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2.
N Z Med J ; 133(1508): 123-126, 2020 01 17.
Artículo en Inglés | MEDLINE | ID: mdl-31945049

RESUMEN

Methotrexate monotherapy is a common management strategy in rheumatoid arthritis (RA). Treatment with immunosuppression can lead to opportunistic infections such as Pneumocystis jirovecii pneumonia (PJP). The treatment options for PJP include cotrimoxazole, clindamycin-primaquine and dapsone. Though these drugs are generally well tolerated, they can result in potentially severe adverse effects. Sometimes several undesired events may occur in a single patient, reminding us of Murphy's law. Herein, we report a case which exemplifies this adage. A 50-year-old female developed PJP, while on methotrexate therapy for RA and was treated with cotrimoxazole. The latter resulted in painful peripheral neuropathy, which improved after cotrimoxazole was stopped. Salvage therapy for PJP with primaquine-clindamycin, lead to another serious adverse event, methemoglobinemia. Withdrawing the offending drug resulted in dramatic improvement.


Asunto(s)
Aplicación de la Ley/métodos , Metahemoglobinemia/inducido químicamente , Enfermedades del Sistema Nervioso Periférico/inducido químicamente , Neumonía por Pneumocystis/tratamiento farmacológico , Antibacterianos/efectos adversos , Antibacterianos/uso terapéutico , Antimaláricos/efectos adversos , Antimaláricos/uso terapéutico , Clindamicina/efectos adversos , Clindamicina/uso terapéutico , Dapsona/efectos adversos , Dapsona/uso terapéutico , Quimioterapia Combinada/métodos , Femenino , Humanos , Persona de Mediana Edad , Nueva Zelanda/epidemiología , Neumonía por Pneumocystis/complicaciones , Primaquina/efectos adversos , Primaquina/uso terapéutico , Combinación Trimetoprim y Sulfametoxazol/efectos adversos , Combinación Trimetoprim y Sulfametoxazol/uso terapéutico , Privación de Tratamiento
4.
J Dermatolog Treat ; 31(2): 204-209, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-30821591

RESUMEN

Background: The real-life data on the effectiveness and safety of omalizumab in chronic spontaneous urticaria (CSU) with validated methods are scarce. There is also a lack of information on the use of combination treatments.Methods: A retrospective cohort study was done to evaluate the effectiveness and safety of omalizumab in real-life conditions. The patients with CSU treated with omalizumab between 2015 and 2018 were included. The response to therapy was evaluated using urticaria activity score over 7 days (UAS7) and urticaria control test (UCT).Results: A total of 106 patients were included. A complete response (CR) (UAS7:0) and a well-controlled activity (WCA) (UAS7:1 to <6) were observed in 50 (47.2%) and 35 (33%) patients, respectively. The number of patients with an UCT score ≥12 was also significantly increased. Higher rates of CR/WCA were observed with omalizumab monotherapy compared to combination with antihistamines. The combination of dapsone, colchicine, and omalizumab provided additional benefit in a small group.Conclusion: Treatment with omalizumab provided a rapid and sustainable improvement in real-life settings. The use of omalizumab as monotherapy or combined with antihistamines does not show differences in the treatment response. The combination of omalizumab with immunomodulatory agents might be of benefit in selected cases.


Asunto(s)
Antialérgicos/uso terapéutico , Urticaria Crónica/tratamiento farmacológico , Omalizumab/uso terapéutico , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Alopecia/etiología , Antialérgicos/efectos adversos , Enfermedad Crónica , Urticaria Crónica/patología , Colchicina/uso terapéutico , Dapsona/uso terapéutico , Quimioterapia Combinada , Femenino , Antagonistas de los Receptores Histamínicos/uso terapéutico , Humanos , Masculino , Persona de Mediana Edad , Omalizumab/efectos adversos , Estudios Retrospectivos , Resultado del Tratamiento , Adulto Joven
6.
BMJ Case Rep ; 12(12)2019 Dec 19.
Artículo en Inglés | MEDLINE | ID: mdl-31862814

