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1.
PLoS One ; 15(11): e0242184, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33175880

RESUMEN

Ivermectin has recently shown efficacy against SARS-CoV-2 in-vitro. We retrospectively reviewed severe COVID-19 patients receiving standard doses of ivermectin and we compared clinical and microbiological outcomes with a similar group of patients not receiving ivermectin. No differences were found between groups. We recommend the evaluation of high-doses of ivermectin in randomized trials against SARS-CoV-2.


Asunto(s)
Infecciones por Coronavirus/tratamiento farmacológico , Inmunosupresores/uso terapéutico , Ivermectina/uso terapéutico , Neumonía Viral/tratamiento farmacológico , Adulto , Anticuerpos Monoclonales Humanizados/uso terapéutico , Betacoronavirus/aislamiento & purificación , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/virología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Nasofaringe/virología , Pandemias , Neumonía Viral/diagnóstico , Neumonía Viral/virología , Estudios Retrospectivos , Resultado del Tratamiento
2.
Medicine (Baltimore) ; 99(45): e23029, 2020 Nov 06.
Artículo en Inglés | MEDLINE | ID: mdl-33157952

RESUMEN

RATIONALE: Neuromyelitis optica spectrum disorder (NMOSD) patients, especially those with anti-aquaporin-4 antibody positivity, a water channel expressed on astrocytes, is often accompanied by autoimmune diseases (ADs) including Sjogren syndrome (SS). Here, we report a case of a young Chinese woman with recurrent optic neuritis who was diagnosed with asymptomatic SS and NMOSD. PATIENT CONCERNS: A 22-year-old Chinese woman suffered from optic neuritis for 3 years. The main manifestation was recurrent loss of vision. The anti-aquaporin-4 antibody was positive in the cerebrospinal fluid, and she was diagnosed with NMOSD. Other laboratory tests revealed positive anti-SSA and anti-SSB antibodies, and labial gland biopsy showed lymphocytic infiltration. She also fulfilled the international criteria for SS. DIAGNOSIS: On the basis of recurrent vision loss and laboratory examination, we defined the patient with SS accompanied by NMOSD. INTERVENTIONS: When the patient first experienced vision loss, the corticosteroid treatment in the external hospital was effective, and her visual acuity improved significantly. However, in several later attacks, such treatment was no longer obviously effective. Considering the patient's condition, she was treated with corticosteroids, cyclophosphamide, and immunoglobulin therapy on admission. OUTCOMES: The patient's visual acuity was increased to the right eye 20/800 and left eye finger counting when she was discharged from the hospital. LESSONS: SS accompanied with NMOSD is common in clinical practice, and always with the positive Anti-AQP4 antibody as a potential biomarker. Patients with SS and NMOSD showed significant neurological symptoms and had a worse prognosis than SS patients with negative anti-AQP4 antibody because of cross-immunity between anti-SSA antibody and anti-AQP4 antibody. Rheumatologists and ophthalmologists should pay attention to this and perform appropriate tests.


Asunto(s)
Acuaporina 4/líquido cefalorraquídeo , Neuromielitis Óptica/complicaciones , Neuritis Óptica/etiología , Síndrome de Sjögren/complicaciones , Corticoesteroides/uso terapéutico , Acuaporina 4/antagonistas & inhibidores , Ceguera/diagnóstico , Ceguera/etiología , Ciclofosfamida/uso terapéutico , Femenino , Humanos , Inmunización Pasiva/métodos , Inmunosupresores/uso terapéutico , Neuromielitis Óptica/inmunología , Neuritis Óptica/tratamiento farmacológico , Recurrencia , Resultado del Tratamiento , Agudeza Visual/efectos de los fármacos , Adulto Joven
3.
Int J Med Sci ; 17(18): 2974-2986, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33173418

RESUMEN

In the ongoing COVID-19 pandemic, all COVID-19 patients are naïve patients as it is the first-time humans have been exposed to the SARS-CoV-2 virus. As with exposure to many viruses, individuals with pre-existing, compromised immune systems may be at increased risk of developing severe symptoms and/or dying because of (SARS-CoV-2) infection. To learn more about such individuals, we conducted a search and review of published reports on the clinical characteristics and outcomes of COVID-19 patients with pre-existing, compromised immune systems. Here we present our review of patients who possess pre-existing primary antibody deficiency (PAD) and those who are organ transplant recipients on maintenance immunosuppressants. Our review indicates different clinical outcomes for the patients with pre-existing PAD, depending on the underlying causes. For organ transplant recipients, drug-induced immune suppression alone does not appear to enhance COVID-19 mortality risk - rather, advanced age, comorbidities, and the development of secondary complications appears required.


