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1.
BMJ Case Rep ; 14(2)2021 Feb 04.
Artículo en Inglés | MEDLINE | ID: mdl-33541971

RESUMEN

COVID-19 is a biphasic illness with an initial viraemia phase and later effective adaptive immune phase, except in a minority of people who develop severe disease. Immune regulation is the key target to treat COVID illness. In anticipation, an elderly man self-medicated himself with dexamethasone on the day of symptom onset of a flu-like illness, took other symptomatic measures and was tested positive for SARS-CoV-2. His condition deteriorated with each passing day resulting in hospitalisation. He demanded oxygen and declared as severe COVID. With supportive treatment, he recovered after the 20th day of illness. Immunosuppression and anti-inflammation are likely to benefit when the immune response is dysregulated and turning into a cytokine storm. A medication that has saved many could be the one predisposing to severity if taken as a preventive measure, too early in the disease course, especially the viraemia phase.


Asunto(s)
Antiinflamatorios/efectos adversos , Dexametasona/efectos adversos , Viremia/tratamiento farmacológico , Anciano , Antiinfecciosos/uso terapéutico , Antiinflamatorios/uso terapéutico , Dexametasona/uso terapéutico , Hospitalización , Humanos , Hidroxicloroquina/uso terapéutico , Masculino , Neumonía Viral/complicaciones , Neumonía Viral/tratamiento farmacológico , Automedicación/métodos , Esteroides/efectos adversos , Esteroides/uso terapéutico , Resultado del Tratamiento , Viremia/complicaciones
2.
BMJ Case Rep ; 14(2)2021 Feb 09.
Artículo en Inglés | MEDLINE | ID: mdl-33563667

RESUMEN

Goodpasture's syndrome is a rare vasculitis associated with anti-glomerular basement membrane (anti-GBM) autoantibodies that target type IV collagen found in the basement membranes of glomeruli and alveoli. We present a case of a 79-year-old man with seronegative Goodpasture's syndrome with predominant respiratory symptoms and mild acute kidney injury that initially improved. Final diagnosis was made by immunofluorescent staining on open lung biopsy which also revealed concomitant organising pneumonia. The patient underwent treatment with corticosteroids, cyclophosphamide, haemodialysis and plasmapheresis. This was an atypical presentation wherein the patient only exhibited pulmonary symptoms early in the course of illness in the setting of negative anti-GBM antibody serum testing, which made diagnosis challenging. With this case, we emphasise that clinicians should have a high suspicion for Goodpasture's syndrome in the setting of unexplained severe pulmonary or renal disease despite negative anti-GBM antibody testing.


Asunto(s)
Lesión Renal Aguda/diagnóstico , Enfermedad por Anticuerpos Antimembrana Basal Glomerular/diagnóstico , Neumonía/diagnóstico , Lesión Renal Aguda/terapia , Anciano , Enfermedad por Anticuerpos Antimembrana Basal Glomerular/terapia , Antiinfecciosos/uso terapéutico , Biomarcadores/análisis , Broncoscopía , Diagnóstico Diferencial , Resultado Fatal , Humanos , Intubación Intratraqueal , Masculino , Plasmaféresis , Neumonía/terapia , Diálisis Renal , Esteroides/uso terapéutico
3.
BMJ Case Rep ; 14(2)2021 Feb 09.
Artículo en Inglés | MEDLINE | ID: mdl-33563689

RESUMEN

A 67-year-old African-American woman with remote history of complete heart block (s/p pacemaker 3 years ago) and recent onset of ventricular tachycardia (VT) (s/p VT ablation and cardiac resynchronisation therapy defibrillator upgrade 3 months ago) presented to the hospital with VT storm. Workup showed newly reduced left ventricular ejection fraction with global hypokinesis (20%) and restrictive physiology. Positive technetium pyrophosphate scan was suspicious for TTR amyloid while serological workup revealed a monoclonal gammopathy. Cardiac MRI was contraindicated given remote brain aneurysm clip. Given clinical suspicion for cardiac sarcoidosis and divergent non-invasive workup, endomyocardial biopsy was performed which showed non-necrotising granulomas consistent with cardiac sarcoidosis. She was started on steroids with clinical improvement. Cardiac sarcoidosis is a challenging clinical diagnosis, particularly in patients without extracardiac manifestations. This case highlights the importance of a detailed and thorough workup of non-ischaemic cardiomyopathy and being cognizant of infiltrative disease as it can change patient management and outcomes.