RESUMEN

Immune thrombocytopenia is an autoimmune disorder characterised by autoantibody production against platelets, increased platelet destruction and impaired thrombopoiesis. Steroids are the first-line agents whenever treatment is indicated; however, some patients may not respond and the responders may as well relapse while the dose is being tapered. Side effects of steroids prohibits their long-term use and patients often have to be switched to other agents. Standard drug management with intravenous immunoglobulins and thrombopoietin receptor analogues is difficult to administer in patients from low socioeconomic regions of the world making the management even more challenging. Hence, after reviewing the literature and considering the cost in comparison to all the second-line agents available, we tried dapsone in a steroid-dependent patient of immune thrombocytopenic purpura who had developed major steroid-related side effects. Patient showed good response to dapsone and has been in remission for around one and a half years.


Asunto(s)
Dapsona/uso terapéutico , Púrpura Trombocitopénica Idiopática/diagnóstico , Adulto , Dapsona/administración & dosificación , Diagnóstico Diferencial , Hemorragia Gingival/etiología , Humanos , India , Masculino , Área sin Atención Médica , Púrpura Trombocitopénica Idiopática/complicaciones , Púrpura Trombocitopénica Idiopática/tratamiento farmacológico
8.
Actas dermo-sifiliogr. (Ed. impr.) ; 110(8): 673-680, oct. 2019. tab, ilus
Artículo en Español | IBECS | ID: ibc-185506

RESUMEN

La dermatosis ampollar IgA lineal es una enfermedad vesicoampollar subepidérmica, adquirida, mediada por inmunoglobulinas. Presentamos nuestra serie con el objetivo de describir las características clínicas, evolución y tratamientos instaurados. Se realizó un estudio descriptivo, observacional retrospectivo. Se incluyeron 17 pacientes. Como antecedentes 2 niños recibieron vacunas 2 semanas antes del inicio de los síntomas; en 2 casos la enfermedad estuvo precedida por cuadros respiratorios broncoobstructivos. Un paciente recibió antibioticoterapia endovenosa antes del inicio del cuadro. Hallamos asociación con hepatitis autoinmune en un caso y con alopecia areata en otro. Un niño padecía asociación VACTERL. El diagnóstico se confirmó con histopatología e inmunofluorescencia directa. Como tratamiento 16 pacientes recibieron dapsona, 8 de ellos asociaron corticoides orales y 2 esteroides tópicos. Destacamos la presencia de rebrotes con compromiso perioral ante cuadros infecciosos e inmunizaciones, la asociación con síndrome de VACTERL y con hepatitis autoinmune


Linear IgA bullous dermatosis is an acquired subepidermal immunoglobulin-mediated vesiculobullous disease. In this retrospective, observational, descriptive study, we describe the clinical characteristics, treatments, and outcomes of 17 patients with linear IgA bullous dermatosis. Two children had been vaccinated 2 weeks before the onset of symptoms, 2 had had bronco-obstructive respiratory symptoms, and 1 had received intravenous antibiotic therapy. We also observed an association with autoimmune hepatitis in one patient and alopecia areata in another. One boy had VACTERL association. Diagnosis was confirmed by histopathology and direct immunofluorescence. Sixteen patients were treated with dapsone, which was combined with oral corticosteroids in 8 cases and topical corticosteroids in two. Of note in this series was the occurrence of relapses in the perioral area coinciding with infections and vaccination, and the association between linear IgA bullous dermatosis and autoimmune hepatitis and VACTERL association


Asunto(s)
Humanos , Masculino , Femenino , Lactante , Preescolar , Niño , Dermatosis Bullosa IgA Lineal/diagnóstico , Dermatosis Bullosa IgA Lineal/tratamiento farmacológico , Dermatosis Facial/tratamiento farmacológico , Dermatosis del Pie/tratamiento farmacológico , Dermatosis de la Pierna/tratamiento farmacológico , Epidemiología Descriptiva , Estudios Retrospectivos , Dermatosis Bullosa IgA Lineal/patología , Dapsona/uso terapéutico , Corticoesteroides/uso terapéutico , Esteroides/uso terapéutico , Administración Tópica , Técnica del Anticuerpo Fluorescente Indirecta/métodos , Diagnóstico Diferencial
9.
Skinmed ; 17(3): 172-179, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31496471

RESUMEN

Glucocorticoids, corticosteroids/steroids sparing (replacement) maintenance immunosuppressive/adjunct drugs delivery has always been a challenging overture. Azathioprine, cyclophosphamide, dapsone, immunoglobulin, and interferon are agents in this category. The pharmacology and pharmacokinetics of the preceding drugs include specific recommendations, generic names, availability, mode of administration, dosage schedule, and the essentials of drug management.


