Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 12.076
Filtrar
1.
Medicine (Baltimore) ; 99(19): e19949, 2020 May.
Artículo en Inglés | MEDLINE | ID: mdl-32384442

RESUMEN

Nephrotic syndrome (NS) can be divided into primary, secondary, and congenital NS 3 types, and primary nephrotic syndrome (PNS) accounts for about 90% of the total number of NS in children, which is a common childhood glomerular disease one. The treatment of children with PNS has been controversial and confused because of hormone tolerance, complications, multiple drug combinations, and other issues, but there are no indicators to assess the rational drug use (RDU) of children with PNS. This study aims to develop a set of indicators to assess the RDU in children with PNS.The study is an observational study and the procedure includes 3 steps:A consensus was reached after 2 rounds of the Delphi survey and each indicator was weighted. The final indicators included 2 first-rank indicators and 16 second-rank indicators. In round 1, modified 3 indicators, increase 2 indicators and delete 6 indicators. In round 2, reached consensus. The first-rank indicators comprised drug choice (46.96%) and drug usage and dosage (53.04%); The second-rank indicators aimed to the specific drug therapy, including the RDU of hormones, immunomodulators, and adjuvant drug. The score of each indicator met the requirements, therefore, childrens PNS RDU evaluation index system had been established and the index was scientific and credible.The first set indicators had been established to assess RDU of children with PNS. Monitoring these indicators will guide people towards the promotion of RDU for PNS. Whats more, the indicator provided a methodological reference for the development of other indicator sets.


Asunto(s)
Diuréticos/uso terapéutico , Hormonas/uso terapéutico , Factores Inmunológicos/uso terapéutico , Síndrome Nefrótico/tratamiento farmacológico , Indicadores de Calidad de la Atención de Salud , Niño , Consenso , Técnica Delfos , Femenino , Humanos , Masculino
3.
Expert Opin Pharmacother ; 21(4): 435-444, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-31957506

RESUMEN

Introduction: Chronic subdural hematoma (CSDH) is a common neurosurgical disease, whose incidence has been steadily increasing with our aging population. While not common, CSDH can also occur in children. CSDH is often associated with traumatic head injury, but its underlying mechanism remains poorly understood. The first line treatment for CSDH is surgery. However, surgery is contraindicated in some patients and has a high rate of recurrence. Effective non-surgical treatment is therefore highly desirable.Areas covered: This review discusses the pathogenesis of CSDH and drugs that have been used to treat CSDH either as monotherapy or an adjuvant to surgery, including controlled clinical trials.Expert opinion: The pathophysiology of CSDH remains poorly understood. Developing effective drug treatments is therefore challenging. Most drugs discussed in this review are evaluated in small clinical studies without sufficient sample size and controls for confounding variables. More controlled clinical trials are therefore needed to carefully evaluate drugs for the non-surgical treatment of CSDH, especially for drugs targeting specific pathogenic pathways of CSDH.


Asunto(s)
Hematoma Subdural Crónico/tratamiento farmacológico , Corticoesteroides/administración & dosificación , Corticoesteroides/uso terapéutico , Antiinflamatorios no Esteroideos/administración & dosificación , Antiinflamatorios no Esteroideos/uso terapéutico , Atorvastatina/administración & dosificación , Atorvastatina/uso terapéutico , Diuréticos/administración & dosificación , Diuréticos/uso terapéutico , Hematoma Subdural Crónico/epidemiología , Hematoma Subdural Crónico/etiología , Humanos , Incidencia , Recurrencia , Resultado del Tratamiento
4.
J Cardiothorac Surg ; 15(1): 1, 2020 Jan 06.
Artículo en Inglés | MEDLINE | ID: mdl-31906990

