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1.
Med Clin (Barc) ; 2022 Jul 20.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-35987733

RESUMO

OBJECTIVES: To compare the 30-day outcome (mortality and/or ICU admission) of patients admitted for moderate-severe SARS-CoV-2 pneumonia treated with dexamethasone after the Recovery study versus those treated with weight-adjusted methylprednisolone. METHODS: Retrospective cohort study of 65 patients with moderate-severe pneumonia who received dexamethasone 6 mg/day (DXM group) versus 80 treated with weight-adjusted methylprednisolone (MTPN group). RESULTS: Twenty-one (32.3%) patients in the DXM group died vs. 8 (10%) in the MTPN group (p-value < 0.001) and 29 (44.6%) in the DXM group required ICU admission vs. 2 (2.5%) of the MTPN group (p-value < 0.001). There were no baseline differences regarding sociodemographic characteristics with a higher mean qSOFA in the MTPN group. The hazard ratio for mortality and ICU admission adjusted for age, sex, and admission CRP was 2.189 (1.082-4.426; 95% CI) and 10.589 (2.139-48.347; 95% CI) for the DXM group, respectively, vs. MTPN group. CONCLUSIONS: Mortality and admission to the ICU were lower in patients treated with weight-adjusted methylprednisolone compared to those treated with dexamethasone.

2.
Artigo em Inglês | MEDLINE | ID: mdl-35879177

RESUMO

OBJECTIVE: Evaluate the incidence of pigment epithelial tear when intravitreal delayed-release dexamethasone implant is administered (off-label use) prior to antiangiogenic treatment in pigment epithelium detachments (PED) secondary to neovascular age-related macular degeneration (nAMD) with high-risk rupture characteristics and investigate if it causes a decrease in the PED size. METHODS: Patients with nAMD, PED height >500 microns and Ozurdex implant prior to the antiangiogenic therapy were included. The presence of pigment epithelium rupture in optical coherence tomography scans, best-corrected visual acuity (BCVA) and PED measurements (maximum height and diameter) were registered. RESULTS: The study included 14 eyes of 14 patients: mean age 77 ±â€¯7 years, 11 (79%) females. 25 ±â€¯13 days after the Ozurdex, patients started with at least 3 anti-VEGF monthly injections. BCVA improved from 64 ±â€¯14-69 ±â€¯11 letters after anti-VEGF therapy (p > 0.05). Mean baseline PED height was 817 ±â€¯269 µm, being 639 ±â€¯268 µm after Ozurdex and 370 ±â€¯260 µm after anti-VEGF injections (p = 0.035 and p = 0.009). One retinal pigment epithelium tear occurred (7%). No other adverse effects were reported. CONCLUSIONS: Dexamethasone implant prior to anti-VEGF therapy may represent a promising therapeutic modality for large PED in nAMD, reducing PED dimensions and the risk of pigment epithelium tears prior to anti VEGF therapy.

3.
Infectio ; 26(2): 156-160, Jan.-June 2022. tab
Artigo em Espanhol | LILACS-Express | LILACS | ID: biblio-1356262

RESUMO

Resumen Introducción: La mortalidad por SARS-COV-2 ha disminuido en diferentes países, pero no se ha evaluado si es igual en Colombia, o si se relaciona con las carac terísticas de los pacientes y tratamientos utilizados. Objetivo: Comparar la mortalidad por SARS-COV-2, en dos periodos de tiempo controlando por factores de riesgo asociados con mortalidad. Metodología: Estudio observacional, basado en una cohorte retrospectiva de pacientes con SARS-COV-2 atendidos en el Hospital Universitario San Ignacio, Bogotá (Colombia), desde el 19 de marzo al 12 de noviembre, 2020. Se comparó la tasa de mortalidad intrahospitalaria de los pacientes egresados antes y después del 21 de agosto de 2020 (primer pico de mortalidad en Colombia) y se analizó el impacto del momento de atención controlando por comorbilidades, severidad al ingreso y tratamiento recibido, usando un modelo de regresión logística. Resultados: 1399 pacientes (944 antes y 455 después del primer pico de mortalidad) fueron analizados. La tasa de mortalidad intrahospitalaria global fue similar en ambos periodos (17.6% vs 16.3%, p=0.539). En el análisis multivariado se encontró que la atención en el segundo periodo de tiempo se asoció a menor mortalidad (OR 0.66 IC95% 0.47; 0.93, p=0.018), a diferencia del aumento de la misma asociado a la edad (OR 1.06 IC95% 1.05; 1.07, p<0.001), sexo masculino (OR 1.84 IC95% 1.33; 2.54 p<0.001), cirrosis (OR 1.89 IC95% 1.24; 2.88, p=0.003), enfermedad renal (OR 1.36 IC95% 1.00; 1.83, p=0.043) y el uso de dexametasona (OR 1.53 IC95% 1.03; 2.28, p=0.031). Conclusiones: La tasa de mortalidad intrahospitalaria se redujo después del 21 de agosto durante la primera ola de la pandemia en Bogotá, posiblemente asociado a la mejoría en la capacidad de respuesta del sistema de salud en ese momento, o a un menor inoculo viral de los pacientes infectados. Estos hallazgos pueden cambiar con la saturación del sistema de salud.