Asunto(s)
Infecciones por Coronavirus/complicaciones , Infecciones por Coronavirus/diagnóstico , Enfermedades del Sistema Inmune/complicaciones , Enfermedades del Sistema Inmune/diagnóstico , Huésped Inmunocomprometido , Neumonía Viral/complicaciones , Neumonía Viral/diagnóstico , Betacoronavirus/inmunología , Betacoronavirus/fisiología , Comorbilidad , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/inmunología , Humanos , Huésped Inmunocomprometido/inmunología , Inmunosupresores/uso terapéutico , Mortalidad , Pandemias , Neumonía Viral/epidemiología , Neumonía Viral/inmunología , Enfermedades de Inmunodeficiencia Primaria/complicaciones , Enfermedades de Inmunodeficiencia Primaria/diagnóstico , Enfermedades de Inmunodeficiencia Primaria/inmunología , Enfermedades de Inmunodeficiencia Primaria/mortalidad , Pronóstico , Receptores de Trasplantes/estadística & datos numéricos
6.
J Int Med Res ; 48(10): 300060520964009, 2020 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-33100064

RESUMEN

BACKGROUND: The causative virus of coronavirus disease 2019 (COVID-19) may cause severe fatal pneumonia. The clinical presentation includes asymptomatic infection, severe pneumonia, and acute respiratory failure. Data pertaining to acute renal injury due to COVID-19 in patients who have undergone renal transplantation are scarce. We herein report two cases of COVID-19 along with acute kidney injury following kidney transplantation.Case presentation: Two patients with COVID-19 underwent renal transplantation and were subsequently diagnosed with acute kidney injury. The first patient presented with progressive respiratory symptoms and acute renal injury. He was treated with diuretics and suspension of immunosuppressive therapy; however, the patient died. The second patient presented with respiratory tract symptoms, hypoxemia, and progressive deterioration of renal function followed by improvement. Her mycophenolate mofetil was stopped after admission, and tacrolimus was discontinued 10 days later. Moxifloxacin and methylprednisolone were continued in combination with albumin and gamma globulin infusion. A diuretic was administered, and prednisone was gradually reduced along with tacrolimus. The patient exhibited a satisfactory clinical recovery. CONCLUSION: Patients who develop COVID-19 after kidney transplantation are at risk of acute kidney injury, and their prednisone, immunosuppressant, and gamma globulin treatment must be adjusted according to their condition.


Asunto(s)
Lesión Renal Aguda/patología , Infecciones por Coronavirus/patología , Trasplante de Riñón/efectos adversos , Riñón/patología , Neumonía Viral/patología , Lesión Renal Aguda/virología , Adulto , Betacoronavirus , Esquema de Medicación , Femenino , Humanos , Inmunosupresores/administración & dosificación , Inmunosupresores/uso terapéutico , Riñón/virología , Masculino , Persona de Mediana Edad , Pandemias , Prednisona/administración & dosificación , Prednisona/uso terapéutico , Receptores de Trasplantes , gammaglobulinas/administración & dosificación , gammaglobulinas/uso terapéutico
7.
Transplant Proc ; 52(9): 2703-2706, 2020 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-33039144

RESUMEN

The global outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has had an enormous impact on the world. Owing to limited data available, it remains unclear to what extent liver transplant recipients should be considered at a higher risk of severe disease. We describe a moderate course of coronavirus disease 2019 (COVID-19) in a patient who underwent a liver transplant 2 years earlier because of Budd-Chiari syndrome. The patient presented with malaise, headache, dry cough, and fever for 4 days. Immunosuppressive therapy with tacrolimus and mycophenolate mofetil was continued throughout the course of infection. Oxygen therapy was given for a single night, and the patient gradually recovered with supportive care only. With this case report, we demonstrate that liver transplantation and immunosuppression is not necessarily associated with severe COVID-19 and emphasize that more information on this matter is urgently required. Withdrawal of immunosuppressive therapy could be associated with higher mortality.


Asunto(s)
Infecciones por Coronavirus/inmunología , Huésped Inmunocomprometido , Trasplante de Hígado , Neumonía Viral/inmunología , Betacoronavirus , Femenino , Humanos , Inmunosupresores/uso terapéutico , Persona de Mediana Edad , Pandemias
8.
Transplant Proc ; 52(9): 2654-2658, 2020 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-33041077

