RESUMO
Durvalumab is a selective, high-affinity human immunoglobulin monoclonal antibody in a class called check point inhibitors, that blocks PD-L1 on tumour cells. Despite clinical success in increasing progression-free survival rates in patients with stage III non-small-cell lung cancer, durvalumab has been associated with immune-related side effects such as pneumonitis and colitis. We present a case of an 84-year-old woman with acral vasculitis presenting as blue toe syndrome, associated with prolonged use of durvalumab. After 1 year of fortnightly durvalumab therapy postchemoradiation therapy, the patient came in with a left blue big toe, and later developed bilateral livedo racemosa. The diagnosis of durvalumab-associated vasculitis was made and treatment with prednisolone was started with clinical improvement.
Assuntos
Anticorpos Monoclonais/efeitos adversos , Antineoplásicos Imunológicos/efeitos adversos , Síndrome do Artelho Azul/induzido quimicamente , Carcinoma Pulmonar de Células não Pequenas/tratamento farmacológico , Vasculite/induzido quimicamente , Idoso de 80 Anos ou mais , Anticorpos Monoclonais/uso terapêutico , Antineoplásicos Imunológicos/uso terapêutico , Síndrome do Artelho Azul/tratamento farmacológico , Síndrome do Artelho Azul/patologia , Carcinoma Pulmonar de Células não Pequenas/classificação , Feminino , Glucocorticoides/uso terapêutico , Humanos , Neoplasias Pulmonares/patologia , Prednisolona/uso terapêutico , Resultado do Tratamento , Vasculite/tratamento farmacológicoRESUMO
Community-acquired pneumonia (CAP) is a common acute medical illness with a standard, effective treatment that was introduced before the evidenced-based medicine era. Mortality rates have improved in recent decades but improvements have been minimal when compared to other conditions such as acute coronary syndromes. The standardized approach to treatment makes CAP a target for comparative performance and outcome measures. While easy to collect, simplistic outcomes such as mortality, readmission and length of stay are difficult to interpret as they can be affected by subjective choices and health care resources. Proposed clinical- and patient-reported outcomes are discussed below and include measures such as the time to clinical stability (TTCS) and patient satisfaction, which can be compared between health institutions. Strategies to improve these outcomes include use of a risk stratification tool, local antimicrobial guidelines with antibiotic stewardship and care bundles to include early administration of antibiotics and early mobilization.
Assuntos
Infecções Comunitárias Adquiridas/diagnóstico , Infecções Comunitárias Adquiridas/terapia , Pneumonia/diagnóstico , Pneumonia/terapia , Antibacterianos/uso terapêutico , Infecções Comunitárias Adquiridas/mortalidade , Humanos , Tempo de Internação , Satisfação do Paciente , Pneumonia/mortalidade , Resultado do TratamentoRESUMO
This article discusses the effect of the role of the modern matron on healthcare-associated infection (HCAI) and hospital cleanliness. The way the modern matron's role is developing is examined in relation to HCAI in a large acute NHS trust. As set out in Implementing the NHS Plan: Modern Matrons (Department of Health (DH) 2001), the role of modern matron includes a responsibility to lead clinical teams in the prevention of HCAI.