Asunto(s)
Cardiomiopatías/diagnóstico , Sarcoidosis/diagnóstico , Taquicardia Ventricular/diagnóstico , Anciano , Biopsia , Cardiomiopatías/tratamiento farmacológico , Cardiomiopatías/patología , Diagnóstico Diferencial , Electrocardiografía , Femenino , Humanos , Sarcoidosis/tratamiento farmacológico , Sarcoidosis/patología , Esteroides/uso terapéutico
4.
Expert Opin Investig Drugs ; 30(2): 167-176, 2021 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-33393390

RESUMEN

INTRODUCTION: Duchenne muscular dystrophy (DMD) is an X-linked recessive disorder caused by mutations in the dystrophin (DMD) gene. Most patients die from respiratory failure or cardiomyopathy. There are significant unmet needs for treatments for DMD as the standard of care is principally limited to symptom relief through treatments including steroids. AREAS COVERED: This review summarizes safety and efficacy in promising areas of DMD therapeutics - small molecules, stop codon readthrough, gene replacement, and exon skipping - under clinical examination from 2015-2020 as demonstrated in the NIH Clinical Trials and PubMed search engines. EXPERT OPINION: Currently, steroids persist as the most accessible medicine for DMD. Stop-codon readthrough, gene replacement, and exon-skipping therapies all aim to restore dystrophin expression. Of these strategies, gene replacement therapy has recently gained momentum while exon-skipping retains great traction. The  FDA approval of three exon-skipping antisense oligonucleotides illustrate this regulatory momentum, though the effectiveness and sequence design of eteplirsen remain controversial. Cell-penetrating peptides promise to more efficaciously treat DMD-related cardiomyopathy.The recent success of antisense therapies, however, poses major regulatory challenges. To fully realize the benefits of exon-skipping, including cocktail oligonucleotide-mediated multiple exon-skipping and oligonucleotide drugs for very rare mutations, regulatory challenges need to be addressed in coordination with scientific advances.


Asunto(s)
Péptidos de Penetración Celular/uso terapéutico , Distrofina/genética , Terapia Genética , Distrofia Muscular de Duchenne/terapia , Oligonucleótidos/uso terapéutico , Animales , Péptidos de Penetración Celular/efectos adversos , Codón de Terminación , Desarrollo de Medicamentos , Drogas en Investigación/efectos adversos , Drogas en Investigación/uso terapéutico , Exones , Regulación de la Expresión Génica , Predisposición Genética a la Enfermedad , Terapia Genética/efectos adversos , Humanos , Distrofia Muscular de Duchenne/diagnóstico , Distrofia Muscular de Duchenne/genética , Mutación , Oligonucleótidos/efectos adversos , Esteroides/efectos adversos , Esteroides/uso terapéutico , Resultado del Tratamiento
5.
Ideggyogy Sz ; 74(1-2): 27-32, 2021 Jan 30.
Artículo en Inglés | MEDLINE | ID: mdl-33497058

RESUMEN

Background and purpose: Far lateral lumbar disc herniations (FLDH) consist approximately 0.7-12% of all lumbar disc herniations. Compared to the more common central and paramedian lumbar disc herniations, they cause more severe and persistent radicular pain due to direct compression of the nerve root and dorsal root ganglion. In patients who do not respond to conservative treatments such as medical treatment and physical therapy, and have not developed neurological deficits, it is difficult to decide on surgical treatment because of the nerve root damage and spinal instability risk due to disruption of facet joint integrity. In this study, we aimed to evaluate the effect of transforaminal epidural steroid injection (TFESI) on the improvement of both pain control and functional capacity in patients with FLDH. Methods: A total of 37 patients who had radicular pain caused by far lateral disc herniation which is visible in their lumbar magnetic resonance imaging (MRI) scan, had no neurological deficit and did not respond to conservative treatment, were included the study. TFESI was applied to patients by preganglionic approach. Pre-treatment Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI) scores of the patients were compared with the 3rd week, 3rd month and 6th month scores after the procedure. Results: The mean initial VAS score was 8.63 ± 0.55, while it was 3.84 ± 1.66, 5.09 ± 0.85, 4.56 ± 1.66 at the 3rd week, 3rd month and 6th month controls, respectively. This decrease in the VAS score was found statistically significant (p = 0.001). ODI score with baseline mean value of 52.38 ± 6.84 was found to be 18.56 ± 4.95 at the 3rd week, 37.41 ± 14.1 at the 3rd month and 34.88 ± 14.33 at the 6th month. This downtrend of pa-tient's ODI scores was found statistically significant (p = 0.001). Conclusion: This study has demonstrated that TFESI is an effective method for gaining increased functional capacity and pain control in the treatment of patients who are not suitable for surgical treatment with radicular complaints due to far lateral lumbar disc hernia.