RESUMEN

PURPOSE: We reviewed the clinical experience of kidney transplant recipients diagnosed with severe acute respiratory syndrome coronavirus 2 infection in order to understand the impact of the current coronavirus disease 2019 (COVID-19) pandemic infection on transplant recipients. Given that early reports from heavily affected areas demonstrated a very high mortality rate amongst kidney transplant recipients, ranging between 30% and 40%, we sought to evaluate outcomes at a center with a high burden of cases but not experiencing acute crisis due to COVID-19. PROCEDURES: In this single center retrospective observational study, medical records of all kidney transplant recipients at the UCLA Medical Center were reviewed for a diagnosis of COVID-19 by polymerase chain reaction, followed by chart review to determine kidney transplant characteristics and clinical course. MAIN FINDINGS: A total of 41 kidney transplant recipients were identified with COVID-19 positive polymerase chain reaction. Recipients had been transplanted for a median of 47 months before diagnosis. The large proportion of infected individuals were minorities (Hispanic 65.9%, black 14.6%), on prednisone, tacrolimus, and mycophenolate mofetil (95.1%, 87.8%, and 87.8%, respectively), and had excellent allograft function (median 1.25 mg/dL). The most common presenting symptoms were fever, dyspnea, or cough. Most patients were hospitalized (63.4%); mortality was 9.8% and occurred only in patients in the intensive care unit. The most common treatment was reduction or removal of antimetabolite (77.8%). Approximately 26.9% presented with AKI. CONCLUSIONS: COVID-19 infection in kidney transplant recipients results in a higher rate of hospitalization and mortality than in the general population. In an area with a high number of infections, the mortality rate was lower compared with earlier reports from areas experiencing early surge and strain on the medical system. Minorities were disproportionately affected. Future studies are needed to determine optimal approach to treatment and management of immunosuppression in kidney transplant recipients with COVID-19 infection.


Asunto(s)
Infecciones por Coronavirus/inmunología , Huésped Inmunocomprometido , Trasplante de Riñón , Neumonía Viral/inmunología , Receptores de Trasplantes , Adulto , Betacoronavirus , Infecciones por Coronavirus/mortalidad , Femenino , Humanos , Inmunosupresores/uso terapéutico , Trasplante de Riñón/mortalidad , Masculino , Persona de Mediana Edad , Pandemias , Neumonía Viral/mortalidad , Estudios Retrospectivos
9.
BMC Infect Dis ; 20(1): 753, 2020 Oct 14.
Artículo en Inglés | MEDLINE | ID: mdl-33054715

RESUMEN

BACKGROUND: Safety of live vaccines in patients treated with immunosuppressive therapies is not well known, resulting in contradictory vaccination recommendations. We describe here the first case of vaccine-associated measles in a patient on natalizumab treatment. CASE PRESENTATION: A young female patient with relapsing-remitting multiple sclerosis on natalizumab treatment received the live attenuated measles, mumps, and rubella vaccine in preparation for a change in her treatment in favour of fingolimod, with established immunosuppressive qualities. Seven days after receiving the vaccine, our patient experienced diffuse muscle pain, fatigue, and thereafter developed a fever and then an erythematous maculopapular rash, compatible with vaccine associated measles. This was later confirmed by a positive measles RT-PCR throat swab. The patient's symptoms resolved without any sequelae. CONCLUSION: In this case report we review the immunosuppressive qualities of natalizumab and the evidence in favour and against live vaccines in patients on this treatment. Our findings reveal the insufficient understanding of the immunosuppressive effects of new immunomodulators, and thus of the safety of live vaccines in patients on such medications. While this case triggers precaution, there is insufficient evidence to conclude that natalizumab treatment could favor the onset of vaccine-associated measles.


Asunto(s)
Vacuna Antisarampión/efectos adversos , Vacuna contra el Sarampión-Parotiditis-Rubéola/uso terapéutico , Sarampión/etiología , Natalizumab/uso terapéutico , Adulto , Exantema/inducido químicamente , Femenino , Fiebre/etiología , Humanos , Factores Inmunológicos/uso terapéutico , Inmunosupresión/efectos adversos , Inmunosupresores/efectos adversos , Inmunosupresores/uso terapéutico , Sarampión/diagnóstico , Vacuna Antisarampión/uso terapéutico , Vacuna contra el Sarampión-Parotiditis-Rubéola/efectos adversos , Esclerosis Múltiple Recurrente-Remitente/tratamiento farmacológico , Natalizumab/inmunología , Vacunas Atenuadas/efectos adversos , Vacunas Atenuadas/inmunología , Vacunas Atenuadas/uso terapéutico
10.
Medicine (Baltimore) ; 99(43): e22926, 2020 Oct 23.
Artículo en Inglés | MEDLINE | ID: mdl-33120848

RESUMEN

RATIONALE: Acquired hemophilia A (AHA) is a rare autoimmune disease caused by autoantibodies directed against the activity of factor VIII (FVIII) and presents with prolonged bleeding. 5.7% of systemic lupus erythematosus (SLE) patients are affected by AHA. PATIENT CONCERNS: A 51-year-old female patient with SLE presenting with the fatigue and spontaneous clinical bleeding symptoms such as hematuria and ecchymoses for 1 week. DIAGNOSIS: Laboratory examinations revealed prolongation of the activated partial thromboplastin time (APTT) (65.7 s), decreased FVIII activity (1.4%), and a titer of FVIII inhibitors of 8.5 Bethesda units/mL. INTERVENTIONS: Transfusion of recombinant human FVIII (ADVATE) in combination with intravenous methylprednisolone, cyclophosphamide, plasmapheresis, and fresh frozen plasma successfully stopped the bleeding and reduced the level of FVIII inhibitor. OUTCOMES: The size of the hematoma slowly decreased. The skin ecchymosis was gradually absorbed, the hemoglobin count increased, and the coagulation index gradually improved. There was no new bleeding or bleeding site. The patient was discharged and transferred to a local hospital for hospice care. LESSONS: AHA in a patient with SLE is rare. Once it occurs, it can be life-threatening. Clinicians should remain aware that because some cases of AHA may have features of SLE, appropriate distinction and diagnosis of these different but associated diseases is necessary.