Abstract Introduction: Mortality secondary to SARS-COV 2 has decreases around the world, however this has not been evaluated in Colombia neither has the correlation between patient characteristics or treatments. Objective: To compare the mortality due to SARS-COV-2, in two periods of time, controlling risk factors associated with mortality. Methodology: Observational retrospective cohort study of patients with SARS- COV-2 treated at the San Ignacio University Hospital in Bogotá (Colombia), from March 19 to November 12, 2020. The in-hospital mortality rate of patients discharged before and after August 21, 2020 (surge mortality in Colombia) was com pared. The impact of the moment of attention was analyzed controlled by comorbidities, severity at admission and treatment received using a bivariate and multivariate logistic regression model. Results: 1399 patients (944 before and 455 after August 21) were analyzed. The overall in-hospital mortality rate was similar at both times (17.6%vs16.3percentage, p=0.539). In the multivariate analysis, it was found that the moment of attention was associated with lower mortality (OR 0.66 95% CI0.47;0.93,p=0.018), in contrast to its increase associated with age (OR 1.06 95% CI 1.05;1.07,p=<0.001), male sex (OR 1.84 95%CI 1.33;2.54,p=<0.001), cirrhosis (OR1.89 95%CI 1.24;2.88, p=0.003), kidney disease (OR 1.36 95% CI1.00;1.83,p=0.043) and the use of dexamethasone (OR1.53 95%CI 1.03;2.28,p=0.031). Conclusions: The in-hospital mortality rate fell after August 21 during the first wave of the pandemic in Bogotá-Colombia, possibly associated with an improvement in response capacity, or a lower viral inoculum of infected patients. These findings may change with the saturation of the health system

4.
Med Clin (Barc) ; 2022 Apr 25.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-35659421

RESUMO

BACKGROUND AND AIM: The most effective way to control severity and mortality rate of the novel coronavirus disease (COVID-19) is through sensitive diagnostic approaches and an appropriate treatment protocol. We aimed to identify the effect of adding corticosteroid and Tocilizumab to a standard treatment protocol in treating COVID-19 patients with chronic disease through hematological and lab biomarkers. MATERIALS AND METHODS: This study was performed retrospectively on 68 COVID-19 patients with chronic disease who were treated by different therapeutic protocols. The patients were categorized into four groups: control group represented the patients' lab results at admission before treatment protocols were applied; group 1 included patients treated with anticoagulants, Hydroxychloroquine, and antibiotics; group 2 comprised patients treated with Dexamethasone; and group 3 included patients treated with Dexamethasone and Tocilizumab. RESULTS: The WBC and neutrophil counts were increased significantly in group 3 upon the treatment when they were compared with patients in group 1 (p=0.004 and p=0.001, respectively). The comparison of C-reactive Protein (CRP) level at admission was higher in group 3 than in group 1 with p=0.030. After 10 days of treatment, CRP level was decreased in all groups, but in group 3 it was statistically significant (p=0.002). CONCLUSION: The study paves the way into the effectiveness of combining Dexamethasone with Tocilizumab in treatment COVID-19 patients with chronic diseases.

5.
Rev. esp. quimioter ; 35(2): 115-130, abr.-mayo 2022. tab
Artigo em Inglês | IBECS | ID: ibc-205323

RESUMO

The precocity and efficacy of the vaccines developed so far against COVID-19 has been the most significant and saving advance against the pandemic. The development of vaccines has not prevented, during the whole period of the pandemic, the constant search for therapeutic medicines, both among existing drugs with different indications and in the development of new drugs. The Scientific Committee of the COVID-19 of the Illustrious College of Physicians of Madrid wanted to offer an early, simplified and critical approach to these new drugs, to new developments in immunotherapy and to what has been learned from the immune response modulators already known and which have proven effective against the virus, in order to help understand the current situation. (AU)


La precocidad y la eficacia de las vacunas desarrolladas hasta ahora frente al COVID-19, ha sido el avance más significativo y salvador frente a la pandemia. El desarrollo vacunal no ha impedido, durante todo el periodo de la pandemia, la búsqueda constante de remedios terapéuticos, tanto entre los medicamentos ya existentes y con indicaciones diversas, como en el desarrollo de nuevos fármacos. Sobre estos nuevos fármacos, sobre las novedades en la inmunoterapia y sobre lo aprendido de los moduladores de la respuesta inmune ya conocidos y que se han mostrado eficaces frente al virus, el Comité Científico del COVID-19 del Ilustre Colegio de Médicos de Madrid ha querido ofrecer una aproximación precoz, simplificada y critica que pueda ayudar a comprender la situación actual. (AU)