Asunto(s)
Desplazamiento del Disco Intervertebral , Vértebras Lumbares , Humanos , Inyecciones Epidurales , Desplazamiento del Disco Intervertebral/complicaciones , Desplazamiento del Disco Intervertebral/diagnóstico por imagen , Desplazamiento del Disco Intervertebral/tratamiento farmacológico , Vértebras Lumbares/diagnóstico por imagen , Esteroides/uso terapéutico , Resultado del Tratamiento
6.
Int J Risk Saf Med ; 32(1): 3-17, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33386817

RESUMEN

Coronavirus disease 2019 (COVID-19) is a viral illness caused by severe acute respiratory syndrome coronavirus 2 (SARS- CoV-2) presenting with pulmonary and extra-pulmonary manifestations. The first case was reported in Wuhan, China in December 2019 and it has rapidly progressed to the form of a pandemic. The presentation is mild in about 80 percent of the cases but the disease can also progress to a severe form of respiratory illness leading to acute respiratory distress syndrome (ARDS) and sometimes multi-organ failure, especially in people with other co-morbidities. Pregnant women also appear to be at a greater risk of acquiring a severe infection due to physiological changes during pregnancy. Many drugs with in vitro activity against the virus or an immunomodulatory effect have been considered for repurposing or have been tried as off-label drugs. The safety data regarding the use of newly approved or off-label or investigational drugs in pregnant women is limited and this poses a great challenge for clinicians. Therefore, it is important to know the utility and safety of the medications to avoid untoward adverse effects on pregnant women and fetuses. In this review, we aim to provide an overview of the approved, off-label, unlicensed, new and some promising pharmacological options for their use in the treatment of COVID-19 and the safety profile in pregnancy in an Indian scenario.


Asunto(s)
Antivirales/uso terapéutico , Feto/efectos de los fármacos , Complicaciones Infecciosas del Embarazo/tratamiento farmacológico , Complicaciones Infecciosas del Embarazo/virología , Antiinfecciosos/efectos adversos , Antiinfecciosos/uso terapéutico , Antivirales/efectos adversos , Drogas en Investigación , Femenino , Humanos , Hidroxicloroquina/efectos adversos , Hidroxicloroquina/uso terapéutico , India/epidemiología , Uso Fuera de lo Indicado , Pandemias , Neumonía Viral/tratamiento farmacológico , Neumonía Viral/epidemiología , Neumonía Viral/virología , Embarazo , Complicaciones Infecciosas del Embarazo/epidemiología , Mujeres Embarazadas , Esteroides/efectos adversos , Esteroides/uso terapéutico
8.
Medicina (Kaunas) ; 56(12)2020 Dec 09.
Artículo en Inglés | MEDLINE | ID: mdl-33317101

RESUMEN

Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) gained worldwide attention at the end of 2019 when it was identified to cause severe respiratory distress syndrome. While it primarily affects the respiratory system, we now have evidence that it affects multiple organ systems in the human body. Cardiac manifestations may include myocarditis, life threatening arrhythmias, acute coronary syndrome, systolic heart failure, and cardiogenic shock. Myocarditis is increasingly recognized as a complication of Coronavirus-19 (COVID-19) and may result from direct viral injury or from exaggerated host immune response. The diagnosis is established similar to other etiologies, and is based on detailed history, clinical exam, laboratory findings and non-invasive imaging studies. When available, cardiac MRI is the preferred imaging modality. Endomyocardial biopsy may be performed if the diagnosis remains uncertain. Current management is mainly supportive with the potential addition of interventions recommended for severe COVID-19 disease, such as remdesivir, steroids, and convalescent plasma. In the setting of cardiogenic shock and refractory, life-threatening arrhythmias that persist despite medical therapy, advanced mechanical circulatory support devices should be considered. Ultimately, early recognition and aggressive intervention are key factors in reducing morbidity and mortality. Our management strategy is expected to evolve further as we learn more about COVID-19 disease and the associated cardiac complications.