Asunto(s)
Azatioprina/uso terapéutico , Ciclofosfamida/uso terapéutico , Dapsona/uso terapéutico , Inmunosupresores/uso terapéutico , Interferones/uso terapéutico , Metotrexato/uso terapéutico , Antiinfecciosos/farmacología , Antiinfecciosos/uso terapéutico , Azatioprina/farmacología , Ciclofosfamida/farmacología , Dapsona/farmacología , Humanos , Inmunoglobulinas Intravenosas/farmacología , Inmunoglobulinas Intravenosas/uso terapéutico , Inmunosupresores/farmacología , Interferones/farmacología , Metotrexato/farmacología , Enfermedades de la Piel/tratamiento farmacológico
10.
Theriogenology ; 140: 136-142, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31473496

RESUMEN

Testicular torsion is a serious urologic emergency and one of the causes of infertility in males. Hence, prompt diagnosis and treatment are important to prevent testicular damages. It has been proved that dapsone (4, 40 diamino-diphenyl sulfone) has anti-oxidative and anti-inflammatory effects. Therefore, the aim of this study was to investigate the influence of dapsone on ischemia/reperfusion (I/R) injury in bilateral testes after unilateral testicular torsion/detorsion (T/D) in rats. In this experiment, eighteen male Wistar rats were allocated into three groups, including sham-operated, T/D + vehicle, and T/D + dapsone (12.5 mg/kg). Testicular torsion was induced for 1 h by rotating right (ipsilateral) testis 7200 in the clockwise direction. After 7 days of reperfusion, bilateral orchiectomy was conducted and evaluations of biochemical markers - tumor necrosis factor alpha (TNF-α) and superoxide dismutase (SOD) - and histological changes were performed. While induction of testicular T/D remarkably increased the level of TNF-α in the ipsilateral (torted) and contralateral (non-torted) testes, intraperitoneal (i.p) administration of dapsone (12.5 mg/kg) significantly lowered the TNF-α level (p < 0.001). Additionally, after induction of T/D, SOD activity was notably decreased, whereas administration of dapsone (12.5 mg/kg, i.p.) significantly raised SOD activity in the bilateral testes (p < 0.001). I/R injury also caused lesions in the microscopic pattern of the bilateral testicular tissues, while administration of dapsone (12.5 mg/kg, i.p.) led to a significant improvement in testicular damages. It was concluded that dapsone had a protective impact on I/R injury in the rat model of testicular T/D, and this effect was most likely induced by anti-inflammatory and anti-oxidative properties of dapsone.


Asunto(s)
Dapsona/uso terapéutico , Daño por Reperfusión/tratamiento farmacológico , Torsión del Cordón Espermático/complicaciones , Animales , Masculino , Ratas , Ratas Wistar , Especies Reactivas de Oxígeno/metabolismo , Daño por Reperfusión/complicaciones , Torsión del Cordón Espermático/patología , Superóxido Dismutasa/metabolismo
11.
Actas dermo-sifiliogr. (Ed. impr.) ; 110(7): 590-596, sept. 2019. ilus, tab
Artículo en Español | IBECS | ID: ibc-185530