RESUMEN

BACKGROUND: In pediatric cardiac anesthesiology, there is increased focus on minimizing morbidity, ensuring optimal functional status, and using health care resources sparingly. One aspect of care that has potential to affect all of the above is postoperative mechanical ventilation. Historically, postoperative ventilation was considered a must for maintaining patient stability. Ironically, it is recognized that mechanical ventilation may increase risk of adverse outcomes in the postoperative period. Hence, many institutions have advocated for immediate extubation or early extubation after many congenital heart surgeries which was first reported decades ago. METHODS: 637 consecutive patient charts were reviewed for pediatric patients undergoing cardiac surgery with cardiopulmonary bypass. Patients were placed into three groups. Those that were extubated in the operating room (OR) at the conclusion of surgery (Immediate Extubation or IE), those that were extubated within six hours of admission to the ICU (Early Extubation or EE) and those that were extubated sometime after six hours (Delayed Extubation or DE). Multiple variables were then recorded to see which factors correlated with successful Immediate or Early Extubation. RESULTS: Overall, 338 patients (53.1%) had IE), 273 (42.8%) had DE while only 26 patients (4.1%) had EE. The median age was 1174 days for the IE patients, 39 days for the DE patients, whereas 194 days for EE patients (p < 0.001). Weight and length were also significantly different in at least one extubation group from the other two (p < 0.001). The median ICU LOS was 3 and 4 days for IE and EE patients respectively, whereas it was 9.5 days for DE patients (p < 0.001). DE group had a significant longer median anesthesia time and cardiopulmonary bypass time than the other two extubation groups (p > 63,826.88 < 0.001). Regional low flow perfusion, deep hypothermia, deep hypothermic circulatory arrest, redo sternotomy, use of other sedatives, furosemide, epinephrine, vasopressin, open chest, cardiopulmonary support, pulmonary edema, syndrome, as well as difficult intubation were significantly associated with delayed extubation (IE, EE or DE). CONCLUSIONS: Immediate and early extubation was significantly associated with several factors, including patient age and size, duration of CPB, use of certain anesthetic drugs, and the amount of blood loss and blood replacement. IE can be successfully accomplished in a majority of pediatric patients undergoing surgery for congenital heart disease, including in a minority of infants.


Asunto(s)
Extubación Traqueal/métodos , Procedimientos Quirúrgicos Cardíacos , Puente Cardiopulmonar , Cardiopatías Congénitas/cirugía , Intubación Intratraqueal/estadística & datos numéricos , Complicaciones Posoperatorias/epidemiología , Anestesia/métodos , Niño , Preescolar , Paro Circulatorio Inducido por Hipotermia Profunda/estadística & datos numéricos , Diuréticos/uso terapéutico , Femenino , Furosemida/uso terapéutico , Humanos , Hipnóticos y Sedantes/uso terapéutico , Lactante , Unidades de Cuidado Intensivo Pediátrico , Tiempo de Internación/estadística & datos numéricos , Masculino , Quirófanos , Periodo Posoperatorio , Edema Pulmonar/epidemiología , Respiración Artificial , Factores de Riesgo , Esternotomía , Factores de Tiempo , Vasoconstrictores/uso terapéutico
5.
Anaesthesia ; 75 Suppl 1: e134-e142, 2020 01.
Artículo en Inglés | MEDLINE | ID: mdl-31903562

RESUMEN

The impact of the use of loop diuretics to prevent cumulative fluid balance in non-oliguric patients is uncertain. This is a retrospective study to estimate the association of time-averaging loop diuretic exposure in a large population of non-cardiac, critically ill patients with a positive fluid balance (> 5% of body weight). The exposure was loop diuretic and the main outcomes were 28-day mortality, severe acute kidney injury and successful mechanical ventilation weaning. Time-fixed and daily time-varying variables were evaluated with a marginal structural Cox model, adjusting bias for time-varying exposure and the presence of time-dependent confounders. A total of 14,896 patients were included. Patients receiving loop diuretics had better survival (unadjusted hazard ratio 0.56, 95%CI 0.39-0.81 and baseline variables adjusted hazard ratio 0.53, 95%CI 0.45-0.62); after full adjusting, loop diuretics had no association with 28-day mortality (full adjusted hazard ratio 1.07, 95%CI 0.74-1.54) or with reducing severe acute kidney injury occurrence during intensive care unit stay - hazard ratio 1.05 (95%CI 0.78-1.42). However, we identified an association with prolonged mechanical ventilation (hazard ratio 1.59, 95%CI 1.35-1.89). The main results were consistent in the sub-group analysis for sepsis, oliguria and the study period (2002-2007 vs. 2008-2012). Also, equivalent doses of up to 80 mg per day of furosemide had no significant association with mortality. After adjusting for time-varying variables, the time average of loop diuretic exposure in non-cardiac, critically ill patients has no association with overall mortality or severe acute kidney injury; however, prolonged mechanical ventilation is a concern.


Asunto(s)
Cuidados Críticos/métodos , Diuréticos/uso terapéutico , Equilibrio Hidroelectrolítico , Lesión Renal Aguda/prevención & control , Enfermedad Crítica , Femenino , Humanos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Respiración Artificial/estadística & datos numéricos , Estudios Retrospectivos , Análisis de Supervivencia
6.
Heart Fail Clin ; 16(1): 81-97, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31735318

RESUMEN

Abnormal fluid handling leads to physiologic abnormalities in multiple organ systems. Deranged hemodynamics, neurohormonal activation, excessive tubular sodium reabsorption, inflammation, oxidative stress, and nephrotoxic medications are important drivers of harmful cardiorenal interactions in patients with heart failure. Accurate quantitative measurement of fluid volume is vital to individualizing therapy for such patients. Blood volume analysis and pulmonary artery pressure monitoring seem the most reliable methods for assessing fluid volume and guiding decongestive therapies. Still the cornerstone of decongestive therapy, diuretics' effectiveness decreases with progression of heart failure. Extracorporeal ultrafiltration, an alternative to diuretics, has been shown to reduce heart-failure events.