Assuntos
Humanos , Pandemias , Vacinação em Massa , Infecções por Coronavirus/epidemiologia , Imunoterapia , Tratamento Farmacológico
6.
Braz. dent. sci ; 25(1): 1-13, 2022. tab, ilus
Artigo em Inglês | LILACS, BBO - Odontologia | ID: biblio-1353764

RESUMO

Objective: The aim of this study was to provide evidence for comparing the effectiveness of three different routes of local administration of Dexamethasone on the postoperative pain, edema and trismus following surgical removal of impacted mandibular third molar. Material and Methods: Forty-five patients underwent surgical removal of impacted lower third molars and were randomly allocated postoperatively into 3 groups: 8 mg of dexamethasone injected into the submucosa of the vestibule near the surgical site (group I), 8 mg of dexamethasone injected into the pterygomandibular space (group II) and 10 mg of dexamethasone powder applied to the extraction site, after bleeding control (group III). Facial swelling and maximal interincisal opening were measured at preoperatively. Pain was measured by the patient response to a visual analogue scale. Pain perception, Facial edema and trismus were evaluated for one week postoperatively. Results: There was no significant difference between the three groups concerning pain after 1, 2, 5, 7 days of follow up. However, group II showed less pain at 3 and 4 days. The difference between edema measurements was not significant in the three groups at 1, 5, 7 days, though in group I and II edema subsided from day 2. As for trismus, group I and III showed statistically significant lower maximum interincisal opening measurement than group II after two days. Conclusion: Local administration of Dexamethasone through three different routes is beneficial in decreasing postoperative sequelae following third molar surgery. Pterygomandibular space injection of Dexamethasone resulted in earlier resolution of pain, and less facial edema and trismus at the second postoperative day compared to the submucosal injection and transalveolar application. However, at one week the difference in measurements of the three variables between the groups was not significant. (AU)


Objetivo: O objetivo deste estudo foi fornecer evidências para comparar a eficácia de três diferentes vias de administração local de dexametasona na dor pós-operatória, edema e trismo após a remoção cirúrgica do terceiro molar inferior impactado. Material e Métodos: Quarenta e cinco pacientes foram submetidos à remoção cirúrgica de terceiros molares inferiores impactados e distribuídos aleatoriamente no pós-operatório em 3 grupos: 8 mg de dexametasona injetados na submucosa vestíbular próximo ao local da cirurgia (grupo I), 8 mg de dexametasona injetados no espaço pterigomandibular (grupo II) e 10 mg de pó de dexametasona aplicados no local da extração, após o controle do sangramento (grupo III). Edema facial e abertura interincisal máxima foram medidos no pré-operatório. A dor foi medida pela resposta do paciente a uma escala visual analógica. Percepção de dor, edema facial e trismo foram avaliados por uma semana de pós-operatório. Resultados: Não houve diferença significativa entre os três grupos em relação à dor após 1, 2, 5, 7 dias de acompanhamento. No entanto, o grupoII mostrou menos dor em 3 e 4 dias. A diferença entre as medidas de edema não foi significativa nos três grupos em 1, 5, 7 dias, embora nos grupos I e II o edema cedeu a partir do dia 2. Quanto ao trismo, os grupos I e III apresentaram medida de abertura interincisal máxima inferior estatisticamente significativa do que o grupo II depois de dois dias. Conclusão: A administração local de dexametasona por três vias diferentes é benéfica na redução das sequelas pós-operatórias após a cirurgia do terceiro molar. A injeção de dexametasona no espaço pterigomandibular resultou na resolução mais precoce da dor e menos edema facial e trismo no segundo dia de pós-operatório em comparação com a injeção submucosa e a aplicação transalveolar. No entanto, em uma semana, a diferença nas medidas das três variáveis entre os grupos não foi significativa.(AU)


Assuntos
Humanos , Cirurgia Bucal , Dexametasona , Dente Serotino
7.
Rev. cir. traumatol. buco-maxilo-fac ; 21(4): 6-13, out.-dez. 2021. ilus
Artigo em Português | LILACS, BBO - Odontologia | ID: biblio-1391244