Asunto(s)
Coagulantes/uso terapéutico , Factor VIII/uso terapéutico , Hemofilia A/etiología , Lupus Eritematoso Sistémico/complicaciones , Administración Intravenosa , Antiinflamatorios/administración & dosificación , Antiinflamatorios/uso terapéutico , Pruebas de Coagulación Sanguínea/métodos , Coagulantes/administración & dosificación , Terapia Combinada , Ciclofosfamida/administración & dosificación , Ciclofosfamida/uso terapéutico , Equimosis/diagnóstico , Equimosis/etiología , Factor VIII/administración & dosificación , Femenino , Hematuria/diagnóstico , Hematuria/etiología , Hemofilia A/terapia , Hemorragia/diagnóstico , Hemorragia/etiología , Humanos , Inmunosupresores/administración & dosificación , Inmunosupresores/uso terapéutico , Metilprednisolona/administración & dosificación , Metilprednisolona/uso terapéutico , Persona de Mediana Edad , Tiempo de Tromboplastina Parcial/métodos , Tiempo de Tromboplastina Parcial/estadística & datos numéricos , Plasma , Plasmaféresis/métodos , Resultado del Tratamiento
11.
Front Immunol ; 11: 572635, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33123149

RESUMEN

The effects of cytokine inhibition in the different phases of the severe coronavirus disease 2019 (COVID-19) are currently at the center of intense debate, and preliminary results from observational studies and case reports offer conflicting results thus far. The identification of the correct timing of administration of anti-cytokine therapies and other immunosuppressants in COVID-19 should take into account the intricate relationship between the viral burden, the hyperactivation of the innate immune system and the adaptive immune dysfunction. The main challenge for effective administration of anti-cytokine therapy in COVID-19 will be therefore to better define a precise "window of therapeutic opportunity." Only considering a more specific set of criteria able to integrate information on direct viral damage, the cytokine burden, and the patient's immune vulnerability, it will be possible to decide, carefully balancing both benefits and risks, the appropriateness of using immunosuppressive drugs even in patients affected primarily by an infectious disease.


Asunto(s)
Infecciones por Coronavirus/tratamiento farmacológico , Infecciones por Coronavirus/inmunología , Citocinas/antagonistas & inhibidores , Inmunosupresores/uso terapéutico , Inmunoterapia/métodos , Neumonía Viral/tratamiento farmacológico , Neumonía Viral/inmunología , Betacoronavirus/efectos de los fármacos , Betacoronavirus/inmunología , Infecciones por Coronavirus/patología , Humanos , Pandemias , Neumonía Viral/patología , Carga Viral/inmunología
12.
Niger J Clin Pract ; 23(10): 1387-1394, 2020 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-33047695

RESUMEN

Background: Chronic kidney disease (CKD) is a common late complication in liver-transplanted patients who have received long-term therapy with calcineurin inhibitors (CNIs). Aims: To analyze kidney disease progression after liver transplantation. Methods: We analysed the clinical data of adult single-organ liver transplant recipients performed at our centre between October 2003 and September 2009. The patients with the estimated glomerular filtration rate (eGFR) greater than 60 ml/min/1.73 m2 before surgery were included in the study. Results: 69 patients with complete follow-up data were analysed. We found that eGFR at 1 or 2 years after liver transplantation correlated well with eGFR at 5 years. In addition, our results showed that patients whose eGFR declined below 60 at 2 years after liver transplantation would develop an irreversible renal injury in the following years. At 2 years, 12 patients had an eGFR less than 60, which were maintained in 11 patients at 5 years (Sensitivity = 11/12, 91.67%; Specificity = 57/58, 98.28%, Youden's index = 89.95%). The annual rate of eGFR reduction of the tacrolimus group was greater than that of the tacrolimus sparing group based on the value-time variation curve in our study. Moreover, the tacrolimus concentration influenced the CKD progression at 1 and 2 years with an under the ROC curve of 0.73 and 0.78 when Youden's index was at its maximum and the tacrolimus concentrations were 8.55 and 5.96 ng/ml, respectively. Conclusion: We confirmed that eGFR at 2 years after liver transplantation is useful for observing a meaningful change in eGFR and renal damage. Obtaining the appropriate serum concentration of an early decrease of the dose of CNIs and transforming non-nephrotoxic immunosuppressants would help improve renal function to prevent CKD progression and end-stage renal disease (ESRD).