Asunto(s)
Síndrome Cardiorrenal/etiología , Diuréticos/uso terapéutico , Insuficiencia Cardíaca/complicaciones , Hemodinámica/fisiología , Ultrafiltración/métodos , Síndrome Cardiorrenal/terapia , Progresión de la Enfermedad , Insuficiencia Cardíaca/fisiopatología , Insuficiencia Cardíaca/terapia , Humanos
7.
Medicine (Baltimore) ; 98(49): e17963, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31804307

RESUMEN

Renin angiotensin aldosterone system inhibitors (RAASi) and diuretics are among the most frequently prescribed anti-hypertensives. Individuals with chronic kidney disease (CKD) are particularly at risk for electrolyte disturbances and kidney injury but the appropriate use of lab monitoring following RAASi or diuretic initiation is uncertain in CKD.We describe the frequency and time interval of lab monitoring during initiation of RAASi and diuretics in CKD and assess whether close lab monitoring associates with one-year risk of emergency department (ED) visit or hospitalization.We evaluated an observational cohort of 8,217 individuals with stage 3-5 non-dialysis CKD newly prescribed a RAASi (52.3%) or diuretic (47.7%) from thirty-six primary care offices affiliated with Brigham and Women's Hospital and Massachusetts General Hospital between 2009 and 2011.Overall, 3306 (40.2%) individuals did not have pre-prescription labs done within 2 weeks, and 5957 (72.5%) did not have post-prescription labs done within 2 weeks which includes 524 (6.4%) individuals without post-prescription within 1 year. Close monitoring occurred in only 1547 (20.1%) and was more likely in individuals prescribed diuretics compared to RAASi (adjusted OR 1.39; 95%CI 1.20-1.62), with CKD stage 4,5 compared with stage 3 (adjusted OR 1.47; 95%CI 1.16-1.86) and with cardiovascular disease (adjusted OR 1.42; 95%CI 1.21-1.66). Close monitoring was not associated with decreased risk of ED visit or hospitalization.Close lab monitoring during initiation of RAASi or diuretics was more common in participants with cardiovascular disease and advanced CKD suggesting physicians selected high-risk individuals for close monitoring. As nearly 80% of individuals did not receive close lab monitoring there may be value in future research on electronic physician decision tools targeted at lab monitoring.


Asunto(s)
Atención Ambulatoria/estadística & datos numéricos , Antihipertensivos/uso terapéutico , Hipertensión/tratamiento farmacológico , Hipertensión/epidemiología , Pruebas de Función Renal/estadística & datos numéricos , Insuficiencia Renal Crónica/epidemiología , Anciano , Anciano de 80 o más Años , Antagonistas de Receptores de Angiotensina/uso terapéutico , Inhibidores de la Enzima Convertidora de Angiotensina/uso terapéutico , Antihipertensivos/administración & dosificación , Antihipertensivos/efectos adversos , Boston , Comorbilidad , Diuréticos/uso terapéutico , Femenino , Humanos , Masculino , Persona de Mediana Edad , Antagonistas de Receptores de Mineralocorticoides/uso terapéutico , Potasio/sangre , Sistema Renina-Angiotensina/efectos de los fármacos , Índice de Severidad de la Enfermedad , Factores Socioeconómicos
8.
Harefuah ; 158(12): 774-777, 2019 Dec.
Artículo en Hebreo | MEDLINE | ID: mdl-31823528

RESUMEN

BACKGROUND: UROCIT-K is a potassium-citrate regimen prescribed for the prevention of kidney stone formation. In 2013, K-CITEK was introduced to the local market as a new potassium-citrate regimen that reduces kidney stone formation in a declared rate of 93. OBJECTIVES: We sought to explore the efficacy of K-CITEK versus UROCIT-K. METHODS: A prospective database of patients treated with potassium-citrate regimens for nephrolithiasis has been reviewed. Patients were divided into two groups: those who were treated with UROCIT-K only (Group 1) and those who were treated with K-CITEK only (Group 2). The two groups were compared as regards to demographics, length of follow-up, urinary citrate level and stone burden changes, as well as the number of stone events (i.e: colic, surgery) throughout the follow-up period. In a separate analysis another group (Group 3) was checked. This group consisted of patients who were initially treated with UROCIT-K and later on were switched to K-CITEK. RESULTS: The study group consisted of 104 patients: 54 patients in Group 1, 38 in group 2 and 12 in group 3. The latter was omitted from analysis due to the small size. Groups 1 and 2 resembled in their demographic data and medical comorbidities. No statistically significant differences were found in terms of change in urinary citrate levels, stone burden or recurrent stone events. CONCLUSIONS: K-CITEK for the treatment of kidney stone prevention was found to be as equally effective as UROCIT-K in terms of increasing urinary citrate levels, reducing stone burden and maintaining the intervals between kidney stone events.