RESUMO

Complicações pós-operatórias como edema, dor e trismo são comuns em cirurgias orais. Terapias, como o uso de analgésicos e anti-inflamatórios, são indicadas para estas complicações. No entanto, intervenções pré-operatórias podem ser alternativas. Desta forma, o presente estudo avaliou o efeito da dexametasona no edema, intensidade de dor e abertura de boca (trismo) no pós-operatório de retirada de terceiros molares inferiores. Pacientes (n=14, 9 mulheres) foram incluídos em um estudo clínico, cruzado, cego, randomizado, placebo-controlado e boca dividida. Pacientes receberam aleatoriamente medicação preemptiva (dexametasona 8mg, intramuscular, músculo masseter) ou placebo (soro fisiológico) uma hora antes da primeira cirurgia. O procedimento contralateral foi realizado 21 dias após. Avaliou se o edema e a abertura bucal nos momentos pré-operatórios e no 3º e 7º dias pós-operatórios, além de dor espontânea (imediatamente, 2 e 24 horas, 3 dias e 7 dias). Os dados foram analisados usando anova de medidas repetidas seguida do teste post hoc LSD de Fisher. Comparado ao placebo, a medicação reduziu edema (3 dias), dor (2 e 24 horas) e trismo (3 dias). Os resultados sugerem que o uso preemptivo da dexametasona intramuscular é capaz de aumentar o bem-estar dos pacientes submetidos a cirurgias orais, tendo o potencial de reduzir os custos pós-operatórios... (AU)


Postoperative complications such as edema, pain, and trismus are common in oral surgery. Therapies, such as the use of painkillers and anti inflammatory drugs, are indicated for the reversal of these complications. However, preoperative (preemptive) interventions can be alternatives. Thus, the present study aimed to evaluate the effect of dexamethasone on edema, pain intensity, and mouth opening (trismus) in the postoperative period of removal of impacted lower third molars. Patients (n = 14, 9 women) were included in a clinical, crossover, blinded, randomized, placebo-controlled, and divided mouth study. Preemptive mediation (dexamethasone 8mg, intramuscular, masseter muscle) or placebo (saline) was randomly given before the first surgery. The contralateral procedure was performed 21 days later. In the postoperative period, edema, mouth opening (preoperative, 3 and 7 days), and spontaneous pain (immediately, 2 and 24 hours, 3 days and 7 days) were analyzed. The data were analyzed using the one-way repeated measures ANOVA followed by Fisher's LSD post hoc. Compared to placebo, the medication reduced edema (3 days), pain (2 and 24 hours), and trismus (3 days). The results suggest that the preemptive use of dexamethasone is able to increase the well-being of patients undergoing oral surgeries, with the potential to reduce postoperative costs... (AU)


Las complicaciones posoperatorias como hinchazón, dolor y trismo son comunes en las cirugías orales. Las terapias, como el uso de analgésicos y antiinflamatorios, están indicadas para estas complicaciones. Sin embargo, las intervenciones preoperatorias pueden ser alternativas. Así, el presente estudio evaluó el efecto de la dexametasona sobre el edema, la intensidad del dolor y la apertura de la boca (trismo) en el postoperatorio de remoción del tercer molar inferior. Los pacientes (n = 14, 9 mujeres) se incluyeron en un estudio clínico, cruzado, ciego, aleatorizado, controlado con placebo y de boca dividida. Los pacientes recibieron aleatoriamente medicación preventiva (8 mg de dexametasona, intramuscular, músculo masetero) o placebo (solución salina) una hora antes de la primera cirugía. El procedimiento contralateral se realizó 21 días después. Se evaluó el edema y la apertura de la boca en el preoperatorio y en el tercer y séptimo días postoperatorios, además del dolor espontáneo (inmediato, 2 y 24 horas, 3 días y 7 días). Los datos se analizaron utilizando anova de medidas repetidas seguido de la prueba post hoc de LSD de Fisher. En comparación con el placebo, el medicamento redujo el edema (3 días), el dolor (2 y 24 horas) y el trismo (3 días). Los resultados sugieren que el uso preventivo de dexametasona intramuscular puede aumentar el bienestar de los pacientes sometidos a cirugía oral, con el potencial de reducir los costos posoperatorios... (AU)


Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Dor , Dor Pós-Operatória , Complicações Pós-Operatórias , Período Pós-Operatório , Cirurgia Bucal , Trismo , Dexametasona , Dente Serotino , Medição da Dor , Edema , Analgésicos , Anti-Inflamatórios , Dente Molar , Dente Serotino/cirurgia
8.
Rev. peru. med. exp. salud publica ; 38(4): 608-614, oct.-dic. 2021. tab, graf
Artigo em Espanhol | LILACS-Express | LILACS | ID: biblio-1365941

RESUMO

Resumen Con el objetivo de evaluar las tendencias en el uso de fármacos en pacientes con la COVID-19 de un hospital del Perú durante la primera ola de la pandemia se realizó un estudio retrospectivo entre abril y septiembre del 2020. Se revisaron las historias clínicas de pacientes hospitalizados por neumonía por COVID-19 en el Hospital Nacional Dos de Mayo (Lima, Perú). De un total de 3103 pacientes, se incluyeron 381 historias clínica (77,4% varones y mediana de edad de 44 años). Se observó un incremento del uso de cuatro fármacos prehospitalarios (azitromicina, ivermectina, corticoides y ceftriaxona), y una disminución del uso de seis fármacos intrahospitalarios (ceftriaxona, azitromicina, hidroxicloroquina, ivermectina, pulso de corticoides y anticoagulación profiláctica); además, el uso de anticoagulación intrahospitalaria aumentó. Estos hallazgos sugieren que el manejo de la COVID-19 varió durante la primera ola de la pandemia, aumentando el uso de fármacos prehospitalarios y disminuyendo el uso de fármacos intrahospitalarios.


