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1.
Curr Opin Ophthalmol ; 31(6): 462-468, 2020 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-33009077

RESUMEN

PURPOSE OF REVIEW: Neuromyelitis optica spectrum disorder is an autoimmune disease that causes optic neuritis and transverse myelitis. Attacks can cause severe neurological damage leading to blindness and paralysis. Understanding of the immunopathogenesis of this disease has led to major breakthroughs in diagnosis and treatment. In the past 18 months, three successful phase 3 clinical trials have been published using targeted approaches to preventing relapses. RECENT FINDINGS: Updates in epidemiology, imaging, quality of life and treatment for acute relapse and prevention have been published in the past 18 months. Epidemiology studies are distinguishing patients based on their antigen specificity for aquaporin-4 and myelin oligodendrocyte glycoprotein, which are increasingly recognized as separate immunological conditions. Imaging by MRI and optical coherence tomography continue to be developed as tools to distinguish neuromyelitis optica spectrum disorders (NMOSD) from other diseases. This is especially relevant as the recent clinical trials showed differences in response between aquaporin-4 seropositive and seronegative patients. The three drugs that were tested for prevention of NMOSD relapses were eculizumab, inebilizumab, and satralizumab. All of the trials were worldwide, placebo-controlled, double-masked studies that demonstrated a clear benefit with each approach. SUMMARY: Recent research in NMOSD has resulted in improved diagnosis and approved treatments.


Asunto(s)
Neuromielitis Óptica , Animales , Acuaporina 4/inmunología , Humanos , Neuromielitis Óptica/diagnóstico , Neuromielitis Óptica/inmunología , Neuromielitis Óptica/patología , Neuritis Óptica , Calidad de Vida , Recurrencia , Prevención Secundaria
2.
Curr Opin Ophthalmol ; 31(6): 483-488, 2020 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-33009080

RESUMEN

PURPOSE OF REVIEW: Eye pain is one of the most common presenting symptoms in ophthalmology. It can range from bothersome to debilitating for patients, and it can be vexing for clinicians, especially in the white and quiet eye. The purpose of this review is to provide updates of recent literature regarding eye pain and to communicate our current understanding regarding the evaluation and management of conditions that cause eye pain with a relatively normal examination. RECENT FINDINGS: This review concerns recent literature regarding eye pain in the white and quiet eye. It is arranged by cause of pain and discusses dry eye syndrome, recurrent corneal erosion, postrefractive surgical pain, eye strain, intermittent angle closure, benign essential blepharospasm, trochleodynia, trochleitis and trochlear headache, and posterior scleritis. SUMMARY: Eye pain in the white and quiet eye remains a difficult-to-navigate topic for practitioners. However, a careful history and focused physical examination can elucidate the diagnosis in many cases. Recent updates to the literature have advanced our knowledge of how to identify and treat the underlying causes of eye pain.


Asunto(s)
Dolor Ocular/etiología , Enfermedad Crónica , Síndromes de Ojo Seco/complicaciones , Dolor Ocular/fisiopatología , Cefalea , Humanos , Recurrencia
3.
Artículo en Chino | MEDLINE | ID: mdl-33040500

RESUMEN

Objective:To report the nonsurgical correction of congenital auricular deformities in children older than 3 months, analysis the effect and the recurrence and the influencing factors. Method:Patients with auricular deformities who came to our department from July 2017 to August 2019 were collected. EarWell correction was performed for non-invasive correction. Follow-up was performed for at least 3 months after treatment. Data was collected to analysis the effect and the recurrence and the influencing factors. Result:At the end of follow-up, 76 cases of 88 ears were collected, at the end of treatment in this group, the efficiency was 87.5%, and the recurrence rate was 19.48%, 3 months after the end of treatment. There was a statistically significant difference in the distribution of auricle deformities(P=0.018) and the age of first treatment(P=0.028) between children in the effective group and those in the ineffective group. Of all the auricle deformities, the treatment of cryptotia was the most effective, and the effectiveness of prominent ears was the lowest. The family history(P=0.314), gender(P=0.421), and feeding method(P=0.557) of the effective and ineffective groups. There was no significant difference in the gestational weeks at birth(P=0.641), the mode of production(P=0.849), and birth weight(P=0.08). There was no significant difference in age between the relapsed group and the non-relapsed group at the age of first treatment(P=0.833).There was significant difference in the distribution of auricle deformities between the relapsed group and the non-relapsed group(P=0.013). There was no statistically significant difference between the effective group and the ineffective group at the age of first diagnosis and treatment time if we exclude cryptotia. Conclusion:For children who are treated beyond the treatment time window, the main factor affecting the treatment effect is the type of deformity. Nonsurgical correction can still be tried for older than 3 months with auricular deformities, especially for cryptotia, ear wheel deformities, and auricular cavity deformities. We do not recommend to try nonsurgical correction for children older than 3 months with prominent ears and cup ears.