Asunto(s)
/complicaciones , /terapia , Miocarditis/virología , Adenosina Monofosfato/análogos & derivados , Adenosina Monofosfato/uso terapéutico , Alanina/análogos & derivados , Alanina/uso terapéutico , Antivirales/uso terapéutico , Humanos , Inmunización Pasiva , Miocarditis/mortalidad , Miocarditis/terapia , Esteroides/uso terapéutico
9.
Artículo en Inglés | MEDLINE | ID: mdl-33093769

RESUMEN

Background and Objectives: Sarcoidosis typically presents with peribronchovascular and perilymphatic nodules on high-resolution computed tomography (HRCT); a miliary pattern is reported but not well described. Design setting: We describe four patients with miliary sarcoidosis and results of a systematic review of all previously reported cases from 1985 onwards. Results: We identified only 27 cases of "miliary" sarcoidosis in the HRCT era. These patients were older (85.2% older than 40 years), had more co-morbidities (72.7%) and were symptomatic compared to "typical" sarcoidosis. Respiratory symptoms were present in 61.9% at diagnosis. Hypercalcemia was seen in 28.5%. On review of HRCT images, only 34.6% (9/26) had a "true miliary" pattern without fissural nodules. In our series, prominent perivascular granulomas were seen on histopathology in all. 44.4% (12/27) had tuberculosis preceding or concurrent to miliary sarcoidosis. Of the eight true associations, tuberculosis preceded sarcoidosis by 52 (median, IQR 36) weeks in six and occurred concurrently in another two. The diagnosis of tuberculosis was clinical in all with concurrent diagnosis of tuberculosis and sarcoidosis. Treatment with steroids had 100% response and 14.2% relapse. Conclusions: A true miliary pattern in the HRCT era is very rare in sarcoidosis and subtle perilymphatic pattern is nearly always seen; this should be labeled "pseudo-miliary". Prominent perivascular granulomas are associated with true miliary pattern. Miliary sarcoidosis patients are older and symptomatic, needing treatment at diagnosis. "Miliary" sarcoidosis may follow treatment for tuberculosis; concurrent cases possibly indicate the difficulty in differentiating both or a "tuberculo-sarcoid" presentation. (Sarcoidosis Vasc Diffuse Lung Dis 2020; 37 (1): 53-65).


Asunto(s)
Pulmón/diagnóstico por imagen , Sarcoidosis Pulmonar/diagnóstico , Tomografía Computarizada por Rayos X , Tuberculosis Miliar/diagnóstico , Adulto , Anciano , Antituberculosos/uso terapéutico , Técnicas Bacteriológicas , Biopsia , Diagnóstico Diferencial , Femenino , Humanos , Pulmón/efectos de los fármacos , Pulmón/microbiología , Pulmón/fisiopatología , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Recuperación de la Función , Recurrencia , Sarcoidosis Pulmonar/tratamiento farmacológico , Sarcoidosis Pulmonar/fisiopatología , Esteroides/uso terapéutico , Resultado del Tratamiento , Tuberculosis Miliar/tratamiento farmacológico , Tuberculosis Miliar/microbiología , Tuberculosis Miliar/fisiopatología
10.
J Hematol Oncol ; 13(1): 131, 2020 10 02.
Artículo en Inglés | MEDLINE | ID: mdl-33008453

RESUMEN

SARS-CoV-2 has infected millions of people worldwide, but little is known at this time about second infections or reactivation. Here, we report a case of a 55-year-old female undergoing treatment for CD20+ B cell acute lymphoblastic leukemia who experienced a viral reactivation after receiving rituximab, cytarabine, and dasatinib. She was initially hospitalized with COVID-19 in April and developed a high antibody titer with two negative nasal polymerase chain reaction (PCR) swabs for SARS-CoV-2 on discharge. After recovery, she resumed treatment in June for her leukemia, which included rituximab, cytarabine, and dasatinib. She promptly lost her COVID-19 antibodies, and her nasal PCR turned positive in June. She developed a severe COVID-19 pneumonia with lymphopenia, high inflammatory markers, and characteristic bilateral ground-glass opacities on chest CT, requiring high-flow nasal cannula and transfer to the intensive care unit. She received steroids, anticoagulation, and convalescent plasma, and within 48 h she was off oxygen. She was discharged home in stable condition several days later. Given the short time frame from leukemia treatment to PCR positivity and the low case rate in mid-June in New York City, reinfection appears to have been unlikely and SARS-CoV-2 reactivation is a possible explanation. This case illustrates the risks of treating recently recovered COVID-19 patients with immunosuppressive therapy, particularly lymphocyte- and antibody-depleting therapy, and raises new questions about the potential of SARS-CoV-2 reactivation.