Asunto(s)
Diuréticos/uso terapéutico , Cálculos Renales/tratamiento farmacológico , Citrato de Potasio/uso terapéutico , Citratos , Humanos
9.
Medicina (B Aires) ; 79(6): 477-482, 2019.
Artículo en Español | MEDLINE | ID: mdl-31829950

RESUMEN

Idiopathic hypercalciuria is defined as calcium excretion greater than 220 and 300 mg/day in women and men respectively, or greater than 4 mg/kg body weight. In women with osteoporosis it is observed in 19% of cases, while in kidney stones cases varies between 50 and 70%. We selected 206 hypercalciuric patients from our database, with and without renal lithiasis, to whom a restricted diet had been indicated. We divided them, according to the response, into a dependent diet and an independent diet. We considered 122 patients with diagnosis of hypercalciuria diet dependent (105 women and 17 men), which were followed with dietary control (800 mg of calcium, around 1 g of animal proteins and < 100 mEq sodium a day). The appearance of stones, or the recurrence of stones, was not considered, nor was bone involvement. After an average of 17 months, everyone had their calciuria controlled and there were even 16 (13%) who, after 42 months of follow-up, continued to be normocalciuric only on a diet. We conclude that the division of the hypercalciurias is fundamental, according to their response to a restricted diet, in order to avoid or postpone the use of diuretics and its adverse effects, with an adequate management of the diet.


Asunto(s)
Diuréticos/uso terapéutico , Hipercalciuria/dietoterapia , Adulto , Anciano , Índice de Masa Corporal , Calcio/sangre , Calcio/orina , Femenino , Estudios de Seguimiento , Humanos , Hipercalciuria/etiología , Masculino , Persona de Mediana Edad , Fósforo/sangre , Fósforo/orina , Valores de Referencia , Factores Sexuales , Factores de Tiempo , Resultado del Tratamiento
10.
Neurosciences (Riyadh) ; 24(4): 257-263, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31872803

RESUMEN

OBJECTIVE: To review the experience of 2 tertiary centers in Saudi Arabia with intracranial hypertension (IH) in the pediatric population. METHODS: We retrospectively reviewed and analyzed pediatric patients diagnosed with IH from June 2002 to May 2017 in 2 institutes. RESULTS: We identified 53 patients (30 females and 23 males) with a mean age of 7 years at the time of presentation. Among them, 41 patients were younger than 12 years, and 12 were older. Obese and overweight patients constituted 27.00% (n = 14) of all cases, 8 (66.7%) of whom were older than 12 years. The most common presenting feature was papilledema followed by headache. Vitamin D deficiency, which constituted the most common associated condition, was identified in 12 (22.6%) patients. Acetazolamide was the treatment option in 98.11% of patients, and only 5.7% underwent surgical interventions. The length of follow-up ranged from 6 months to 8 years. CONCLUSION: Intracranial hypertension is rare in children and commonly seen in overweight females older than 12 years similar to adults. Patients younger than 12 years tend to develop secondary IH. More studies are needed to characterize the clinical presentation and guide the management plan.


Asunto(s)
Cefalea/epidemiología , Hipertensión Intracraneal/complicaciones , Obesidad/epidemiología , Papiledema/epidemiología , Deficiencia de Vitamina D/epidemiología , Acetazolamida/uso terapéutico , Niño , Preescolar , Diuréticos/uso terapéutico , Femenino , Hospitales Pediátricos/estadística & datos numéricos , Humanos , Lactante , Hipertensión Intracraneal/tratamiento farmacológico , Hipertensión Intracraneal/epidemiología , Hipertensión Intracraneal/patología , Masculino , Arabia Saudita , Centros de Atención Terciaria/estadística & datos numéricos
11.
Arch. argent. pediatr ; 117(6): 626-630, dic. 2019. tab, ilus
Artículo en Español | LILACS, BINACIS | ID: biblio-1046470