Asunto(s)
Inhibidores de la Calcineurina/efectos adversos , Tasa de Filtración Glomerular/efectos de los fármacos , Inmunosupresores/uso terapéutico , Riñón/efectos de los fármacos , Trasplante de Hígado/efectos adversos , Insuficiencia Renal Crónica/complicaciones , Tacrolimus/uso terapéutico , Proteínas Adaptadoras Transductoras de Señales , Adolescente , Adulto , Inhibidores de la Calcineurina/uso terapéutico , Progresión de la Enfermedad , Femenino , Humanos , Pruebas de Función Renal , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias , Factores de Riesgo
13.
Medicine (Baltimore) ; 99(40): e22310, 2020 Oct 02.
Artículo en Inglés | MEDLINE | ID: mdl-33019406

RESUMEN

Immunoglobulin A nephropathy (IgAN) is a major cause of secondary hypertension (HT) of renal origin - a significant prognostic factor of IgAN. In children, similar to HT, prehypertension (pre-HT) is becoming a significant health issue. However, the role of secondary HT and pre-HT (HT/pre-HT) in the progression of pediatric IgAN remains unclear. We investigated the effects of HT/pre-HT on prognosis and its determinants as well as their correlation with clinicopathological parameters to identify more effective therapeutic targets.This single-center retrospective study compared clinicopathological features and treatment outcomes between patients with and without HT/pre-HT in 108 children with IgAN. Independent risk factors for HT/pre-HT were evaluated; segmental glomerulosclerosis was a significant variable, whose relationship with clinicopathological parameters was analyzed.Clinical outcomes of patients with and without HT/pre-HT differed considerably (P = .006) on ≥6 months follow-up. Patients with HT/pre-HT reached complete remission less frequently than those without HT/pre-HT (P = .014). Age, serum creatinine, prothrombin time, and segmental glomerulosclerosis or adhesion were independent risk factors for HT/pre-HT in pediatric IgAN (P = .012, P = .017, P = .002, and P = .016, respectively). Segmental glomerulosclerosis or adhesion was most closely associated with glomerular crescents (r = 0.456, P < .01), followed by Lees grades (r = 0.454, P < .01), renal arteriolar wall thickening (r = 0.337, P < .01), and endocapillary hypercellularity (r = 0.306, P = .001). The intensity of IgA deposits, an important marker of pathogenetic activity in IgAN, was significantly associated with the intensity and location of fibrinogen deposits (intensity: r = 0.291, P = .002; location: r = 0.275, P = .004).HT/pre-HT in pediatric IgAN patients is an important modifiable factor. A relationship is observed between HT/pre-HT and its determinants, especially segmental glomerulosclerosis. Potential therapeutic approaches for IgAN with HT/pre-HT might be directed toward the management of coagulation status, active lesions, and hemodynamics for slowing disease progression.


Asunto(s)
Glomerulonefritis por IGA/epidemiología , Hipertensión/epidemiología , Prehipertensión/epidemiología , Adolescente , Factores de Edad , Antihipertensivos/uso terapéutico , Biomarcadores , Niño , Creatinina/sangre , Progresión de la Enfermedad , Femenino , Fibrinolíticos/uso terapéutico , Tasa de Filtración Glomerular , Glomerulonefritis por IGA/tratamiento farmacológico , Glomeruloesclerosis Focal y Segmentaria/epidemiología , Humanos , Hipertensión/tratamiento farmacológico , Inmunosupresores/uso terapéutico , Masculino , Prehipertensión/tratamiento farmacológico , Pronóstico , Tiempo de Protrombina , Estudios Retrospectivos , Factores de Riesgo
14.
Clin Exp Rheumatol ; 38 Suppl 126(4): 291-300, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33095142

RESUMEN

Interstitial lung disease (ILD) is considered the most frequent and serious pulmonary complication in primary Sjögren's syndrome (pSS), with the majority of the studies indicating a prevalence of about 20%, and resulting in significant morbidity and mortality. Although ILD was historically described as a late manifestation of pSS, more recently, a high variability of the time of onset of pSS-ILD has been observed and from 10 to 51% of patients can develop ILD years before the onset of pSS. Lymphocytic interstitial pneumonia is highly typical for SS, but it occurs only in a few cases, while the most common ILD pattern is nonspecific interstitial pneumonia, followed by usual interstitial pneumonia and organising pneumonia. Multidisciplinary discussion can be necessary in pSS cases with ambiguous clinical findings, when differential diagnosis with IIPs might be very difficult. Up to date, available data do not allow to establish an evidence-based treatment strategy in pSS-ILD. Glucocorticoids are empirically used, usually in association to immunosuppressive drugs, such as cyclophosphamide and mycophenolate mofetil. A better understanding of the molecular mechanisms involved in the pathogenesis of pSS should facilitate the development of new therapies. Recently, a trial showed the efficacy of the antifibrotic drug nintedanib in slowing progression of various interstitial lung diseases, including patients with connective tissue diseases. The aims of this review are to describe clinical features, imaging, pathology, together with diagnostic criteria, prognosis and management of pSS-ILD patients.