Asunto(s)
Pabellón Auricular , Oído Externo , Niño , Pabellón Auricular/cirugía , Oído Externo/cirugía , Humanos , Lactante , Recién Nacido , Anamnesis , Recurrencia
4.
Proc Biol Sci ; 287(1935): 20201831, 2020 09 30.
Artículo en Inglés | MEDLINE | ID: mdl-32962545

RESUMEN

Urban habitats can shape interactions between hosts and parasites by altering not only exposure rates but also within-host processes. Artificial light at night (ALAN) is common in urban environments, and chronic exposure can impair host immunity in ways that may increase infection. However, studies of causal links between this stressor, immunity, and infection dynamics are rare, particularly in migratory animals. Here, we experimentally tested how ALAN affects cellular immunity and haemosporidian parasite intensity across the annual cycle of migrant and resident subspecies of the dark-eyed junco (Junco hyemalis). We monitored an experimental group exposed to light at night and a control group under natural light/dark cycles as they passed through short days simulating early spring to longer days simulating the breeding season, followed by autumn migration. Using generalized additive mixed models, we show that ALAN increased inflammation, and leucocyte counts were greatest in early spring and autumn. At the start of the experiment, few birds had active infections based on microscopy, but PCR revealed many birds had chronic infections. ALAN increased parasitaemia across the annual cycle, with strong peaks in spring and autumn that were largely absent in control birds. As birds were kept in indoor aviaries to prevent vector exposure, this increased parasitaemia indicates relapse of chronic infection during costly life-history stages (i.e. reproduction). Although the immunological and parasitological time series were in phase for control birds, cross-correlation analyses also revealed ALAN desynchronized leucocyte profiles and parasitaemia, which could suggest a general exaggerated inflammatory response. Our study shows how a common anthropogenic influence can shape within-host processes to affect infection dynamics.


Asunto(s)
Migración Animal , Pájaros Cantores/parasitología , Animales , Cruzamiento , Parasitemia , Parásitos , Recurrencia , Estaciones del Año
5.
N Z Med J ; 133(1520): 73-82, 2020 08 21.
Artículo en Inglés | MEDLINE | ID: mdl-32994595

RESUMEN

AIM: Takotsubo syndrome (TS) mimics acute coronary syndrome but has a distinct pathophysiology. This study aimed to compare and contrast the clinical presentation, management and outcomes of patients with TS in five large New Zealand hospitals. METHODS: We identified 632 consecutive patients presenting to the five major tertiary hospitals in New Zealand (Middlemore Hospital, Auckland City Hospital, North Shore Hospital, Christchurch Hospital and Dunedin Hospital) between January 2006 and June 2018 and obtained clinical, laboratory, electrocardiography, echocardiography, coronary angiography and long-term follow-up data. RESULTS: Six hundred and thirty-two consecutive patients with TS (606 women, mean age 65.0+11.1 years) were included. An associated stressor was identified in two-thirds of patients, and emotional triggers were more frequent than physical triggers (62.9% and 37.1%, respectively). Overall, 12.7% of patient had depression and 11.7% anxiety but this was more common in patients from Christchurch Hospital (20.4% and 23.4%, respectively). The in-hospital mortality among the five hospitals ranges between 0 to 2.0%. The mean follow-up was 4.9+3.4 years (median 4.4 years). Fifty-four people died post-discharge, all but one from a non-cardiac cause. Forty patients had recurrent TS. Mortality post-discharge (p=0.63) and TS recurrence (p=0.38) did not differ significantly among the five hospitals. CONCLUSION: In this large New Zealand TS cohort, the clinical characteristics and presentation were similar among the five hospitals. A subset of patients had a complicated in-hospital course, but late deaths were almost all from non-cardiac causes and recurrence was infrequent. Mortality post-discharge and recurrence was similar between the hospitals.