RESUMEN

El cierre prematuro del foramen oval o foramen oval restrictivo intraútero es una entidad rara de etiología desconocida. Dicha patología se asocia a un riesgo elevado de hipertensión pulmonar y puede ocasionar insuficiencia cardíaca congestiva con hidrops y muerte fetal. También, se puede asociar con disfunción diastólica en el período neonatal. Se presenta a un recién nacido en el que, en una ecografía prenatal, se visualizó un aumento de las cavidades derechas. En el ecocardiograma posnatal, se confirmó la dilatación de las cavidades derechas con hipertensión pulmonar en rango sistémico y septo interauricular inmóvil con foramen oval cerrado. A los 9 días, ante la persistencia de dificultad respiratoria, se realizó un ecocardiograma, con mejoría de la hipertensión pulmonar, pero con disfunción sistólica biventricular leve y diastólica del ventrículo izquierdo con edema pulmonar. Se indicó el tratamiento diurético, con normalización de la función ventricular.


Premature closure of the foramen ovale (FO) or intrauterine restrictive FO is a rare entity of unknown etiology. This pathology is associated with an elevated risk of pulmonary hypertension, which can cause congestive heart failure with hydrops and fetal death. Patients with restrictive intrauterine FO may develop left ventricle diastolic dysfunction and pulmonary edema. A newborn with increased right cavities in the prenatal ultrasound is presented. In postnatal echocardiogram, dilatation of right cavities was confirmed with pulmonary hypertension in the systemic range and immobile interatrial septum with closed FO. After 9 days of persistent respiratory distress, an echocardiogram was performed with improvement of pulmonary hypertension but with mild biventricular and diastolic and systolic dysfunction of the left ventricle with pulmonary edema. Diuretic treatment was decided, with normalization of ventricular function.


Asunto(s)
Humanos , Masculino , Recién Nacido , Foramen Oval , Hipertensión Pulmonar , Diuréticos/uso terapéutico
12.
Lancet ; 394(10211): 1816-1826, 2019 11 16.
Artículo en Inglés | MEDLINE | ID: mdl-31668726

RESUMEN

BACKGROUND: Uncertainty remains about the optimal monotherapy for hypertension, with current guidelines recommending any primary agent among the first-line drug classes thiazide or thiazide-like diuretics, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, dihydropyridine calcium channel blockers, and non-dihydropyridine calcium channel blockers, in the absence of comorbid indications. Randomised trials have not further refined this choice. METHODS: We developed a comprehensive framework for real-world evidence that enables comparative effectiveness and safety evaluation across many drugs and outcomes from observational data encompassing millions of patients, while minimising inherent bias. Using this framework, we did a systematic, large-scale study under a new-user cohort design to estimate the relative risks of three primary (acute myocardial infarction, hospitalisation for heart failure, and stroke) and six secondary effectiveness and 46 safety outcomes comparing all first-line classes across a global network of six administrative claims and three electronic health record databases. The framework addressed residual confounding, publication bias, and p-hacking using large-scale propensity adjustment, a large set of control outcomes, and full disclosure of hypotheses tested. FINDINGS: Using 4·9 million patients, we generated 22 000 calibrated, propensity-score-adjusted hazard ratios (HRs) comparing all classes and outcomes across databases. Most estimates revealed no effectiveness differences between classes; however, thiazide or thiazide-like diuretics showed better primary effectiveness than angiotensin-converting enzyme inhibitors: acute myocardial infarction (HR 0·84, 95% CI 0·75-0·95), hospitalisation for heart failure (0·83, 0·74-0·95), and stroke (0·83, 0·74-0·95) risk while on initial treatment. Safety profiles also favoured thiazide or thiazide-like diuretics over angiotensin-converting enzyme inhibitors. The non-dihydropyridine calcium channel blockers were significantly inferior to the other four classes. INTERPRETATION: This comprehensive framework introduces a new way of doing observational health-care science at scale. The approach supports equivalence between drug classes for initiating monotherapy for hypertension-in keeping with current guidelines, with the exception of thiazide or thiazide-like diuretics superiority to angiotensin-converting enzyme inhibitors and the inferiority of non-dihydropyridine calcium channel blockers. FUNDING: US National Science Foundation, US National Institutes of Health, Janssen Research & Development, IQVIA, South Korean Ministry of Health & Welfare, Australian National Health and Medical Research Council.