Asunto(s)
Betacoronavirus/genética , Infecciones por Coronavirus/inmunología , Citarabina/uso terapéutico , Inmunosupresores/uso terapéutico , Neumonía Viral/inmunología , Leucemia-Linfoma Linfoblástico de Células Precursoras B/tratamiento farmacológico , Rituximab/uso terapéutico , Enfermedad Aguda , Anticuerpos Antivirales/sangre , Anticuerpos Antivirales/inmunología , Anticoagulantes/uso terapéutico , Infecciones por Coronavirus/tratamiento farmacológico , Infecciones por Coronavirus/terapia , Infecciones por Coronavirus/virología , Citarabina/efectos adversos , Femenino , Humanos , Inmunización Pasiva , Inmunosupresores/efectos adversos , Persona de Mediana Edad , Pandemias , Neumonía Viral/tratamiento farmacológico , Neumonía Viral/virología , Reacción en Cadena de la Polimerasa , Recurrencia , Rituximab/efectos adversos , Esteroides/uso terapéutico , Resultado del Tratamiento
14.
PLoS One ; 15(9): e0237523, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32870918

RESUMEN

BACKGROUND: Meniere's disease (MD) is a chronic condition of the inner ear consisting of symptoms that include vertigo attacks, fluctuating sensorineural hearing loss, tinnitus and aural fullness. Despite availability of various interventions, there is uncertainty surrounding their relative efficacy, thus making it difficult to select the appropriate treatments for MD. The objective of this systematic review was to assess the relative effects of the available pharmacologic and surgical interventions in patients with MD with regard to vertigo and other key patient outcomes based on data from randomized clinical trials (RCTs). METHODS: Our published protocol registered with PROSPERO (CRD42019119129) provides details on eligibility criteria and methods. We searched various databases including MEDLINE, Embase and the Cochrane Library from inception to December 10th, 2018. Screening at citation and full-text levels and risk of bias assessment were performed by two independent reviewers in duplicate, with discrepancies resolved by consensus or third-party adjudication. Bayesian network meta-analyses (NMA) were performed for hearing change and vertigo control outcomes, along with pairwise meta-analyses for these and additional outcomes. RESULTS: We identified 2,889 unique citations, that yielded 23 relevant publications describing 18 unique RCTs (n = 1,231 patients). Overall, risk-of bias appraisal suggested the evidence base to be at unclear or high risk of bias. Amongst pharmacologics, we constructed treatment networks of five intervention groups that included placebo, intratympanic (IT) gentamicin, oral high-dose betahistine, IT steroid and IT steroid plus high-dose betahistine for NMAs of hearing change (improvement or deterioration) and complete vertigo control. IT steroid plus high-dose betahistine was associated with the largest difference in hearing improvement compared to placebo, followed by high-dose betahistine and IT steroid (though 95% credible intervals failed to rule out the possibility of no difference), while IT gentamicin was worse than IT steroid. The NMA of complete vertigo control suggested IT gentamicin was associated with the highest probability of achieving better complete vertigo control compared to placebo, followed by IT steroid plus high-dose betahistine. Only two studies related to surgical interventions were found, and data suggested no statistically significant difference in hearing changes between endolymphatic duct blockage (EDB) versus endolymphatic sac decompression (ESD), and ESD with or without steroid injection. One trial reported that 96.5% of patients in EDB group compared to 37.5% of the patients in ESD group achieved complete vertigo control 24 months after surgery (p = 0.002). CONCLUSION: To achieve both hearing preservation and vertigo control, the best treatment option among the pharmacologic interventions compared may be IT steroid plus high-dose betahistine, considering that IT gentamicin may have good performance to control vertigo but may be detrimental to hearing preservation with high cumulative dosage and short interval between injections. However, IT steroid plus high-dose betahistine has not been compared in head-to-head trials against other interventions except for IT steroid alone in one trial, thus future trials that compare it with other interventions will help establish comparative effectiveness with direct evidence.


Asunto(s)
Enfermedad de Meniere/tratamiento farmacológico , Enfermedad de Meniere/cirugía , Antibacterianos/uso terapéutico , Betahistina/uso terapéutico , Gentamicinas/uso terapéutico , Audición/efectos de los fármacos , Humanos , Esteroides/uso terapéutico , Resultado del Tratamiento , Vasodilatadores/uso terapéutico
15.
Am J Trop Med Hyg ; 103(4): 1473-1479, 2020 10.
Artículo en Inglés | MEDLINE | ID: mdl-32876006