Asunto(s)
Enfermedades del Tejido Conjuntivo , Enfermedades Pulmonares Intersticiales , Síndrome de Sjögren , Humanos , Inmunosupresores/uso terapéutico , Enfermedades Pulmonares Intersticiales/diagnóstico , Enfermedades Pulmonares Intersticiales/tratamiento farmacológico , Enfermedades Pulmonares Intersticiales/epidemiología , Pronóstico , Síndrome de Sjögren/complicaciones , Síndrome de Sjögren/diagnóstico , Síndrome de Sjögren/tratamiento farmacológico
15.
J Crohns Colitis ; 14(Supplement_3): S807-S814, 2020 Oct 21.
Artículo en Inglés | MEDLINE | ID: mdl-33085970

RESUMEN

The rapid emergence of the novel coronavirus [SARS-CoV2] and the coronavirus disease 2019 [COVID-19] has caused significant global morbidity and mortality. This is particularly concerning for vulnerable groups such as pregnant women with inflammatory bowel disease [IBD]. Care for pregnant IBD patients in itself is a complex issue because of the delicate balance between controlling maternal IBD as well as promoting the health of the unborn child. This often requires continued immunosuppressive maintenance medication or the introduction of new IBD medication during pregnancy. The current global COVID-19 pandemic creates an additional challenge in the management of pregnant IBD patients. In this paper we aimed to answer relevant questions that can be encountered in daily clinical practice when caring for pregnant women with IBD during the current COVID-19 pandemic. PODCAST: This article has an associated podcast which can be accessed at https://academic.oup.com/ecco-jcc/pages/podcast.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/prevención & control , Enfermedades Inflamatorias del Intestino/terapia , Pandemias/prevención & control , Neumonía Viral/prevención & control , Complicaciones del Embarazo/terapia , Betacoronavirus/aislamiento & purificación , Técnicas de Laboratorio Clínico , Infecciones por Coronavirus/complicaciones , Infecciones por Coronavirus/diagnóstico , Progresión de la Enfermedad , Femenino , Humanos , Inmunosupresores/uso terapéutico , Enfermedades Inflamatorias del Intestino/complicaciones , Neumonía Viral/complicaciones , Neumonía Viral/diagnóstico , Embarazo , Medición de Riesgo , Índice de Severidad de la Enfermedad
16.
J Crohns Colitis ; 14(Supplement_3): S769-S773, 2020 Oct 21.
Artículo en Inglés | MEDLINE | ID: mdl-33085972

RESUMEN

Patients with inflammatory bowel diseases [IBD] are frequently treated with immunosuppressant medications. During the coronavirus disease 2019 [COVID-19] pandemic, recommendations for IBD management have included that patients should stay on their immunosuppressant medications if they are not infected with the severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2], but to temporarily hold these medications if symptomatic with COVID-19 or asymptomatic but have tested positive for SARS-CoV-2. As more IBD patients are infected globally, it is important to also understand how to manage IBD medications during convalescence while an individual with IBD is recovering from COVID-19. In this review, we address the differences between a test-based versus a symptoms-based strategy as related to COVID-19, and offer recommendations on when it is appropriate to consider restarting IBD therapy in patients testing positive for SARS-CoV-2 or with clinical symptoms consistent with COVID-19. In general, we recommend a symptoms-based approach, due to the current lack of confidence in the accuracy of available testing and the clinical significance of prolonged detection of virus via molecular testing.


Asunto(s)
Betacoronavirus , Técnicas de Laboratorio Clínico , Infecciones por Coronavirus/inmunología , Infecciones por Coronavirus/prevención & control , Huésped Inmunocomprometido , Inmunosupresores/administración & dosificación , Enfermedades Inflamatorias del Intestino/tratamiento farmacológico , Pandemias/prevención & control , Neumonía Viral/inmunología , Neumonía Viral/prevención & control , Infecciones Asintomáticas , Betacoronavirus/aislamiento & purificación , Infecciones por Coronavirus/diagnóstico , Esquema de Medicación , Humanos , Inmunosupresores/uso terapéutico , Enfermedades Inflamatorias del Intestino/complicaciones , Enfermedades Inflamatorias del Intestino/inmunología , Neumonía Viral/diagnóstico , Medición de Riesgo
17.
Front Immunol ; 11: 2055, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33042116