Asunto(s)
Antihipertensivos/uso terapéutico , Hipertensión/tratamiento farmacológico , Adolescente , Adulto , Anciano , Antagonistas de Receptores de Angiotensina/efectos adversos , Antagonistas de Receptores de Angiotensina/uso terapéutico , Inhibidores de la Enzima Convertidora de Angiotensina/efectos adversos , Inhibidores de la Enzima Convertidora de Angiotensina/uso terapéutico , Antihipertensivos/efectos adversos , Bloqueadores de los Canales de Calcio/efectos adversos , Bloqueadores de los Canales de Calcio/uso terapéutico , Niño , Estudios de Cohortes , Investigación sobre la Eficacia Comparativa/métodos , Bases de Datos Factuales , Diuréticos/efectos adversos , Diuréticos/uso terapéutico , Medicina Basada en la Evidencia/métodos , Femenino , Insuficiencia Cardíaca/etiología , Insuficiencia Cardíaca/prevención & control , Humanos , Hipertensión/complicaciones , Masculino , Persona de Mediana Edad , Infarto del Miocardio/etiología , Infarto del Miocardio/prevención & control , Accidente Cerebrovascular/etiología , Accidente Cerebrovascular/prevención & control , Adulto Joven
13.
Wilderness Environ Med ; 30(4): 450-453, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31685322

RESUMEN

Loxoscelism is a systemic inflammatory reaction in response to a brown recluse spider bite (BRSB). In this case we describe a patient with a heightened inflammatory response to a presumed BRSB, with Coomb's positive hemolysis, cytoplasmic antineutrophil cytoplasmic antibody (cANCA) vasculitis, and features of hemophagocytic lymphohistiocytosis (HLH). A 24-y-old female presented with sudden pain and swelling to her lower back, nausea, fever, and tachycardia after a presumed BRSB. Hemolysis began on hospital day 3 (15.9 g·dL-1) with a nadir on hospital day 5 (6.3 g·dL-1). She had an lactate dehydrogenase of 1415 U·L-1, ferritin of 15534 ng·mL-1, persistent fever, and signs of bone marrow suppression despite hemolysis, with thrombocytopenia (100,000 µL-1) and an inadequate reticulocyte response (1.7%) suggestive of HLH. The patient's blood was Coomb's and cANCA/antiproteinase 3 positive. She had signs of toxin-induced vasculitis, with respiratory failure requiring bilevel positive airway pressure, radiographs with bilateral pulmonary infiltrates, and a desquamating rash. She received 6 U of packed red blood cells, furosemide for pleural and pericardial effusions, antibiotics, and symptomatic treatment during the acute phase of her illness. Hemolysis improved without glucocorticoids by hospital day 6. The patient demonstrated a dysregulated immunologic and complement-mediated response to the presumed BRSB. The triad of Coomb's positive hemolysis, cANCA vasculitis, and HLH-like reaction associated with a presumed BRSB is described for the first time in the literature and brings up questions for future research regarding the role of immune modulators and complement inhibitors in the treatment of severe loxoscelism as well as the genetic factors that predispose certain individuals to such reactions.


Asunto(s)
Araña Reclusa Parda , Picaduras de Arañas/inmunología , Picaduras de Arañas/patología , Animales , Antibacterianos , Diuréticos/uso terapéutico , Transfusión de Eritrocitos , Furosemida/uso terapéutico , Humanos , Oxígeno/uso terapéutico , Picaduras de Arañas/terapia , Venenos de Araña , Adulto Joven
14.
Medicine (Baltimore) ; 98(41): e17551, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31593137

RESUMEN

RATIONALE: Refractory edema is characterized by persistent swelling which does not react to diuretic use and sodium restriction. Traditional herbal medicine, Gwack Rhyung Tang and Chunggan extract effectively treated refractory lower limb edema caused by cirrhosis and improved liver function. PATIENT CONCERNS: A 64-year-old male patient with a history of hypertension, diabetes mellitus, hepatic encephalopathy, and cellulitis presented lower limb edema which did not react to diuretics for more than 7 months. DIAGNOSES: Refractory edema caused by cirrhosis. INTERVENTIONS: The patient was treated for 25 days using Gwack Rhyung Tang and Chunggan extract. OUTCOMES: Loss of body weight, decrease in circumferences of both lower limb and improvement of liver function biochemistry results are checked. There was no recurrence or aggravation of the condition up to 3 weeks of follow-up periods. LESSONS: Traditional herbal medicine can be an effective alternative for refractory edema due to cirrhosis with improving liver function.


Asunto(s)
Medicamentos Herbarios Chinos/uso terapéutico , Edema/tratamiento farmacológico , Medicina Tradicional/métodos , Diuréticos/uso terapéutico , Resistencia a Medicamentos , Medicamentos Herbarios Chinos/administración & dosificación , Fibrosis/complicaciones , Medicina de Hierbas , Humanos , Extremidad Inferior/patología , Masculino , Persona de Mediana Edad , Resultado del Tratamiento
15.
S Afr Med J ; 109(9): 632-634, 2019 Aug 28.
Artículo en Inglés | MEDLINE | ID: mdl-31635585