RESUMEN

Phaeohyphomycosis causes a wide spectrum of systemic manifestations and can affect even the immunocompetent hosts. Involvement of the central nervous system is rare. A 48-year-old farmer presented with chronic headache, fever, and impaired vision and hearing. Serial MRIs of the brain showed enhancing exudates in the basal cisterns, and lesions in the sella and perichiasmatic and cerebellopontine angle regions along with enhancement of the cranial nerves and leptomeninges. Cerebrospinal fluid (CSF) showed lymphocytic pleocytosis with elevated protein and decreased glucose on multiple occasions. Clinical, imaging, and CSF abnormalities persisted despite treatment with antitubercular drugs and steroids for 2 years. Biopsy of the dura mater at the cervicomedullary junction revealed necrotizing granulomatous lesions, neutrophilic abscesses, and giant cells containing slender, pauci-septate, pigmented fungal hyphae. Fungal culture showed growth of Fonsecaea pedrosoi, which is classically known to cause brain abscesses. Here, we report the diagnostic odyssey in a patient with chronic meningitis from a region endemic for tuberculosis and describe the challenges in establishing the accurate diagnosis. Lack of therapeutic response to an adequate trial of empirical antitubercular therapy warrants search for alternative causes, including fungal meningitis. We highlight the uncommon manifestation of F. pedrosoi with chronic meningitis as well as the protracted clinical course despite not receiving antifungal therapy.


Asunto(s)
Absceso Encefálico/microbiología , Diagnóstico Diferencial , Meningitis Fúngica/diagnóstico , Meningitis/patología , Tuberculosis Meníngea/diagnóstico , Anfotericina B/administración & dosificación , Anfotericina B/uso terapéutico , Antifúngicos/administración & dosificación , Antifúngicos/uso terapéutico , Antituberculosos/uso terapéutico , Ascomicetos/aislamiento & purificación , Encéfalo/patología , Absceso Encefálico/patología , Humanos , Masculino , Meningitis Fúngica/tratamiento farmacológico , Persona de Mediana Edad , Feohifomicosis/diagnóstico , Esteroides/uso terapéutico , Tuberculosis Meníngea/tratamiento farmacológico , Voriconazol/administración & dosificación , Voriconazol/uso terapéutico
16.
BMC Infect Dis ; 20(1): 708, 2020 Sep 29.
Artículo en Inglés | MEDLINE | ID: mdl-32993546

RESUMEN

BACKGROUND: Intravesical administration of Bacillus Calmette-Guérin (BCG) has proven useful for treatment and prevention of recurrence of superficial bladder cancer and in situ carcinoma. However, fatal side effects such as disseminated infections may occur. Early diagnosis and accurate therapy for interstitial pneumonitis (IP) are important because exacerbation of IP triggered by infections is the major cause of death. Although some fatality reports have suggested newly appeared IP after intravesical BCG treatment, to our knowledge, there are no reports which have demonstrated acute exacerbation of existing IP. Moreover, autopsy is lacking in previous reports. We report the case of a patient with fatal IP exacerbation after BCG instillation and the pathological findings of the autopsy. CASE PRESENTATION: A 77-year-old man with a medical history of IP was referred to our hospital because of fever and malaise. He had received an intravesical injection of BCG 1 day before the admission. His fever reduced after the use of antituberculosis drugs, so he was discharged home. He was referred to our hospital again because of a high fever 7 days after discharge. On hospitalisation, he showed high fever and systemic exanthema. Hepatosplenomegaly and myelosuppression were also observed. Biopsies revealed multiple epithelioid cell granulomas with Langhans giant cells of the liver and bone marrow. Biopsy DNA analyses of Mycobacterium bovis in the bone marrow, sputum, and blood were negative. His oxygen demand worsened drastically, and the ground-glass shadow expanded on the computed tomography scan. He was diagnosed with acute exacerbation of existing IP. We recommenced the antituberculosis drugs with steroid pulse therapy, but he died on day 35 because of respiratory failure. The autopsy revealed a diffuse appearance of multiple epithelioid cell granulomas with Langhans giant cells in multiple organs, although BCG was not evident. CONCLUSIONS: We report the first case of acute exacerbation of chronic IP by BCG infection. This is also the first case of autopsy of a patient with acute exacerbation of existing IP induced by intravesical BCG treatment. Whether the trigger of acute IP exacerbation is infection or hypersensitivity to BCG is still controversial, because pathological evidence confirming BCG infection is lacking. Physicians who administer BCG against bladder cancer should be vigilant for acute exacerbation of IP.