RESUMEN

La vasculitis eosinofílica recurrente cutánea primaria es una enfermedad rara, caracterizada por placas purpúricas, eritematosas y pruriginosas asociadas a edema. Comparamos y analizamos las características clínicas, dermatoscópicas e histológicas de la enfermedad en 4 pacientes de nuestro hospital y en 13 casos de pacientes publicados previamente. Se incluyeron 17 pacientes, con una mediana de edad de 56 años, y una mediana de duración de la enfermedad de 6 meses. En la mayoría de los casos las lesiones fueron generalizadas (47%) o localizadas en los miembros inferiores (41%). Las características histológicas más frecuentes fueron: color purpúrico (71%), edema local (65%), vasculitis necrosante (94%) e infiltración eosinofílica (100%). La mayoría de los pacientes (82,4%) recibió esteroides orales (mediana de la dosis de 30 mg). La vasculitis eosinofílica recurrente cutánea primaria podría ser una entidad clínica infradiagnosticada. El análisis de los pacientes nos permitió proponer algunos criterios diagnósticos para su definición. Recomendamos una estrategia terapéutica con esteroides de alta potencia y dapsona, pudiéndose considerar como el tratamiento de primera línea


Primary recurrent cutaneous eosinophilic vasculitis is a rare condition characterized by pruritic, erythematous, purpuric plaques associated to edema. We compared and analyze the clinical, dermoscopic and histological features of the disease in 4 patients from our hospital and 13 patients published in the literature. Seventeen patients were included, with a median age of 56 yo, a median duration of disease of 6 months. Lesions were most frequently generalized (47%) or localized in lower limbs (41%). The most frequent features were purpuric color (71%), local edema (65%), necrotizing vasculitis (94%) and eosinophil infiltration (100%) in histology. Most of the patients (82.4%) were given oral steroids with a median dose of 30 mg. Primary recurrent cutaneous eosinophilic vasculitis might be an infra-diagnosed condition. The analysis of the patients allowed us to propose diagnostic criteria for the definition of this disease. We suggest a therapeutic strategy with high-potency steroids and dapsone, which might be considered as first-line treatment


Asunto(s)
Humanos , Masculino , Femenino , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Vasculitis/tratamiento farmacológico , Enfermedades Cutáneas Vasculares/tratamiento farmacológico , Eosinofilia/complicaciones , Recurrencia , Dermoscopía/instrumentación , Vasculitis/diagnóstico , Dapsona/uso terapéutico , Corticoesteroides/uso terapéutico , Enfermedades Cutáneas Vasculares/fisiopatología , Prednisona/uso terapéutico , Diagnóstico Diferencial
12.
J Eur Acad Dermatol Venereol ; 33(10): 1847-1862, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31265737

RESUMEN

Lichen planus (LP) is a chronic-relapsing inflammatory skin disease. Although many drugs have been used for the management of LP, some of them lack the backup by strong therapeutic evidence, while others are not suitable for some patients due to safety profile issues. The aim of this study was to review the recent status of available medical therapies for LP to help physicians make better decisions upon best medical practice while facing patients with this condition. A review of published articles on management of LP was conducted with the MEDLINE and PubMed databases. The quality of the evidence was graded as high, moderate, low or very low. A total of 1366 articles were retrieved, and 219 (16%) were included in the final analysis. Twenty-one different treatment modalities were analysed. The quality of evidence was high for topical steroid and calcineurin inhibitor, while it was moderate for oral steroids. All the other modalities reached low or very low quality of evidence. Topical steroids and calcineurin inhibitors are the current first-line therapies, while for other therapies the strength of recommendation is not so evident. Unfortunately, larger randomized, controlled trials to support the efficacy, safety and tolerability of other therapies in LP are lacking, and many of them are recommended based on studies with small sample sizes, lack of standardized outcome measures or lack of controlled duration or even in anecdotal evidence. Thus, large-scale randomized clinical trials are still warranted to establish the exact benefits of other topical treatments, phototherapy, immunosuppressant and new immunomodulators for an optimized treatment of LP.