RESUMEN

The clinical and laboratory features of COVID-19 are reviewed with attention to the immunologic manifestations of the disease. Recent COVID-19 publications describe a variety of clinical presentations including an asymptomatic state, pneumonia, a hemophagocytic lymphohistiocytosis like syndrome, Multisystem Inflammatory Syndrome in Children (MIS-C) but, also called Pediatric Inflammatory Multisystem Syndrome-Toxic Shock (PIMS-TS), Kawasaki Disease, and myocarditis. A common theme amongst multiple reports suggests an overexuberant autoimmune component of the disease but a common pathophysiology to explain the variations in clinical presentation has been elusive. Review of the basic science of other viral induced autoimmune disorders may give clues as to why immunosuppressive and immunomodulating regimens now appear to have some efficacy in COVID-19. Review of the immunopathology also reveals other therapies that have yet to be explored. There is potential use of T cell depleting therapies and possibly anti-CD20 therapy for COVID-19 and clinical research using these medications is warranted.


Asunto(s)
Betacoronavirus/inmunología , Infecciones por Coronavirus , Inmunosupresores/uso terapéutico , Depleción Linfocítica , Pandemias , Neumonía Viral , Síndrome de Respuesta Inflamatoria Sistémica , Linfocitos T , Niño , Preescolar , Infecciones por Coronavirus/inmunología , Infecciones por Coronavirus/patología , Infecciones por Coronavirus/terapia , Humanos , Linfohistiocitosis Hemofagocítica/inmunología , Linfohistiocitosis Hemofagocítica/patología , Linfohistiocitosis Hemofagocítica/terapia , Linfohistiocitosis Hemofagocítica/virología , Síndrome Mucocutáneo Linfonodular/inmunología , Síndrome Mucocutáneo Linfonodular/patología , Síndrome Mucocutáneo Linfonodular/terapia , Síndrome Mucocutáneo Linfonodular/virología , Miocarditis/inmunología , Miocarditis/terapia , Miocarditis/virología , Neumonía Viral/inmunología , Neumonía Viral/patología , Neumonía Viral/terapia , Síndrome de Respuesta Inflamatoria Sistémica/inmunología , Síndrome de Respuesta Inflamatoria Sistémica/patología , Síndrome de Respuesta Inflamatoria Sistémica/terapia , Síndrome de Respuesta Inflamatoria Sistémica/virología , Linfocitos T/inmunología , Linfocitos T/patología
18.
Medicine (Baltimore) ; 99(40): e22596, 2020 Oct 02.
Artículo en Inglés | MEDLINE | ID: mdl-33019479

RESUMEN

BACKGROUND: The pathophysiologic of vascular malformations is still unclear, and the treatment of vascular malformations is a challenge. With improvement in the understanding of pathogenesis of vascular malformations, sirolimus has been a promising and effective treatment. As so far, there is absent convincing evidence to confirm the efficacy of sirolimus for vascular malformations. The purpose of this study was to evaluate the effectiveness and safety of sirolimus in the treatment of vascular malformations. METHODS: The literatures about the management of vascular malformations with sirolimus would be searched from databases of MEDLINE, EMBASE, PubMed, Web of Science, Clinicaltrials.org., Cochrane Library, China Biology Medicine Database (CBM), Wan Fang Database, China National Knowledge Infrastructure Database (CNKI), and VIP Science Technology Periodical Database. We will search each database from inception or 1995 to August 20, 2020. Two researchers worked independently on literature selection, data extraction and quality assessment. The efficacy and safety of sirolimus in the treatment of vascular malformations were the main outcomes. Adverse events after sirolimus were evaluated as the secondary outcomes. The included studies will be analyzed by Review Manager 5.3. If the results are applicable, meta-analysis would also be performed. RESULTS: The study will evaluate the efficacy and safety of sirolimus in the treatment of vascular malformations based on current evidence. CONCLUSION: The conclusion of this study will provide more reliable, evidence-based data for the use of sirolimus in the treatment of vascular malformations. PROSPERO REGISTRATION NUMBER: CRD42020167881.


Asunto(s)
Inmunosupresores/uso terapéutico , Sirolimus/uso terapéutico , Malformaciones Vasculares/tratamiento farmacológico , Manejo de Datos , Femenino , Humanos , Inmunosupresores/efectos adversos , Masculino , Proyectos de Investigación , Seguridad , Sirolimus/efectos adversos , Serina-Treonina Quinasas TOR/efectos de los fármacos , Serina-Treonina Quinasas TOR/metabolismo , Resultado del Tratamiento , Malformaciones Vasculares/fisiopatología
19.
Medicine (Baltimore) ; 99(40): e22639, 2020 Oct 02.
Artículo en Inglés | MEDLINE | ID: mdl-33019487