Asunto(s)
Síndrome Coronario Agudo/diagnóstico , Mortalidad Hospitalaria/tendencias , Hospitales Urbanos/estadística & datos numéricos , Cardiomiopatía de Takotsubo/diagnóstico , Cardiomiopatía de Takotsubo/mortalidad , Síndrome Coronario Agudo/fisiopatología , Anciano , Angiografía Coronaria/métodos , Diagnóstico Diferencial , Ecocardiografía/métodos , Electrocardiografía/métodos , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Nueva Zelanda/epidemiología , Nueva Zelanda/etnología , Alta del Paciente/tendencias , Estudios Prospectivos , Recurrencia , Estrés Psicológico/epidemiología , Cardiomiopatía de Takotsubo/epidemiología , Cardiomiopatía de Takotsubo/fisiopatología , Centros de Atención Terciaria/estadística & datos numéricos
6.
Vasc Health Risk Manag ; 16: 325-329, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32982261

RESUMEN

Lumivascular optical coherence tomography (OCT) is a novel adjunct in the field of medicine. It offers clear real-time imaging of artery walls before and during endovascular intervention. This study reports our initial experience on the use of lumivascular OCT-guided atherectomy in the management of two patients with recurrent restenosis in their femoropopliteal arteries associated with in-stent restenosis. Endovascular procedures were successful with a Pantheris atherectomy device (Avinger, Redwood City, CA, USA) and drug-eluting balloons. The OCT images clearly distinguished normal anatomy from plaque pathology, were of great advantage in both the accurate diagnosis and treatment of target lesions, and may reduce radiation during the endovascular procedure. However, the price of the device and its need for contrast infusion limit its routine clinical use.


Asunto(s)
Angioplastia de Balón/instrumentación , Aterectomía , Arteria Femoral/diagnóstico por imagen , Enfermedad Arterial Periférica/terapia , Arteria Poplítea/diagnóstico por imagen , Stents , Tomografía de Coherencia Óptica , Anciano de 80 o más Años , Angioplastia de Balón/efectos adversos , Aterectomía/efectos adversos , Aterectomía/instrumentación , Femenino , Arteria Femoral/fisiopatología , Humanos , Enfermedad Arterial Periférica/diagnóstico por imagen , Enfermedad Arterial Periférica/fisiopatología , Arteria Poplítea/fisiopatología , Valor Predictivo de las Pruebas , Recurrencia , Resultado del Tratamiento
7.
Middle East Afr J Ophthalmol ; 27(2): 110-116, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32874044

RESUMEN

PURPOSE: The purpose is to compare the clinical results of using silk versus nylon sutures for conjunctival autograft suturing in pterygium surgery. METHODS: In this prospective, randomized, controlled, clinical trial 50 eyes from 50 patients with primary nasal pterygium were randomized to undergo pterygium surgery with the use of either nylon sutures or silk sutures for conjunctival autograft suturing. Patients were followed up for 6 months. Main outcome measures included recurrence, postoperative discomfort according to a visual analog scale (VAS), graft hyperemia, and graft edema. RESULTS: According to the results, there was no significant difference between groups regarding recurrence rate of pterygium (P = 0.72). A significant decrease in the mean VAS discomfort score from day 1 to day 14 was observed in both groups (P = 0.001); postoperative discomfort during the first 2 weeks, was not significantly different between the two groups. At 2 weeks' postoperatively, significantly greater number of nylon sutures remained on the autograft (P = 0.021), some of which were buried and could not be removed. CONCLUSION: Both silk and nylon are effective suture materials for autograft suturing in pterygium surgery with similar postoperative discomfort and recurrence rate. Significantly greater number of nylon sutures remains buried on the autograft and could not be removed easily.


Asunto(s)
Conjuntiva/trasplante , Nylons , Pterigion/cirugía , Seda , Técnicas de Sutura , Suturas , Adulto , Anciano , Anciano de 80 o más Años , Autoinjertos , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Procedimientos Quirúrgicos Oftalmológicos/métodos , Periodo Posoperatorio , Estudios Prospectivos , Recurrencia , Trasplante Autólogo , Resultado del Tratamiento
8.
Middle East Afr J Ophthalmol ; 27(2): 123-127, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32874046

RESUMEN

PURPOSE: The purpose of this study was to evaluate predictive factors for intermittent exotropia (XT) recurrence after bilateral lateral rectus (BLR) recession. METHODS: This is a retrospective chart review of patients with XT who underwent BLR recession surgery between January 2007 and March 2017 with at least one postsurgical follow-up. Forty-one medical records were reviewed. Information collected included age, gender, systemic diseases, history of prematurity, family history of eye diseases, visual acuity, refraction, ocular alignment and control, stereoacuity, slit-lamp examination, fundoscopy, and amount of BLR recession. Successful alignment was defined as ≤8 prism diopters of esotropia or exotropia postoperatively. RESULTS: The mean age of patients at the time of surgery and follow-up time was 9.2 ± 12.3 years (y) and 23.6 ± 36.5 months (m), respectively. The mean amount of BLR recession was 6.5 ± 1.0 mm. Recurrence rate was 43.9% on the last follow-up. Age at surgery and at the time of last follow-up were significantly higher in the recurring group (P = 0.04 and P = 0.05, respectively). Postoperative angle of misalignment during the first 3 months was correlated with exotropia recurrence. No statistical significance was found among the remaining factors studied. CONCLUSIONS: The recurrence rate of XT in our study was 43.9%; it was increased in patients operated at older age and amid those with significant exotropia detected in the early postoperative period (within 3 months of surgery).