Asunto(s)
Corticoesteroides/uso terapéutico , Inhibidores de la Calcineurina/uso terapéutico , Fármacos Dermatológicos/uso terapéutico , Liquen Plano/tratamiento farmacológico , Administración Oral , Administración Tópica , Corticoesteroides/administración & dosificación , Antifúngicos/uso terapéutico , Inhibidores de la Calcineurina/administración & dosificación , Calcitriol/análogos & derivados , Calcitriol/uso terapéutico , Ciclosporina/uso terapéutico , Dapsona/uso terapéutico , Enoxaparina/uso terapéutico , Medicina Basada en la Evidencia , Humanos , Hidroxicloroquina/uso terapéutico , Metotrexato/uso terapéutico , Ácido Micofenólico/uso terapéutico , Retinoides/uso terapéutico , Tacrolimus/análogos & derivados , Tacrolimus/uso terapéutico , Terapia Ultravioleta
13.
BMJ Case Rep ; 12(7)2019 Jul 19.
Artículo en Inglés | MEDLINE | ID: mdl-31326906

RESUMEN

A 68-year-old woman was referred to the unit of dermatology for a large basal cell carcinoma on the chin. She was treated with imiquimod cream 5%, and 4 weeks after she developed isolated and grouped tense serum-filled vesicles and bullae on lips, nose, scalp, ankles and lumbar area, and then expanded to the whole body. Histological examination was consistent with a subepidermal bullous dermatosis. Moreover, direct immunofluorescence showed linear deposition of IgA at the basement membrane zone supporting the diagnosis of linear IgA bullous dermatosis (LABD). Dapsone 50 mg/day was administered, and the lesions gradually improved within some weeks, and no new lesions appeared. The temporal relationship between the application of the drug and the development of the disease indicates a role of this topical agent in triggering LABD.


Asunto(s)
Dapsona/uso terapéutico , Imiquimod/efectos adversos , Dermatosis Bullosa IgA Lineal/inducido químicamente , Dermatosis Bullosa IgA Lineal/tratamiento farmacológico , Administración Cutánea , Anciano , Antineoplásicos/efectos adversos , Carcinoma Basocelular/tratamiento farmacológico , Neoplasias Faciales/tratamiento farmacológico , Femenino , Humanos , Imiquimod/administración & dosificación
14.
An Bras Dermatol ; 94(2 Suppl 1): 48-55, 2019 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-31166403

RESUMEN

Dermatitis herpetiformis and linear IgA bullous dermatosis are autoimmune diseases that present with pruritic urticarial papules and plaques, with formation of vesicles and blisters of subepidermal location, mediated by IgA antibodies. Mucosal lesions are present only in linear IgA bullous dermatosis. The elaboration of this consensus consisted of a brief presentation of the different aspects of these dermatoses and, above all, of an updated literature review on the various therapeutic options that were discussed and compared with the authors' experience, aiming at the treatment orientation of these diseases in Brazil. Dermatitis herpetiformis is a cutaneous manifestation of celiac disease, and can be controlled with a gluten-free diet and dapsone. On the other hand, linear IgA bullous dermatosis arises spontaneously or is triggered by drugs, and can be controlled with dapsone, but often requires the association of systemic corticosteroids and eventually immunosuppressants.


Asunto(s)
Consenso , Dermatitis Herpetiforme/terapia , Dermatosis Bullosa IgA Lineal/tratamiento farmacológico , Corticoesteroides/uso terapéutico , Antiinflamatorios , Brasil , Dapsona/uso terapéutico , Dermatología , Dieta Sin Gluten/métodos , Humanos , Pronóstico , Sociedades Médicas
15.
Eur J Pediatr ; 178(8): 1275-1281, 2019 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-31230197