Abstract This study aimed to evaluate the pharmacological trends in patients with COVID-19 from a hospital in Peru during the first wave of the pandemic. Retrospective study conducted between April and September 2020. The medical records of patients hospitalized for COVID-19 pneumonia at the Dos de Mayo National Hospital (Lima, Peru) were reviewed. Of a total of 3103 patients, 381 medical records were included (77.4% male, median age: 44 years). The use of four prehospital drugs increased (azithromycin, ivermectin, corticosteroids, and ceftriaxone), while the in-hospital use of six drugs (ceftriaxone, azithromycin, hydroxychloroquine, ivermectin, corticosteroid pulse, and prophylactic anticoagulation) decreased and in-hospital anticoagulation use decreased. These findings suggest that the management of COVID-19 has varied during the first wave of the pandemic, typically increasing prehospital drug use and decreasing inpatient use.

9.
Artigo em Espanhol | LILACS-Express | LILACS | ID: biblio-1385845

RESUMO

RESUMEN: La exodoncia de terceros molares incluidos conlleva la mayoría de las veces un cuadro inflamatorio agudo, dolor postoperatorio y trismus. En la actualidad, se han propuesto diversos protocolos farmacológicos con el fin de prevenir estas complicaciones, donde los más utilizados son los analgésicos y corticoides. Comparar Dexametasona y Ketoprofeno endovenoso previo a la cirugía de terceros molares mandibulares incluidos, en el control del edema, dolor y trismus. Se realizó un estudio experimental, analítico de corte transversal, autorizado por el comité de ética de la Universidad Andrés Bello. Se escogieron 30 sujetos que requerían exodoncia de terceros molares mandibulares incluidos, de forma aleatoria 15 sujetos recibieron Dexametasona 4 mg endovenoso y 15 Ketoprofeno 200 mg endovenoso 30 minutos antes de la intervención. El procedimiento quirúrgico fue estandarizado, se evaluó el edema facial, trismus y dolor postquirúrgico a los 2 y 7 días terminada la cirugía. Se presentó una diferencia estadísticamente significativa solo en 2 mediadas faciales, de las 5 tomadas, al comparar el porcentaje de edema a los 7 días postoperatorias entre ambos grupos experimentales. La mayoría del grupo Dexametasona presentó un edema de mayor volumen en comparación al grupo Ketoprofeno. En relación al dolor y trismus, sólo se observan diferencias significativas en la intensidad del dolor evaluada a los 7 días, siendo mayor en el grupo Ketoprofeno. En las otras variables medidas, la presencia de odontosección en la cirugía generó una diferencia estadísticamente significativa, siendo mayor el edema en los que se les realizó odontosección. Esta diferencia se vio principalmente en el grupo Ketoprofeno evaluado a los 2 días postoperatorios. El uso de cualquiera de los 2 fármacos está bien indicado para aliviar el dolor e inflamación en este tipo de cirugía. Pese a que el grupo tratado con Dexametasona presentó menor dolor, no fue una diferencia significativa en comparación al grupo con Ketoprofeno.


ABSTRACT: The extraction of included third molars most of the time involves an acute inflammatory picture, postoperative pain and trismus. At present, various pharmacological protocols have been proposed in order to prevent these complications, where the most widely used are analgesics and corticosteroids. Compare Dexamethasone and Ketoprofen used intravenously prior to surgery of mandibular third molars included, in the control of edema, pain and trismus. An experimental, analytical, cross- sectional study was carried out, authorized by the ethics committee of the Andrés Bello University. Thirty subjects who required extraction of included mandibular third molars were chosen, 15randomly received intravenous Dexamethasone 4 mg and 15 intravenous Ketoprofen 200 mg 30 minutes before the intervention. The surgical procedure was standardized, facial edema, trismus and postoperative pain were evaluated at 2 and 7 days after the surgery. There was a statistically significant difference only in 2 facial measures, of the 5 taken, when comparing the percentage of edema at 7 postoperative days between both experimental groups. Most of the Dexamethasone group had a larger volume ede- ma compared to the Ketoprofen group. In relation to pain and trismus, significant differences were only observed in the intensity of pain evaluated at 7 days, being greater in the Ketoprofen group. In the other variables measured, the presence of a dental section in the surgery generated a statistically significant difference, with the edema being greater in those who underwent a dental section. This difference was mainly seen in the Ketoprofen group evaluated at 2 postoperative days. The use of any of the 2 drugs is well indicated to alleviate the pain and inflammation of the patient generated by the trauma caused by this type of surgery. Although the group treated with Dexamethasone presented less pain, it was not a significant difference compared to the group with Ketoprofen.