Asunto(s)
Antituberculosos/uso terapéutico , Vacuna BCG/efectos adversos , Enfermedades Pulmonares Intersticiales/tratamiento farmacológico , Enfermedades Pulmonares Intersticiales/etiología , Infecciones por Mycobacterium no Tuberculosas/tratamiento farmacológico , Infecciones por Mycobacterium no Tuberculosas/etiología , Esteroides/uso terapéutico , Brote de los Síntomas , Administración Intravesical , Anciano , Autopsia , Vacuna BCG/administración & dosificación , Vacuna BCG/uso terapéutico , Carcinoma in Situ/tratamiento farmacológico , Carcinoma in Situ/prevención & control , Resultado Fatal , Humanos , Enfermedades Pulmonares Intersticiales/microbiología , Masculino , Infecciones por Mycobacterium no Tuberculosas/diagnóstico , Mycobacterium bovis/genética , Resultados Negativos , Recurrencia Local de Neoplasia/tratamiento farmacológico , Recurrencia Local de Neoplasia/prevención & control , Quimioterapia por Pulso , Resultado del Tratamiento , Neoplasias de la Vejiga Urinaria/tratamiento farmacológico , Neoplasias de la Vejiga Urinaria/prevención & control
17.
PLoS One ; 15(9): e0239300, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32956418

RESUMEN

BACKGROUND: Recent reports from small studies in West Africa suggest that Black children may have high rate of steroid sensitivity nephrotic syndrome (SSNS) contrary to long held knowledge. Herein, we determined the proportion of children with idiopathic nephrotic syndrome (INS) who achieved complete remission with steroid therapy and identified factors associated with complete remission. METHODS: We reviewed the medical records of 241 children with INS in two centres in Lagos from 2010 to 2019. We extracted demographic data, clinical features, laboratory values at the time of diagnosis, and receipt and response to steroids and other immunosuppressants. RESULTS: The median (interquartile range) age at diagnosis of INS was 5.1 (3.0-8.7) years and boys were 60.2% of the study population. Children with SSNS made up 85.9% (n = 207) of the study cohort. Among those aged 0-5 years, 92.6%were SSNS compared with 69.2% in those aged 11-17 years at the time of diagnosis. In addition, the proportion of children with SSNS increased from 73.8% between year 2010 and 2012 to 88.4% afterwards. Also, children with SSNS had lower serum creatinine (0.44 vs 0.70; p<0.001) and higher estimated glomerular filtration rate (101 vs 74.3 ml/min/1.73 m2; p = 0.008) at the time of diagnosis than those with steroid resistant nephrotic syndrome (SRNS). CONCLUSION: Among Black children in Lagos, the proportion with SSNS is comparable to proportions described in children of Asian and European descent. Furthermore, children with SSNS had lower serum creatinine and higher glomerular filtration rate than those with SRNS.


Asunto(s)
Síndrome Nefrótico/tratamiento farmacológico , Esteroides/efectos adversos , Adolescente , África Occidental/epidemiología , Grupo de Ascendencia Continental Africana/genética , Niño , Preescolar , Estudios Transversales , Femenino , Tasa de Filtración Glomerular/efectos de los fármacos , Humanos , Lactante , Recién Nacido , Masculino , Hombres , Síndrome Nefrótico/epidemiología , Síndrome Nefrótico/genética , Síndrome Nefrótico/patología , Nigeria/epidemiología , Esteroides/uso terapéutico
18.
Drug Discov Ther ; 14(4): 171-176, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32908072

RESUMEN

The healthcare sector has been overwhelmed by the global rise in the number of COVID-19 cases. The primary care physicians at the forefront of this pandemic are being provided with multiple guidelines (state, national, international). The aim of this review was to examine the existing guidelines for congruence and critically analyze them in light of current evidence. A discordance was noted between the national and state guidelines with respect to indication, duration and dosage of antivirals, steroids/immunomodulators, anticoagulation and convalescent plasma. The lack of concordance between various guidelines mandates the need for a unified national guideline that is regularly updated.


Asunto(s)
Antivirales/uso terapéutico , Betacoronavirus/efectos de los fármacos , Infecciones por Coronavirus/terapia , Neumonía Viral/terapia , Guías de Práctica Clínica como Asunto/normas , Pautas de la Práctica en Medicina/normas , Anticoagulantes/uso terapéutico , Antivirales/efectos adversos , Betacoronavirus/patogenicidad , Infecciones por Coronavirus/tratamiento farmacológico , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/inmunología , Infecciones por Coronavirus/virología , Interacciones Microbiota-Huesped , Humanos , Inmunización Pasiva , Factores Inmunológicos/uso terapéutico , India/epidemiología , Pandemias , Neumonía Viral/epidemiología , Neumonía Viral/inmunología , Neumonía Viral/virología , Esteroides/uso terapéutico
19.
Pediatrics ; 146(4)2020 10.
Artículo en Inglés | MEDLINE | ID: mdl-32943536