Asunto(s)
Exotropía/diagnóstico , Músculos Oculomotores/cirugía , Procedimientos Quirúrgicos Oftalmológicos , Adolescente , Niño , Preescolar , Enfermedad Crónica , Exotropía/fisiopatología , Exotropía/cirugía , Femenino , Estudios de Seguimiento , Humanos , Lactante , Recién Nacido , Masculino , Oftalmoscopía , Periodo Posoperatorio , Recurrencia , Refracción Ocular , Estudios Retrospectivos , Microscopía con Lámpara de Hendidura , Resultado del Tratamiento , Visión Binocular/fisiología , Agudeza Visual/fisiología , Adulto Joven
9.
Virulence ; 11(1): 1250-1256, 2020 12.
Artículo en Inglés | MEDLINE | ID: mdl-32921249

RESUMEN

The cause of some patients with negative RT-PCR results experienced turn-positive after treatment remains unclear. In addition, understanding the correlation between changes in clinical data in the course of COVID-19 and treatment outcomes is of great importance in determining the prognosis of COVID-19. To perform cause analysis of RT-PCR turn-positive and the effective screening factors related to treatment outcome in COVID-19. Clinical data, including clinical manifestations, laboratory tests, radiography results, treatment methods and outcomes, were retrospectively collected and analyzed from January to March 2020 in Renmin Hospitals of Wuhan University. 116 COVID-19 patients (40 in recurrent group, 29 in recovered group and 47 in unrecovered group) were recruited. In the recurrent group, white blood cell, Neutrophils, prothrombin time, activated partial thromboplastin time, CD3, CD4, CD8, ratio of CD4/CD8, IgG and C4 complement were of significant difference among the baseline, negative and turn-positive time points. CD19 and CT scan results were found notable difference between recurrent group and recovered group. Odds from CD3, CD4, CD8, CD19, IgM, C3 complement, C4 complement and CT scan results validated associations with clinical outcomes of COVID-19. The so-called recurrence in some COVID-19 patients may be due to the false-negative of nucleic acid test results from nasopharyngeal swabs. Levels of CD3, CD4, CD8, CD19, IgM, C3 complement, C4 complement and CT results were significantly correlated with the outcome of COVID-19. The cellular immunity test could be beneficial to further screen the reliability of RT-PCR test on the basis of CT images.


Asunto(s)
Betacoronavirus , Técnicas de Laboratorio Clínico , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/terapia , Neumonía Viral/diagnóstico , Neumonía Viral/terapia , Reacción en Cadena de la Polimerasa de Transcriptasa Inversa , Adulto , Betacoronavirus/inmunología , Betacoronavirus/patogenicidad , China/epidemiología , Estudios de Cohortes , Infecciones por Coronavirus/epidemiología , Reacciones Falso Negativas , Femenino , Humanos , Inmunidad Celular , Pulmón/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Pandemias , Neumonía Viral/epidemiología , Pronóstico , Recurrencia , Estudios Retrospectivos , Factores de Riesgo , Tomografía Computarizada por Rayos X , Resultado del Tratamiento , Virulencia
10.
Epidemiol Infect ; 148: e218, 2020 09 21.
Artículo en Inglés | MEDLINE | ID: mdl-32951624

RESUMEN

'Recurrence' of coronavirus disease 2019 (COVID-19) has triggered numerous discussions of scholars at home and abroad. A total of 44 recurrent cases of COVID-19 and 32 control cases admitted from 11 February to 29 March 2020 to Guanggu Campus of Tongji Hospital affiliated to Tongji Medical College Huazhong University of Science and Technology were enrolled in this study. All the 44 recurrent cases were classified as mild to moderate when the patients were admitted for the second time. The gender and mean age in both cases (recurrent and control) were similar. At least one concomitant disease was observed in 52.27% recurrent cases and 34.38% control cases. The most prevalent comorbidity among them was hypertension. Fever and cough being the most prevalent clinical symptoms in both cases. On comparing both the cases, recurrent cases had markedly elevated concentrations of alanine aminotransferase (ALT) (P = 0.020) and aspartate aminotransferase (AST) (P = 0.007). Moreover, subgroup analysis showed mild to moderate abnormal concentrations of ALT and AST in recurrent cases. The elevated concentrations of ALT and AST may be recognised as predictive markers for the risk of 'recurrence' of COVID-19, which may provide insights into the prevention and control of COVID-19 in the future.