10.
Arch Soc Esp Oftalmol (Engl Ed) ; 96(10): 549-551, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34620485

RESUMO

CLINICAL CASE: 49-year-old man with diabetic macular edema refractory to antiangiogenics, it is decided to perform therapy with intravitreal dexamethasone implant (Ozurdex; Allergan, California, United States of America). Seven days after treatment, he showed acute endophthalmitis suggestive signs. Despite the intravitreal injection of antibiotics, the patient got worse. Vitreous sampling was repeated for Gram and cultures, and vitrectomy was performed via pars plana. The culture suggested the development of Brevibacterium species. Through an additional test, the presence of Brevibacterium casei was confirmed. Despite the treatment adjusted by antibiogram, retinal ischemia and macular atrophy was evident. DISCUSSION: Brevibacterium casei is a Gram-positive bacterium, barely pathogenic, that mainly affects immunodepressed patients. Only two cases of endophthalmitis are described, one endogenous and the other one secondary to vegetal trauma. This is the first case of endophthalmitis, secondary to an ophthalmological procedure.


Assuntos
Brevibacterium , Retinopatia Diabética , Endoftalmite , Edema Macular , Dexametasona/uso terapêutico , Implantes de Medicamento , Endoftalmite/tratamento farmacológico , Humanos , Edema Macular/tratamento farmacológico , Masculino , Pessoa de Meia-Idade
11.
Rev Clin Esp (Barc) ; 221(10): 592-595, 2021 12.
Artigo em Inglês | MEDLINE | ID: mdl-34563488

RESUMO

INTRODUCTION: The effect of dexamethasone in the initial phase of infection by SARS-CoV-2 and its influence on COVID-19 is not well defined. We describe clinical-radiological characteristics, the cytokine storm parameters, and the clinical evolution of a series of patients treated with dexamethasone in the disease's initial phase. METHOD: A study of 8 patients who received dexamethasone before the development of COVID-19. We evaluate clinical variables, imaging tests, cytokine release parameters, treatment used and patient evolution. RESULTS: All patients received a 6 mg/day dose with a mean duration of 4.5 days before admission. High resolution computed tomography (HRCT) revealed that most of them presented a severe extension; most patients had a slightly elevated level of cytokine release parameters. Three patients required high-flow oxygen therapy due to respiratory failure; none required orotracheal intubation or died. CONCLUSION: Dexamethasone in the early stages of SARS-CoV-2 infection appears to be associated with severe COVID-19.


Assuntos
COVID-19 , COVID-19/tratamento farmacológico , Síndrome da Liberação de Citocina , Dexametasona , Humanos , SARS-CoV-2
12.
Rev. bras. oftalmol ; 80(2): 140-142, Mar.-Apr. 2021. graf
Artigo em Inglês | LILACS | ID: biblio-1280115

RESUMO

ABSTRACT This report aims to describe the effectiveness of a unilateral intravitreal dexamethasone implant (Ozurdex®) used for the treatment of cystoid macular edema in a patient with recurrent intermediate uveitis. Bearing in mind the adverse effects of the prolonged use of systemic corticosteroids, the objective here was to provide a less damaging form of intervention, and also to demonstrate the safety of the dexamethasone implant for patients who fail to respond to conventional treatment. In the present case, there was bilateral improvement in retinal anatomy and function with use of the unilateral intravitreal dexamethasone implant (Ozurdex®).


RESUMO Neste estudo, o objetivo foi descrever, a partir de um relato de caso, a eficácia do uso de implante de dexametasona intravítrea (Ozurdex®) unilateral, para o tratamento de edema macular cistoide, em um paciente com quadro de uveíte intermediária recorrente, visando uma terapêutica menos lesiva, diante dos efeitos colaterais do uso prolongado de corticoesteroides sistêmicos, demonstrando também a segurança desse tratamento alternativo para aqueles pacientes que se apresentam refratários a terapêutica tradicional. No caso relatado, vale ressaltar a melhora bilateral da anatomia e função retiniana com o implante unilateral de dexametasona intravítrea (Ozurdex®).


Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Dexametasona/administração & dosagem , Uveíte Intermediária/complicações , Edema Macular/etiologia , Edema Macular/tratamento farmacológico , Acuidade Visual , Uveíte Intermediária/diagnóstico , Edema Macular/diagnóstico , Tomografia de Coerência Óptica , Implantes de Medicamento/administração & dosagem , Injeções Intravítreas
13.
Cir Cir ; 89(1): 77-82, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33498066

RESUMO

OBJECTIVE: To evaluate the association of the moment of administration of intratympanic dexamethasone with the auditory results in patients with sudden idiopathic hearing loss. METHOD: An observational, longitudinal, analytical, retrospective study on patients treated for sudden idiopathic hearing loss with dexamethasone sodium phosphate as initial management. Auditory threshold, auditory gain (dB) and percentage of patients who improved from those who started treatment in the first week (group 1S) versus those started management from the second week (group 2S) are compared. A p < 0.05 was considered significant. RESULTS: 101 cases (37 males and 64 female) were included. Before disease, patients had similar auditory function, after treatment patients in group 1S had significantly better phonetic discrimination than those in group 2S (33.9 ± 18.3 vs. 43.6 ± 26.1 dB; p = 0.036) hearing gain in group 1S was 32.0±11.9 dB and in group 2S was 18.2 ± 9.5 dB (p < 0.001). 93.5% of those who started treatment the first week had auditory improvement while only 61.8% in second week (p < 0.001). CONCLUSIONS: Intratympanic dexamethasone sodium phosphate administered in the first week was more effective in inducing better phonetic discrimination in most cases and is safe than in the second week.


OBJETIVO: Evaluar la asociación del momento de administración de dexametasona intratimpánica con los resultados auditivos en pacientes con hipoacusia súbita idiopática. MÉTODO: Estudio observacional, longitudinal, analítico y retrospectivo de pacientes tratados por hipoacusia súbita idiopática con fosfato sódico de dexametasona como manejo inicial. Se compararon el umbral auditivo, la ganancia auditiva (dB) y el porcentaje de pacientes que mejoraron de los que iniciaron tratamiento en la primera semana (grupo 1S) y aquellos que lo iniciaron a partir de la segunda semana (grupo 2S). Se consideró significativo un valor de p < 0.05. RESULTADOS: Se incluyeron 101 pacientes (37 hombres y 64 mujeres). Antes de la enfermedad, los pacientes tenían una función auditiva similar. Tras el tratamiento, los pacientes del grupo 1S tuvieron significativamente mejor discriminación fonética que los del grupo 2S (33.9 ± 18.3 vs. 43.6 ± 26.1 dB; p = 0.036). La ganancia auditiva en el grupo 1S fue de 32.0 ± 11.9 dB y en el grupo 2S fue de 18.2 ± 9.5 dB (p < 0.001). El 93.5% de los que iniciaron tratamiento la primera semana tuvieron mejora auditiva y el 61.8% en la segunda semana (p < 0.001). CONCLUSIONES: El fosfato sódico de dexametasona intratimpánico administrado en la primera semana, en comparación con la segunda semana, fue más eficaz e indujo mejor discriminación fonética en la mayoría de los casos.


Assuntos
Dexametasona , Perda Auditiva Neurossensorial , Audiometria de Tons Puros , Feminino , Glucocorticoides , Perda Auditiva Neurossensorial/tratamento farmacológico , Humanos , Masculino , Estudos Retrospectivos , Resultado do Tratamento
15.
Med Clin (Barc) ; 156(1): 7-12, 2021 01 08.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-33129511

RESUMO

OBJECTIVE: To analyze whether there is an association between the use glucocorticoids at high doses, and the evolution of saturation/fraction of inspired oxygen (SAFI) or time to discharge, in patients hospitalized with COVID-19. METHODS: This was an observational study on a cohort of 418 patients admitted to three regional hospitals in Catalonia, Spain. As primary outcomes, we studied the evolution of SAFI in the first 48hours of treatment and the time to discharge. The results were compared between patients treated and untreated with glucocorticoids (methylprednisolone 1-2mg/kg/day o dexamethasone 20-40mg/day) through sub-cohort analyses matched for multiple clinical and prognostic factors, as well as through Cox multivariate models adjusted for prognostic factors. The simultaneous use of different treatments for COVID-19 was taken into account, both in sub-cohorts matching and in Cox regression. RESULTS: There were 187 patients treated with glucocorticoids; of these, 25 patients could be matched with an equivalent number of control patients. In the analysis of these matched sub-cohorts, no significant difference was observed in time to discharge (log-rank: p=0.291) or the increment in SAFI at 48hours of treatment (glucocorticoides: -0.04; controls: +0.37; p=0.095). Multivariate models using Cox regression showed a significantly longer time to discharge in patients treated with glucocorticoids (hazard ratio: 7.26; 95% IC: 3.30-15.95). CONCLUSIONS: We have not found improvement in respiratory function or time until discharge, associated with the use of glucocorticoids at high doses.