RESUMEN

Immunoglobulin A (IgA) vasculitis (Henoch-Schonlein purpura (HSP)) is the most common vasculitis in children. It is characterized by purpuric rash, arthritis, gastrointestinal, and/or renal involvement. Spontaneous resolution is the typical outcome. In chronic cutaneous manifestations of IgA vasculitis, dapsone seems to show a good effectiveness. Multiple case reports and case series about dapsone in chronic IgA vasculitis are available. However, no clear evaluation of its indications, its effectiveness, or its usage guidelines (optimal dosage or duration of treatment) is available. We reviewed the published cases of IgA vasculitis treated by dapsone and compared them with 2 similar cases that we encountered. Seventeen patients (ranging from 22 months old to 16 years old) with severe or persistent clinical signs of IgA vasculitis were included. Dapsone showed good results on the resolution of cutaneous lesions but not on renal manifestations. Complications (methemoglobinemia) were observed on 1 patient. Half of the patients relapsed after treatment discontinuation. The difference between the time lapse before initiation and the duration of the treatment was not significant.Conclusion: We suggest that dapsone can have a positive effect in chronic IgA vasculitis when cutaneous manifestations last more than 6 weeks at the dosage of 1-2 mg/kg once per day during 1 week. What is Known: • IgA vasculitis or Henoch-Schonlein purpura is the most common vasculitis in children and affects mostly small vessels of the skin, kidney, and gastrointestinal tract. It resolves spontaneously in most of the cases. Exceptionally, cutaneous lesions can last several weeks. • Dapsone is a bacteriostatic antibacterial sulfonamide drug found to be effective in the treatment of some inflammatory dermatological diseases like IgA vasculitis. What is New: • Dapsone is effective against chronic purpuric lesion (> 6 weeks) at the minimal dose of 1 mg/kg/day. • Relapse occurs frequently after discontinuation but responds after a second course of treatment. A longer duration of treatment or a delay in treatment by dapsone does not seem to influence the relapse rate.


Asunto(s)
Dapsona/uso terapéutico , Antagonistas del Ácido Fólico/uso terapéutico , Púrpura de Schoenlein-Henoch/tratamiento farmacológico , Preescolar , Enfermedad Crónica , Femenino , Humanos , Masculino , Púrpura de Schoenlein-Henoch/diagnóstico
16.
Cutis ; 103(4): 237-240, 2019 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-31116809

RESUMEN

Relapsing polychondritis (RP) is an inflammatory condition that has been widely accepted as autoimmune in nature and can occur in patients with immune system dysregulation. Although RP has been well documented in patients with other autoimmune conditions, such as vasculitis, its presence in patients with human immunodeficiency virus (HIV) infection has been infrequently described. We describe a case of RP in an HIV-positive patient without other identifiable autoimmune disease.


Asunto(s)
Infecciones por VIH , Policondritis Recurrente/diagnóstico , Adulto , Dapsona/administración & dosificación , Dapsona/uso terapéutico , Diagnóstico Diferencial , Oído Externo/patología , Humanos , Masculino , Policondritis Recurrente/tratamiento farmacológico
17.
BMC Infect Dis ; 19(1): 460, 2019 May 22.
Artículo en Inglés | MEDLINE | ID: mdl-31118048

RESUMEN

BACKGROUND: The multidrug therapy (MDT) for leprosy treatment adopted by Brazil in the 1990s was important for reducing leprosy in the country; however, recurrent cases remained problematic. Mechanisms involved in leprosy recurrence are heterogeneous and can be sorted into three groups: insufficient therapy, bacillary persistence and new infections. This study aimed to analyse the time interval of leprosy recurrence in relation to the therapeutic scheme in the state of Acre. The hypotheses were as follows: 1) treatments (a) rifampicin, ofloxacin and minocycline (ROM) and (b) dapsone (DDS) have a short leprosy recurrence time, 2) treatments based on MDT have a long leprosy recurrence time, 3) there is a dose-response relationship between MDT and the time interval between leprosy episodes. METHODS: This retrospective cohort study included 201 patients with a second episode of clinical leprosy at the reference centers for leprosy control in the state of Acre. Exposure was the type of therapeutic scheme as follows: 1) ROM, 2) DDS, 3) MDT0-9 doses, 4) MDT10-19 doses, 5) MDT20-29 doses, and 6) MDT30+ doses. Outcome was the time interval between release from treatment and a diagnosis of a recurrent leprosy case. Incidence rate ratios and relative risk Poisson regressions adjusted by age and sex were calculated with 95% confidence intervals. RESULTS: The 201 patients studied during this retrospective follow-up resulted in a total of 224 cases of recurrent leprosy. Incidence rate ratios within this therapeutic scheme were as follows: 3.3 (2.39, 4.2; ROM/MDT30+), 1.12 (0.33, 1.92; DDS/MDT30+), 2.17 (1.39, 2.94; MDT0-9/MDT30+), 1.94 (1.13, 2.75; MDT10-19/MDT30+) and 1.26 (0.47, 2.05; MDT20-29/MDT30+). Relative risk Poisson regressions showed a protective effect of MDT30+ in comparison with ROM (0.22; 0.07, 0.72), MDT0-9 (0.42; 0.21, 0.85), and MDT10-19 (0.44; 0.21, 0.92). No differences among MDT30+ and DDS (0.71; 0.36, 1.41) and MDT20-29 (0.76; 0.38, 1.49) were observed. CONCLUSIONS: New infection is an important-yet neglected-mechanism in leprosy recurrence in the state of Acre and can challenge the leprosy elimination plan in Brazil. MDT with few doses might be associated with leprosy recurrence due to insufficient therapy or bacillary persistence.