Asunto(s)
Alanina Transaminasa/sangre , Aspartato Aminotransferasas/sangre , Infecciones por Coronavirus/enzimología , Neumonía Viral/enzimología , Estudios de Casos y Controles , Tos , Femenino , Fiebre , Humanos , Masculino , Persona de Mediana Edad , Pandemias , Recurrencia , Estudios Retrospectivos , Factores de Riesgo
11.
Mil Med Res ; 7(1): 45, 2020 09 23.
Artículo en Inglés | MEDLINE | ID: mdl-32962760

RESUMEN

BACKGROUND: Gastrointestinal symptoms are not rare among coronavirus disease 2019 (COVID-19) patients, but there have been no reports regarding convalescent plasma therapy for the recovery of gastrointestinal problems in COVID-19 patients. CASE PRESENTATION: We present two cases of patients with COVID-19-associated recurrent diarrhea and positive fecal occult blood who successfully recovered after a one-time convalescent plasma administration. CONCLUSION: When COVID-19 patients develop recurrent or refractory gastrointestinal symptoms and fail to respond to the available treatment, alternative therapy with convalescent plasma administration may be considered.


Asunto(s)
Infecciones por Coronavirus/complicaciones , Infecciones por Coronavirus/terapia , Diarrea/terapia , Hemorragia Gastrointestinal/terapia , Neumonía Viral/complicaciones , Neumonía Viral/terapia , Anciano , Infecciones por Coronavirus/diagnóstico , Diarrea/etiología , Femenino , Estudios de Seguimiento , Hemorragia Gastrointestinal/etiología , Humanos , Inmunización Pasiva/métodos , Persona de Mediana Edad , Pandemias , Neumonía Viral/diagnóstico , Recurrencia , Muestreo , Índice de Severidad de la Enfermedad , Taiwán , Resultado del Tratamiento
12.
Medicine (Baltimore) ; 99(35): e22064, 2020 Aug 28.
Artículo en Inglés | MEDLINE | ID: mdl-32871966

RESUMEN

RATIONALE: Patients with relapsed acute myeloid leukemia (AML) after allogeneic hematopoietic stem cell transplantation (allo-HSCT) have poor prognosis. Many patients are not eligible for 2nd HSCT due to organ dysfunction or other complications that prevent them from tolerating conditioning chemotherapy. In those ineligible patients for 2nd HSCT with myeloablative conditioning regimen, reduced intensity conditioning (RIC) are often used. RIC regimens are less toxic but has a less direct anti-tumor efficacy so that RIC regimens are not suitable for the patients with high tumor burden. To overcome this dilemma, Gemtuzumab Ozogamicin (GO) has been used as a part of RIC regimens to add anti-tumor efficacy. We report here a relapsed AML patient who was treated with GO monotherapy followed by stem cell infusion. PATIENT CONCERNS: A 25-year-old male with AML experienced relapse 9 months after allo-HSCT. DIAGNOSIS: Since he had mild renal and cardiac dysfunction and his AML did not progress rapidly, we decided not to give him an intensive chemotherapy. However, after azacitidine (AZA) and donor lymphocyte infusion therapy, his leukemic blasts did not decrease. INTERVENTIONS: Originally, we had planned to proceed with a 2nd allo-HSCT with RIC regimen that consisted of fludarabine, melphalan and fractionated GO (3 mg/m/dose) on day -21, -18, and -15. However, the patient developed appendicitis after the last dose of GO when his neutrophil was 0 cells/µl. Based on his medical acuity, we terminated the rest of the patients conditioning regimen and the patient did not receive any further chemotherapeutics. The patient was still infused with peripheral blood stem cells from the donor on day 0. OUTCOMES: His appendicitis was resolved by antibiotics without surgery. His AML has been in CR more than 18 months under AZA maintenance therapy. LESSONS: GO monotherapy could be a conditioning regimen of 2nd allo HSCT from the same donor as the first HSCT for relapsed AML patients.


