mostrando que el inicio de la terapia antirretroviral en pacientes con infección por VIH cuando el recuento de CD4+ es mayor de 500 células/μL reduce significativamente el riesgo de desenlaces adversos, comparado con aquellos en los que se inicia cuando el recuento de CD4+ es de 350 células/μL o menos.

In this new edition of Ronda Clínica y Epidemiológica, five studies that we consider important in today's clinical practice are analyzed. The RENALRIPC study, in which Zarbock et al., suggest that remote ischemic preconditioning previous to cardiovascular surgery reduces the risk of acute kidney injury. The CAP-START study, in which Postma et al., show that the use of monotherapy with beta-lactams was not inferior to their combination with macrolides or to the use of monotherapy with fluoroquinolones in reducing 90-days mortality in patients with community acquired pneumonia. The STOPAH study, in which neither pentoxifylline nor prednisolone demonstrated a significant effect in preventing 28-day mortality in patients with severe alcoholic hepatitis. Andersson et al., present a study which shows that delaying the clamping of the umbilical cord may lead to a superior cognitive development at the age of four, compared with those in which the clamping was done earlier. Finally, we include an extraordinary press report of the National Institute of Allergy and Infectious Diseases regarding the START study, showing that the start of antiretroviral treatment in patients infected with HIV when the CD4+ cell count is higher than 500/μL significantly reduces the risk of adverse outcomes, when compared with those in which therapy is started when CD4+ cell count declined to 350/μL or less.

Nesta nova edição de Ronda Clínica e Epidemiológica analisamos cinco estudos que consideramos importantes para a atualidade da prática clínica. O estudo RENALRIPC no qual Zarbock e colaboradores sugerem que o acondicionamento isquêmico remoto prévio a cirurgia cardiovascular reduz o risco de apresentar lesão renal aguda. O estudo CAP-START no que Postma e colaboradores mostram que o uso de monoterapia com beta-lactâmicos não é inferior à combinação destes com macrólidos ou às fluoroquinolones para prevenir mortalidade a 90 dias em pacientes com pneumonia adquirida na comunidade. O estudo STOPAH revela que nem a pentoxifilina nem a prednisolona parecem ter efeito significativo na mortalidade a 28 dias dos pacientes com hepatite alcoólica grave. Andersson e colaboradores apresentam um estudo no qual se evidência que postergar ao menos 3 minutos o estrangulamento do cordão umbilical ao nascimento pode significar um melhor desenvolvimento cognitivo aos 4 anos de idade, em comparação com o estrangulamento precoce. Finalizamos com uma nota de imprensa do Instituto de Alergias e Doenças Infecciosas de Estados Unidos sobre o estudo START, mostrando que o início da terapia antirretroviral em pacientes com infecção por HIV quando a recontagem de CD4+ é maior de 500 células/μL reduz significativamente o risco de desenlaces adversos, comparado com aqueles nos que se inicia quando a recontagem de CD4+ é de 350 células/μL ou menos.

Fibrosis retroperitoneal idiopática / Idiopathic retroperitoneal fibrosis

Mujer de 36 años de edad quien consulta por cuadro clínico de ocho meses de evolución consistente en dolor abdominal, asociado a diarrea y emesis, siendo manejada inicialmente como cuadro de colon irritable. Ante la persistencia del dolor solicitan estudios imagenológicos con hallazgos sugestivos de masa retroperitoneal por lo cual remiten para valoración por cirugía. Al examen físico se encuentra dolor a la palpación abdominal generalizada sin adenopatías o masas. Paraclínicos con resonancia abdominal evidenciando masa sólida retroperitoneal de localización paraaórtica izquierda y espacio interaortocavo, englobando de forma circunferencial la aorta abdominal a la emergencia de arterias renales comprometiendo tejidos adyacentes, con disminución del tamaño del riñón izquierdo, compensando con hipertrofia del riñón derecho. Marcadores tumorales negativos, colonoscopia sin evidencia de masas. Es llevada a biopsia guiada por TAC con patología conclusiva de fibrosis retroperitoneal idiopática. Conclusión: se presenta un caso de fibrosis retrooperitoneal idiopática, enfermedad de muy bajafrecuencia de presentación en la práctica clínica diaria. (Acta Med Colomb 2015: 40: 260-262).