RESUMEN

INTRODUCTION: Tuberculous meningitis (TBM) is the most fatal type of tuberculosis in which corticosteroids are added with antitubercular therapy to prevent permanent brain damage. However, this treatment may produce paradoxical reactions. In such cases, thalidomide use might reduce central nervous system inflammation and improve the outcome. We present the case of a human immunodeficiency virus-negative patient with TBM who developed paradoxical reactions manifesting as multiple intracranial tuberculomas that were resistant to standard care (antitubercular drugs and corticosteroids) but responded well to thalidomide. PATIENT'S MAIN CONCERN AND CLINICAL FINDINGS: The patient was a 40-year-old Chinese female, who was admitted with a 10-day history of headaches, night sweats, and cough. She was healthy before contracting the infection and had no history of contact with tuberculosis patients. DIAGNOSES, INTERVENTION, AND OUTCOME: We diagnosed the patient with TBM complicated by the occurrence of pulmonary tuberculosis. Positive results were obtained from Gram and Ziehl-Neelsen staining of the sputum and acid-fast bacilli sputum culture. Standard treatment was initiated with antitubercular drugs (daily isoniazid, rifampicin, ethionamide, and pyrazinamide) and corticosteroids (dexamethasone). However, 3 months later the magnetic resonance imaging of the head revealed some new tuberculoma lesion. Thus, a specific therapy of antitubercular drugs and thalidomide was introduced. On completion of a 12-month course of antitubercular drugs with 2 months of thalidomide, the patient showed favorable outcomes without neurologic sequelae. Moreover, thalidomide appeared safe and well tolerated in the patient. CONCLUSION: In addition to the specific anti-tubercular and adjuvant corticosteroid therapies for TBM, thalidomide can be used as a "salvage" antitubercular drug in cases that are unresponsive to corticosteroids.


Asunto(s)
VIH/inmunología , Inmunosupresores/uso terapéutico , Talidomida/uso terapéutico , Tuberculosis Meníngea/tratamiento farmacológico , Tuberculosis Pulmonar/complicaciones , Corticoesteroides/uso terapéutico , Adulto , Antituberculosos/uso terapéutico , Grupo de Ascendencia Continental Asiática/etnología , Encéfalo/patología , Quimioterapia Combinada , Femenino , Hospitalización , Humanos , Imagen por Resonancia Magnética/métodos , Terapia Recuperativa , Resultado del Tratamiento , Tuberculoma/diagnóstico por imagen , Tuberculosis Meníngea/diagnóstico , Tuberculosis Pulmonar/tratamiento farmacológico
20.
Int Heart J ; 61(5): 1005-1013, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32999188

RESUMEN

This study sought to evaluate clinical features, treatment patterns, and outcomes of patients with idiopathic inflammatory myopathy (IIM) complicated by heart failure (HF). Thirty-two patients with IIM-HF admitted to the Peking Union Medical College Hospital between January 1999 and January 2018 were retrospectively reviewed, including 14 patients with polymyositis, 11 with dermatomyositis, and 7 with overlap syndrome. Survivors and no-survivors were compared on clinical characteristics and treatment. Although systemic symptoms were variable, all patients presented with elevated troponin I. Rapid atrial arrhythmia was the most frequent arrhythmia. Systolic dysfunction and restrictive diastolic dysfunction were typical presentations in echocardiography. Twenty-nine patients were followed up for a median of 2.8 years (0.1 month to 11 years). We recorded 13 deaths of cardiogenic cause, 1 of serious IIM, and 3 of infective complications. The median survival time from diagnosis of IIM-HF to all-cause mortality was 8.4 months (range from 1 month to 5 years). Both all-cause deaths and cardiogenic deaths were more reported in the methotrexate-alone group than in the combination therapy group (6/7 versus 3/10, P = 0.050; 5/6 versus 2/9, P = 0.041). Combination therapy including methotrexate (HR = 0.188, 95%CI 0.040-0.871, P = 0.033) and taking ß-receptor blockers (HR = 0.249, 95%CI 0.086-0.719, P = 0.010) was associated with reduced risk of all-cause deaths. In conclusion, elevated troponin I, atrial arrhythmia, and systolic and restrictive diastolic dysfunction are typical characteristics of IIM-HF. Combined immunosuppression that includes methotrexate and ß-receptor blockers seems to be important to improve survival.


Asunto(s)
Inmunosupresores/uso terapéutico , Metotrexato/uso terapéutico , Miositis/tratamiento farmacológico , Miositis/mortalidad , Adolescente , Antagonistas Adrenérgicos beta/uso terapéutico , Adulto , Anciano , China/epidemiología , Quimioterapia Combinada , Femenino , Glucocorticoides/uso terapéutico , Insuficiencia Cardíaca/etiología , Humanos , Inmunoglobulinas Intravenosas/uso terapéutico , Masculino , Metilprednisolona/uso terapéutico , Persona de Mediana Edad , Miositis/complicaciones , Estudios Retrospectivos , Adulto Joven
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