Asunto(s)
Antineoplásicos Inmunológicos/uso terapéutico , Gemtuzumab/uso terapéutico , Trasplante de Células Madre Hematopoyéticas , Leucemia Mieloide Aguda/terapia , Adulto , Humanos , Masculino , Recurrencia , Trasplante Homólogo
13.
Arthroscopy ; 36(9): 2377-2379, 2020 09.
Artículo en Inglés | MEDLINE | ID: mdl-32891240

RESUMEN

The classic and congruent-arc Latarjet techniques are equally safe and effective in restoring glenohumeral stability, even when performed as a revision of a failed stabilization. The classic technique provides a broader contact area for healing and facilitates and improves screw fixation. The congruent-arc technique theoretically optimizes glenohumeral contact forces because of the matched radius of curvature, provides better restoration of glenoid depth, and restores larger glenoid defects. However, rotating the coracoid graft for the congruent-arc technique eliminates the possibility of imbricating the coracoacromial ligament stump to the capsule. Surgeons have little reason to change from one technique to the other; both techniques result in successful outcomes.


Asunto(s)
Inestabilidad de la Articulación , Articulación del Hombro , Atletas , Humanos , Recurrencia , Volver al Deporte
14.
Arthroscopy ; 36(9): 2533-2536, 2020 09.
Artículo en Inglés | MEDLINE | ID: mdl-32891253

RESUMEN

Historically, a primary anterior instability event has been treated nonoperatively. In the literature, a multitude of outcome scores and definitions for recurrence of instability complicates the interpretation and synthesis of evidence-based recommendations. However, there is an emerging body of high-quality evidence that early surgical stabilization yields better overall outcomes. A wait-and-see approach would be acceptable if it was without detrimental effects, but there is a cost to recurrence of instability events, such as more extensive soft-tissue, cartilage, and bony lesions. Young age, male sex, and contact sport participation have been identified as risk factors for recurrence of anterior shoulder instability, and today, these patients are routinely recommended surgical treatment. It is also paramount to identify concomitant injury following the primary anterior instability event. The sensitivity, specificity, and reliability of radiographs is suboptimal, and the threshold to obtain advanced imaging such as computed tomography or magnetic resonance imaging with 3-dimensional reconstructions should be low. Taking into account the low non-recurrence complication rate following arthroscopic stabilization, early surgical intervention should be considered following the first instability event.


Asunto(s)
Inestabilidad de la Articulación , Luxación del Hombro , Articulación del Hombro , Artroscopía , Tratamiento Conservador , Humanos , Masculino , Recurrencia , Reproducibilidad de los Resultados , Hombro
15.
Rev Soc Bras Med Trop ; 53: e20200619, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32965458

RESUMEN

With the large number of individuals infected and recovered from Covid-19, there is intense discussion about the quality and duration of the immunity elicited by SARS-CoV-2 infection, including the possibility of disease recurrence. Here we report a case with strong clinical, epidemiological and laboratorial evidence of, not only reinfection by SARS-CoV-2, but also clinical recurrence of Covid-19.


Asunto(s)
Infecciones por Coronavirus/diagnóstico , Neumonía Viral/diagnóstico , Recurrencia , Anticuerpos Antivirales/sangre , Betacoronavirus , Brasil , Femenino , Humanos , Pandemias , ARN Viral/aislamiento & purificación , Reacción en Cadena de la Polimerasa de Transcriptasa Inversa , Adulto Joven
16.
G Ital Cardiol (Rome) ; 21(10): 750-756, 2020 Oct.
Artículo en Italiano | MEDLINE | ID: mdl-32968307