The case of a 36-year-old woman who consults for history of abdominal pain associated to diarrhea and emesis of eight months of evolution, being initially handled as irritable bowel syndrome, is presented. Given the persistence of pain, imaging studies suggestive of retroperitoneal mass were requested and were referred for assessment by surgery. Physical examination showed generalized pain at abdominal palpation without lymphadenopathy or masses. Abdominal resonance showed solid retroperitoneal mass of left para-aortic location and interaortocaval space, circumferentially encompassing the abdominal aorta at the emergence of renal arteries engaging adjacent tissue with decreased size of the left kidney, compensated by right kidney hyperthrophy. Tumor markers were negative, and colonoscopy did not show evidence of masses. A carried CT-guided biopsy was performed with conclusive pathology of idiopathic retroperitoneal fibrosis. Conclusion: a case of idiopathic retroperitoneal fibrosis, disease with very low frequency in everyday clinical practice, is presented. (Acta Med Colomb 2015: 40: 260-262).

Costo-utilidad de prednisolona y aciclovir en pacientes con parálisis deBell en Colombia / Cost-utility of prednisolone and acyclovir in patients with Bell’s palsy in Colombia

Existen múltiples alternativas terapéuticas para pacientes con parálisis de Bell; sin embargo, sedesconoce la eficiencia de estas en el sistema de salud colombiano. El objetivo del presente estudio es determinarla razón de costo utilidad incremental (RCUI) y el valor esperado de información perfecta (VEIP) delos diferentes tratamientos para esta condición.Materiales y métodos: Se realizó un estudio de costo utilidad desde la perspectiva del pagador usando unárbol de decisión con un horizonte temporal menor de un año que evaluó: a. prednisolona sola, b. antiviralessolos, c. combinación prednisolona y antivirales, y d. observación. Se obtuvieron los costos directos del tarifarioISS+30%. Se calcularon los años de vida ajustados a calidad (AVAC) usando los datos de utilidad de fuentessecundarias. Se realizó una simulación de Monte Carlo con 10.000 iteraciones y 1.000 microsimulaciones.Resultados: Los costos totales esperados fueron prednisolona sola: $COP 48,315 (95%IC: 16,434-84,252);observación: $COP 49,868 (95%IC: 22,760-84,540); esteroides y antivirales $COP 62,237 (95%IC: 32,112-96,750) y antivirales solos $COP: 96,402 (95%IC: 56,372-139,926). Todas las alternativas obtuvieron 0.72 AVAC(95%IC: 0.68-0.75). La prednisolona sola fue la alternativa dominante para todos los valores de la disposición apagar. El VEIP para las disposiciones a pagar de $COP 47’512,194 y 222’802,847 fueron de $COP: 32’623,700y 134’383,920 respectivamente.Conclusión: La prednisolona sola es la estrategia dominante para cualquier disposición a pagar. El VEIP enColombia para la mayor disposición a pagar fue de $COP: 134’383,920...

There are multiple therapeutic alternatives for patients with Bell’s palsy, however their efficiencywithin the Colombian health system is unknown. The objective of this study is to determine the incrementalcost-utility ratio (ICUR) and the expected value of perfect information (EVPI) of different treatments forthis condition.Materials and methods: A cost-utility analysis was conducted from the perspective of the payer using adecision tree with a time horizon of less than one year. This model evaluated the following alternatives: a.prednisolone only, b. antivirals only, c. a combination of prednisolone and antivirals; d. observation. Directcosts were obtained from national tariff (ISS+30%). Quality adjusted life-years (QALYs) using utility data fromsecondary sources were calculated. Monte Carlo simulation with 10,000 iterations and 1,000 microsimulationwas performe...

Steroid-induced recurrent myocardial ischemia.

We report the case of a female patient under oral prednisolone therapy due to a diagnosis of idiopathic intracranial hypertension with papilledema. Unfortunately, short-term treatment with prednisolone caused an unusual complication in the patient, i.e., recurrent myocardial ischemia. Possible mechanisms leading to this complication were evaluated in the light of current knowledge.