RESUMEN

OBJECTIVES: To evaluate the survival and neurodevelopmental impairment (NDI) in extremely low birth weight (ELBW) infants at 18 to 26 months with early hypoxemic respiratory failure (HRF). We also assessed whether African American infants with early HRF had improved outcomes after exposure to inhaled nitric oxide (iNO). METHODS: ELBW infants ≤1000 g and gestational age ≤26 weeks with maximal oxygen ≥60% on either day 1 or day 3 were labeled as "early HRF" and born between 2007 and 2015 in the Neonatal Research Network were included. Using a propensity score regression model, we analyzed outcomes and effects of exposure to iNO overall and separately by race. RESULTS: Among 7639 ELBW infants born ≤26 weeks, 22.7% had early HRF. Early HRF was associated with a mortality of 51.3%. The incidence of moderate-severe NDI among survivors was 41.2% at 18 to 26 months. Mortality among infants treated with iNO was 59.4%. Female sex (adjusted odds ratio [aOR]: 2.4, 95% confidence interval [CI]: 1.8-3.3), birth weight ≥720 g (aOR: 2.3, 95% CI: 1.7-3.1) and complete course of antenatal steroids (aOR: 1.6, 95% CI: 1.1-2.2) were associated with intact survival. African American infants had a similar incidence of early HRF (21.7% vs 23.3%) but lower exposure to iNO (16.4% vs 21.6%). Among infants with HRF exposed to iNO, intact survival (no death or NDI) was not significantly different between African American and other races (aOR: 1.5, 95% CI: 0.6-3.6). CONCLUSIONS: Early HRF in infants ≤26 weeks' gestation is associated with high mortality and NDI at 18 to 26 months. Use of iNO did not decrease mortality or NDI. Outcomes following iNO exposure were not different in African American infants.


Asunto(s)
Broncodilatadores/uso terapéutico , Hipoxia/complicaciones , Recien Nacido Extremadamente Prematuro , Trastornos del Neurodesarrollo/epidemiología , Óxido Nítrico Sintasa de Tipo II/uso terapéutico , Insuficiencia Respiratoria/mortalidad , Administración por Inhalación , Afroamericanos , Puntaje de Apgar , Peso al Nacer , Broncodilatadores/administración & dosificación , Femenino , Rotura Prematura de Membranas Fetales , Mortalidad Hospitalaria , Humanos , Hipertensión Pulmonar/tratamiento farmacológico , Incidencia , Lactante , Recien Nacido con Peso al Nacer Extremadamente Bajo , Recién Nacido , Masculino , Trastornos del Neurodesarrollo/diagnóstico , Trastornos del Neurodesarrollo/tratamiento farmacológico , Trastornos del Neurodesarrollo/etnología , Óxido Nítrico Sintasa de Tipo II/administración & dosificación , Alta del Paciente , Embarazo , Puntaje de Propensión , Insuficiencia Respiratoria/tratamiento farmacológico , Insuficiencia Respiratoria/etnología , Insuficiencia Respiratoria/etiología , Factores de Riesgo , Factores Sexuales , Esteroides/uso terapéutico
20.
Rev. esp. patol ; 53(3): 182-187, jul.-sept. 2020. ilus, tab
Artículo en Inglés | IBECS | ID: ibc-192407

RESUMEN

We describe the implementation of a COVID-19 Autopsy Programme in our Hospital, report the main findings from the first autopsy of the programme and briefly review the reports of lung pathology of these patients


En este artículo presentamos el proceso de implementación de un Programa de Autopsias COVID-19 en nuestro hospital, presentamos los principales hallagos de la primera autopsia realizada y revisamos brevemente la patología pulmonar publicada previamente en estos pacientes


Asunto(s)
Humanos , Masculino , Persona de Mediana Edad , Embolia Pulmonar/complicaciones , Autopsia/estadística & datos numéricos , Causas de Muerte , Infecciones por Coronavirus/patología , Alveolos Pulmonares/patología , Síndrome Respiratorio Agudo Grave/complicaciones , Virus del SRAS/aislamiento & purificación , Apnea Obstructiva del Sueño/complicaciones , Hipertensión/complicaciones , Reacción en Cadena de la Polimerasa/métodos , Esteroides/uso terapéutico , Pandemias , Técnicas Histológicas/métodos , España/epidemiología
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