RESUMEN

BACKGROUND: During the COVID-19 pandemic, non-urgent outpatient activities were temporarily suspended. The aim of this study was to assess the impact of this measure on the management of the heart failure outpatient clinic at our institution. METHODS: We analyzed the clinical outcome of 110 chronic heart failure patients (mean age 73 ± 9 years) whose follow-up visit had been delayed. RESULTS: At their last visit before the lockdown, 80.9% was in NYHA class II, had an ejection fraction of 37 ± 7%, and B-type natriuretic peptide level was moderately elevated (266 ± 138 pg/ml). All patients received loop diuretics, 97.2% beta-blockers, 64.9% an aldosterone antagonist, 60.9% sacubitril/valsartan (S/V), and 72.2% of the remaining patients were on angiotensin-converting enzyme inhibitor or valsartan therapy. Patients were contacted by phone during and at the end of the lockdown period to fix a new appointment and underwent a structured interview to assess their clinical conditions and ongoing therapy and to verify whether they had contracted SARS-CoV-2 infection. Twelve patients (13.2%) contracted COVID-19. None was hospitalized for worsening heart failure or reported defibrillator shocks and none changed autonomously the prescribed therapy. Overall, 75% of patients reported stable or improved general well-being from the last in-person visit, while 25% described subjective worsening due to the social effect of the pandemic. Unchanged body weight and blood pressure values were reported by 86% and 78.4% of patients, respectively. Lower blood pressure values compared to baseline were recorded in 15.2% of patients on conventional renin-angiotensin system inhibition vs 21% of those on S/V, one of whom had to down-titrate S/V for persistent but asymptomatic hypotension; 4 patients up-titrated S/V to 200 mg/day following phone indications. CONCLUSIONS: Cancellation of scheduled follow-up visits during 3 months did not have significant negative effects in a cohort of stable patients with chronic heart failure on optimized medical therapy. Telephone support was effective in keeping connections with the patients during the lockdown, allowing appropriate management and implementation of drug therapy. In particular, patients who received S/V were not affected by delays in scheduled visits, confirming the tolerability and safety of this novel therapy in terms of both clinical and biohumoral parameters.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/epidemiología , Insuficiencia Cardíaca/tratamiento farmacológico , Neumonía Viral/epidemiología , Cuarentena , Antagonistas Adrenérgicos beta/uso terapéutico , Anciano , Instituciones de Atención Ambulatoria , Aminobutiratos/uso terapéutico , Inhibidores de la Enzima Convertidora de Angiotensina/uso terapéutico , Enfermedad Crónica , Continuidad de la Atención al Paciente/organización & administración , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/psicología , Prestación de Atención de Salud , Progresión de la Enfermedad , Femenino , Insuficiencia Cardíaca/sangre , Insuficiencia Cardíaca/psicología , Humanos , Italia/epidemiología , Masculino , Antagonistas de Receptores de Mineralocorticoides/uso terapéutico , Péptido Natriurético Encefálico/sangre , Pandemias , Neumonía Viral/diagnóstico , Neumonía Viral/psicología , Recurrencia , Inhibidores del Simportador de Cloruro Sódico y Cloruro Potásico/uso terapéutico , Volumen Sistólico , Teléfono , Tetrazoles/uso terapéutico , Privación de Tratamiento
17.
Mult Scler ; 26(10): 1137-1146, 2020 09.
Artículo en Inglés | MEDLINE | ID: mdl-32924838

RESUMEN

Concerns regarding infection with the novel coronavirus SARS-CoV-2 leading to COVID-19 are particularly marked for pregnant women with autoimmune diseases such as multiple sclerosis (MS). There is currently a relative paucity of information to guide advice given to and the clinical management of these individuals. Much of the limited available data around COVID-19 and pregnancy derives from the obstetric literature, and as such, neurologists may not be familiar with the general principles underlying current advice. In this article, we discuss the impact of potential infection on the pregnant woman, the impact on her baby, the impact of the current pandemic on antenatal care, and the interaction between COVID-19, MS and pregnancy. This review provides a framework for neurologists to use to guide the individualised advice given to both pregnant women with MS, and those women with MS who are considering pregnancy. This includes evidence derived from previous novel coronavirus infections, and emerging evidence from the current pandemic.


Asunto(s)
Infecciones por Coronavirus/inmunología , Factores Inmunológicos/uso terapéutico , Esclerosis Múltiple/tratamiento farmacológico , Neumonía Viral/inmunología , Complicaciones Infecciosas del Embarazo/inmunología , Complicaciones del Embarazo/tratamiento farmacológico , Betacoronavirus , Lactancia Materna , Prestación de Atención de Salud , Parto Obstétrico , Susceptibilidad a Enfermedades , Femenino , Retardo del Crecimiento Fetal , Humanos , Esclerosis Múltiple/inmunología , Pandemias , Atención Preconceptiva , Embarazo , Complicaciones del Embarazo/inmunología , Nacimiento Prematuro , Atención Prenatal , Recurrencia
18.
Medicine (Baltimore) ; 99(37): e21943, 2020 Sep 11.
Artículo en Inglés | MEDLINE | ID: mdl-32925726