RESUMEN

Amiloride is an antagonist of the renal tubular epithelial sodium channel (ENaC). As such, it is a diuretic that is both potassium and magnesium sparing. It is used for the treatment of potassium depletion and hypertension, and is the specific therapy for hypertension due to overactivity of the ENaC (Liddle syndrome and several additional genetic causes of the Liddle phenotype - low renin and low aldosterone). It is listed as a World Health Organization essential drug, but has never been registered in South Africa (SA) and can therefore only be prescribed under a Section 21 application to the SA Health Products Regulatory Authority (SAHPRA) on a case-by-case basis. In SA, >50% of patients treated for hypertension are not controlled. In the USA, the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study reported that African Americans are more likely to be diagnosed with hypertension, more likely to be treated, more likely to be treated intensively, and less likely to achieve blood pressure (BP) control. Although the reasons are complex, studies show that 10 - 20% of blacks may carry the Liddle phenotype. Observational data and a controlled clinical trial done in three African countries have shown that these patients respond to amiloride and not to conventional guideline-based antihypertensive treatment. The former is likely to result in a significant reduction in cardiovascular, stroke and kidney morbidity and mortality, because of improved BP control. Amiloride is very unlikely to ever be registered in SA, as it was first developed >50 years ago, and SAHPRA regulations prevent widespread prescription of this essential drug. This is a classic Gordian knot that requires a novel approach from authorities to sever the knot and improve the health of many South Africans.


Asunto(s)
Amilorida/uso terapéutico , Antihipertensivos/uso terapéutico , Control de Medicamentos y Narcóticos/legislación & jurisprudencia , Hipertensión/tratamiento farmacológico , Grupo de Ascendencia Continental Africana/estadística & datos numéricos , Amilorida/farmacología , Antihipertensivos/farmacología , Presión Sanguínea/efectos de los fármacos , Diuréticos/farmacología , Diuréticos/uso terapéutico , Bloqueadores del Canal de Sodio Epitelial/farmacología , Bloqueadores del Canal de Sodio Epitelial/uso terapéutico , Disparidades en el Estado de Salud , Humanos , Hipertensión/fisiopatología , Sudáfrica
16.
Pak J Pharm Sci ; 32(3 Special): 1427-1430, 2019 May.
Artículo en Inglés | MEDLINE | ID: mdl-31551226

RESUMEN

This paper aims to investigate the curative effect of carvedilol combined with conventional therapy in treatment of chronic heart failure. 180 patients who have been treated for chronic heart failure were selected as research objects and divided into control group and research group. The control group was given conventional treatment (including oxygen therapy, ACEI, taking digitalis preparations, vasodilators, diuretics, positive inotropic drugs), while research group was given carvedilol combined with conventional therapy. The overall therapeutic effect of the two groups was observed and compared. The research group had significantly higher overall therapeutic efficiency than control group, P<0.05; by comparing the echocardiographic results of the patients between two groups, the results showed LVEF (left ventricular ejection fraction), LVESD (left ventricular end-systolic diameter) and LVEDD (left ventricular end-diastolic diameter) of the research group after treatment were significantly better than that of control group, P<0.05; through recording the quality of life level of the two groups, the results showed that the score advantages of the research group were significant in terms of social function, psychological function and physical function, P<0.05. For patients with chronic heart failure, carvedilol combined with conventional treatment can effectively improve the efficiency of treatment and improve cardiac function, thus improving the quality of life.


Asunto(s)
Carvedilol/uso terapéutico , Insuficiencia Cardíaca/tratamiento farmacológico , Anciano , Inhibidores de la Enzima Convertidora de Angiotensina/uso terapéutico , Enfermedad Crónica , Diuréticos/uso terapéutico , Quimioterapia Combinada , Electrocardiografía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Calidad de Vida , Resultado del Tratamiento , Vasodilatadores/uso terapéutico
17.
Trans Am Clin Climatol Assoc ; 130: 41-50, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31516163

RESUMEN

Introduction: Prognostic role of worsening renal function (WRF) during hospitalization for acute decompensated heart failure remains controversial. Methods: We reviewed the medical literature on the association of WRF during acute decompensated heart failure with clinical outcomes. Results: WRF is reported in approximately 25% to 40% of acute decompensated heart failure patients. WRF is usually, but not always associated with worse outcomes in patients with heart failure. Transient WRF accompanied with hemoconcentration, effective decongestion strategies, and initiation of appropriate medical treatment for heart failure with angiotensin-converting enzyme inhibitors or mineralocorticoid receptor antagonists is not associated with worse outcomes. Conclusions: Multiple mechanisms may contribute to WRF in acute decompensated heart failure, and prognosis will differ according to etiology, patient features, and treatment strategies. During hospitalization, treatment should focus on the patient's clinical status, resolution of symptoms and signs of congestion rather than temporary changes in renal function.