Asunto(s)
Leprostáticos/uso terapéutico , Lepra/tratamiento farmacológico , Lepra/etiología , Adulto , Brasil/epidemiología , Estudios de Cohortes , Dapsona/uso terapéutico , Quimioterapia Combinada , Femenino , Humanos , Lepra/epidemiología , Masculino , Persona de Mediana Edad , Minociclina/uso terapéutico , Ofloxacino/uso terapéutico , Recurrencia , Estudios Retrospectivos , Rifampin/uso terapéutico , Factores de Tiempo , Resultado del Tratamiento
18.
Hautarzt ; 70(7): 527-529, 2019 Jul.
Artículo en Alemán | MEDLINE | ID: mdl-30937480

RESUMEN

Pyoderma gangraenosum and subcorneal pustulosis are neutrophilic diseases. Different neutrophilic dermatoses can very rarely occur together in one patient, even with a latent period. Furthermore, there seems to be a direct association between IgA gammopathy and neutrophilic dermatosis. Therefore, a gammopathy must always be clarified in the presence of a neutrophilic dermatosis.


Asunto(s)
Mieloma Múltiple/patología , Piodermia Gangrenosa/patología , Enfermedades Cutáneas Vesiculoampollosas/patología , Dapsona/uso terapéutico , Dermatitis/patología , Humanos , Mieloma Múltiple/tratamiento farmacológico , Neutrófilos/metabolismo , Paraproteinemias , Piodermia Gangrenosa/tratamiento farmacológico , Enfermedades Cutáneas Vesiculoampollosas/tratamiento farmacológico , Síndrome de Sweet/tratamiento farmacológico , Síndrome de Sweet/patología
20.
Int J Biol Macromol ; 133: 1268-1279, 2019 Jul 15.
Artículo en Inglés | MEDLINE | ID: mdl-31034906

RESUMEN

Dapsone (DAP) is a bactericidal agent used in the treatment of leprosy, caused by Mycobacterium leprae. Despite its therapeutic potential, DAP has low solubility, which results in allow therapeutic index and a high microbial resistance. Recently, new approaches were used to increase the DAP solubility. In particular, the use of interpenetrating polymer network (IPN)-hydrogels based chitosan (CS) for the controlled release of DAP provides some advantages because they can modify their swelling properties and network structures as a response to environmental stimuli. The aim of this study was to synthesize and physicochemically characterize pH-responsive chitosan/polymer hydrogels to control the release of DAP. For this reason, different combination of polymers, such as polyvinyl pyrrolidone, polyethylene glycol and hydroxypropyl methylcellulose, and concentrations of the cross-linking agents (glutaraldehyde) were used and then blended to the CS. The resulting hydrogels were evaluated in terms of physicochemical and swelling properties, rheological analysis and in vitro release of DAP at different pHs (1.2-6.8). Hydrogels were further characterized by Fourier transformed infrared (FT-IR) spectroscopy and scanning electron microscopy (SEM) analysis. pH-responsive DAP-loaded hydrogels may represent the set-up for developing potential oral formulations for the treatment of leprosy caused by Mycobacterium leprae.


Asunto(s)
Quitosano/química , Dapsona/química , Portadores de Fármacos/química , Liberación de Fármacos , Hidrogeles/química , Fenómenos Químicos , Dapsona/uso terapéutico , Concentración de Iones de Hidrógeno , Lepra/tratamiento farmacológico , Reología
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