RESUMEN

RATIONALE: Antimelanoma differentiation-associated gene 5 antibody (anti-MDA5 Ab)-positive clinically amyopathic dermatomyositis (cADM) is frequently complicated with interstitial lung disease (ILD) and has a poor prognosis. Although the short-term prognosis of anti-MDA5 Ab-positive cADM is poor, it has been suggested that the recurrence rate is not higher than that of anti-MDA5 Ab-negative dermatomyositis. Combination therapy with corticosteroids, calcineurin inhibitors, and cyclophosphamide is the gold standard for the remission induction therapy at the onset. Recently, it has been reported that tofacitinib (TOF) could be effective for refractory anti-MDA5 Ab-positive cADM with ILD. Although initial remission induction therapy has been established, therapeutic strategies for relapse cases have not yet been established. PATIENT CONCERNS: A 57-year-old woman who was diagnosed with anti-MDA5 Ab-positive cADM complicated with ILD. In October 2016, she was treated with prednisolone (PSL), tacrolimus (TAC), and cyclophosphamide (CY). These treatments were successful, and PSL could be tapered. However, she developed strong nausea and general fatigue as adverse events of CY. In April 2018, PSL was discontinued, and maintenance therapy was given with TAC. In July 2018, Gottron's sign and ILD recurred. Skin lesions on the finger were partially ulcerated and ILD was also worsening. We proposed a remission reinduction therapy including CY. However, she was rejected CY from experience with past adverse event of CY. DIAGNOSIS: Based on skin lesions and chest computed tomography (CT) findings, the diagnosis was a recurrence of anti-MDA5 Ab-positive cADM with ILD. INTERVENTIONS: Treatment by TOF 10 mg and PSL 22.5 mg (0.5 mg/kg equivalent) was introduced in November 2018. OUTCOMES: After introducing TOF and PSL, her skin lesions and chest CT findings of ILD gradually improved. Six months after the induction of TOF, the skin ulcer was epithelialized. One year after the introduction of TOF, PSL was decreased to 9 mg, and the disease activity did not re-exacerbate. LESSONS: This case report is the first report suggesting the effectiveness of TOF for recurrent case of anti-MDA5 Ab-positive cADM with ILD. TOF might be an effective therapeutic option for treating recurrent case of anti-MDA5 Ab-positive cADM.


Asunto(s)
Autoanticuerpos/sangre , Dermatomiositis/tratamiento farmacológico , Helicasa Inducida por Interferón IFIH1/inmunología , Piperidinas/uso terapéutico , Inhibidores de Proteínas Quinasas/uso terapéutico , Pirimidinas/uso terapéutico , Pirroles/uso terapéutico , Dermatomiositis/sangre , Dermatomiositis/inmunología , Femenino , Humanos , Persona de Mediana Edad , Recurrencia
19.
BMJ Case Rep ; 13(9)2020 Sep 15.
Artículo en Inglés | MEDLINE | ID: mdl-32933907

RESUMEN

A 51-year-old woman who presented in June 2010 with acute coronary syndrome (ACS) and anterior wall motion abnormality on the echocardiogram but was found to have an insignificant angiogram. Eight years later she presented again with ACS and evidence of worsening cardiac wall motion affecting a similar territory; however, the angiogram revealing spontaneous coronary artery dissection of the distal left anterior descending artery. Extravascular screening revealed evidence of multifocal fibromuscular dysplasia. We suggest offering vascular screening for fibromuscular dysplasia in young women who present with ACS and normal angiograms, after weighing in risks and benefits.


Asunto(s)
Síndrome Coronario Agudo/complicaciones , Anomalías de los Vasos Coronarios/complicaciones , Displasia Fibromuscular/complicaciones , Enfermedades Vasculares/congénito , Femenino , Humanos , Persona de Mediana Edad , Recurrencia , Enfermedades Vasculares/complicaciones
20.
BMJ Case Rep ; 13(9)2020 Sep 15.
Artículo en Inglés | MEDLINE | ID: mdl-32933910

RESUMEN

Sulfasalazine-induced hypersensitivity syndrome (SIHS) is a serious systemic delayed adverse drug reaction that is associated with significant morbidity and mortality. Here, we report the first case, to our knowledge, of a patient with previously unidentified SIHS who developed a significantly more rapid and extreme recurrence on re-exposure to sulfasalazine. The patient is a 58-year-old woman with asymptomatic Crohn's disease who, 10 days after initiating sulfasalazine, developed fevers, diffuse rash, pancytopenia, hypotension and hepatitis without a definitive source of infection. Sixteen days after her first hospitalisation, she was restarted on sulfasalazine and was readmitted within 10 hours with a similar but more serious presentation, requiring vasopressors. She did recover completely without any further recurrence to date, after definitively discontinuing sulfasalazine. This case demonstrates the importance of recognising SIHS early in patients to prevent re-exposure to sulfasalazine and to ensure timely initiation of appropriate treatment.


Asunto(s)
Síndrome de Hipersensibilidad a Medicamentos/etiología , Sulfasalazina/efectos adversos , Femenino , Humanos , Persona de Mediana Edad , Recurrencia , Retratamiento/efectos adversos
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