Asunto(s)
Insuficiencia Cardíaca/metabolismo , Insuficiencia Renal Crónica/metabolismo , Enfermedad Aguda , Inhibidores de la Enzima Convertidora de Angiotensina/uso terapéutico , Progresión de la Enfermedad , Diuréticos/uso terapéutico , Insuficiencia Cardíaca/complicaciones , Insuficiencia Cardíaca/tratamiento farmacológico , Hospitalización , Humanos , Antagonistas de Receptores de Mineralocorticoides/uso terapéutico , Pronóstico , Insuficiencia Renal Crónica/complicaciones
19.
Rev. clín. esp. (Ed. impr.) ; 219(6): 327-331, ago.-sept. 2019. tab
Artículo en Español | IBECS | ID: ibc-186577

RESUMEN

Los síntomas congestivos son la clave para reconocer las descompensaciones de la insuficiencia cardiaca. Su tratamiento se basa en la reducción de la congestión hasta alcanzar una situación clínica que permita el alta del paciente para continuar el tratamiento ambulatoriamente. Lo importante, no obstante, no es el grado de congestión al ingreso, sino la que persiste después de un tratamiento diurético enérgico. A la persistencia de signos congestivos después de un tratamiento aparentemente correcto y eficaz, se le ha denominado «congestión residual» y se asocia con mal pronóstico. Las herramientas para su estimación son todavía rudimentarias, por lo que deben desarrollarse métodos que permitan una valoración más precisa


Congestive symptoms are the key to recognising decompensated heart failure, whose treatment is based on reducing the congestion until a clinical situation has been reached that allows the patient to be discharged to continue outpatient treatment. The important aspect is not the degree of congestion at admission but rather the congestion that persists after energetic diuretic therapy. The persistence of congestive signs following an apparently correct and effective therapy has been called residual congestion and is associated with a poor prognosis. The tools for determining this condition are still rudimentary. Methods therefore need to be developed that enable a more accurate assessment


Asunto(s)
Humanos , Insuficiencia Cardíaca/complicaciones , Brote de los Síntomas , Diuréticos/uso terapéutico , Recurrencia , Técnicas de Diagnóstico Cardiovascular , Readmisión del Paciente/tendencias , Biomarcadores/análisis , Péptidos Natriuréticos/análisis
20.
World J Gastroenterol ; 25(28): 3738-3752, 2019 Jul 28.
Artículo en Inglés | MEDLINE | ID: mdl-31391769

RESUMEN

This review describes current approaches to the management of patients with cirrhotic ascites in relation to the severity of its clinical manifestations. The PubMed database, the Google Scholar retrieval system, the Cochrane Database of Systematic Reviews, and the reference lists from related articles were used to search for relevant publications. Articles corresponding to the aim of the review were selected for 1991-2018 using the keywords: "liver cirrhosis," "portal hypertension," "ascites," "pathogenesis," "diagnostics," and "treatment." Uncomplicated and refractory ascites in patients with cirrhosis were the inclusion criteria. The literature analysis has shown that despite the achievements of modern hepatology, the presence of ascites is associated with poor prognosis and high mortality. The key to successful management of patients with ascites may be the stratification of the risk of an adverse outcome and personalized therapy. Pathogenetically based approach to the choice of pharmacotherapy and optimization of minimally invasive methods of treatment may improve the quality of life and increase the survival rate of this category of patients.


Asunto(s)
Ascitis/terapia , Enfermedad Hepática en Estado Terminal/terapia , Hipertensión Portal/terapia , Cirrosis Hepática/terapia , Agonistas de Receptores Adrenérgicos alfa 1/uso terapéutico , Ascitis/diagnóstico , Ascitis/etiología , Ascitis/mortalidad , Ensayos Clínicos como Asunto , Diuréticos/uso terapéutico , Enfermedad Hepática en Estado Terminal/diagnóstico , Enfermedad Hepática en Estado Terminal/etiología , Enfermedad Hepática en Estado Terminal/mortalidad , Humanos , Hipertensión Portal/diagnóstico , Hipertensión Portal/etiología , Hipertensión Portal/mortalidad , Cirrosis Hepática/complicaciones , Cirrosis Hepática/diagnóstico , Cirrosis Hepática/mortalidad , Trasplante de Hígado , Paracentesis/instrumentación , Paracentesis/métodos , Derivación Portosistémica Intrahepática Transyugular , Pronóstico , Calidad de Vida , Medición de Riesgo , Índice de Severidad de la Enfermedad , Tasa de Supervivencia , Resultado del Tratamiento
SELECCIÓN DE REFERENCIAS
DETALLE DE LA BÚSQUEDA