Assuntos
Anti-Inflamatórios/administração & dosagem , COVID-19/tratamento farmacológico , Dexametasona/administração & dosagem , Tempo de Internação/estatística & dados numéricos , Metilprednisolona/administração & dosagem , Oxigênio/metabolismo , Adulto , Idoso , Idoso de 80 Anos ou mais , Anti-Inflamatórios/uso terapêutico , Biomarcadores/metabolismo , COVID-19/metabolismo , COVID-19/fisiopatologia , Dexametasona/uso terapêutico , Relação Dose-Resposta a Droga , Feminino , Seguimentos , Humanos , Estimativa de Kaplan-Meier , Masculino , Metilprednisolona/uso terapêutico , Pessoa de Meia-Idade , Alta do Paciente/estatística & dados numéricos , Modelos de Riscos Proporcionais , Testes de Função Respiratória , Resultado do Tratamento
16.
Einstein (Säo Paulo) ; 19: eAO6177, 2021. tab
Artigo em Inglês | LILACS | ID: biblio-1345972

RESUMO

ABSTRACT Objective The aim of this study was to evaluate patients with complete response of oral chronic graft-versus-host disease to immunosuppressive treatment. Methods A total of 29 patients submitted to allogeneic hematopoietic stem cell transplantation, with oral chronic graft-versus-host disease, were enrolled in this retrospective study, from September 2012 to February 2018. Patients were treated with combined topical dexamethasone solution and topical tacrolimus ointment, combined topical dexamethasone and topical tacrolimus, systemic immunosuppressive medication, and topical dexamethasone only. Results The mean time of complete response of lichenoid lesions, erythema, and ulcers using dexamethasone and systemic immunosuppressive medication was of 105, 42 and 42 days, respectively (p=0.013).When we associated dexamethasone, tacrolimus and systemic immunosuppressive medication, the mean time of complete response of lichenoid lesions, erythema and ulcers was of 91,84 and 77 days (p=0.011). When dexamethasone was used alone, the mean time of complete response of lichenoid lesions, erythema and ulcers was 182, 140, 21 days, respectively (p=0.042). Conclusion Our study shows that lichenoid lesions require more time to heal. Notably, lichenoid lesions tend to respond better to dexamethasone combined with tacrolimus and systemic immunosuppressive medication, whereas erythema and ulcers respond better to dexamethasone combined with systemic immunosuppressive medication and dexamethasone only, respectively.


RESUMO Objetivo Avaliar os pacientes com resposta completa da doença do enxerto contra hospedeiro crônica oral ao tratamento com imunossupressor. Métodos Vinte e nove pacientes submetidos ao transplante alogênico de células tronco hematopoiéticas, com doença do enxerto contra hospedeiro crônica oral, foram incluídos neste estudo retrospectivo, de setembro de 2012 a fevereiro de 2018. Os pacientes foram tratados com dexametasona para bochecho associada ao tacrolimo pomada, dexametasona para bochecho associada ao tacrolimo tópico, tratamento imunossupressor sistêmico, e dexametasona tópica apenas. Resultados O tempo médio para resposta completa das lesões liquenoides, eritema e ulcerações usando dexametasona e imunossupressor sistêmico foi de 105, 42 e 42 dias, respectivamente (p=0,013). Quando a dexametasona estava associada ao tacrolimo e a medicação imunossupressora sistêmica, o tempo médio para resposta completa das lesões liquenóides, eritema e ulcerações foi de 91, 84 e 77 dias (p=0,011). Quando foi utilizada apenas dexametasona, o tempo médio para resposta completa das lesões liquenoides, eritema e ulcerações foi de 182, 140 e 21 dias, respectivamente (p=0,042). Conclusão Nosso estudo mostra que as lesões liquenoides requerem mais tempo para cicatrização completa. É notável que as lesões liquenoides tendem a responder melhor ao tratamento da dexametasona combinada com o tacrolimo e o imunossupressor sistêmico. Já o eritema e as ulcerações respondem melhor à dexametasona combinada com medicação imunossupressora sistêmica, e dexametasona apenas, respectivamente.


Assuntos
Humanos , Doença Enxerto-Hospedeiro/tratamento farmacológico , Doenças da Boca , Doença Crônica , Estudos Retrospectivos , Tacrolimo , Imunossupressores
17.
Rev. argent. salud publica ; 13(Suplemento COVID-19): 1-2, 2021.
Artigo em Espanhol | LILACS, BINACIS, ARGMSAL | ID: biblio-1177597

RESUMO

La dexametasona es, en la actualidad, uno de los pocos tratamientos que ha demostrado ser efectivo en los pacientes con neumonía moderada o grave por el nuevo coronavirus 2019. Una dosis de 6 mg/día de dexametasona base durante 10 días ha demostrado disminuir de manera significativa la mortalidad en estos pacientes. En Argentina, existen diferentes presentaciones comerciales de dexametasona para la administración por vía intravenosa, que contienen distintas sales (dexametasona fosfato sódico y dexametasona fostato ácido). Por este motivo, es importante conocer cuál es la equivalencia de estas presentaciones en relación con la dexametasona base, con el objetivo de asegurar la administración de la dosis de 6 mg/día que demostró disminuir la mortalidad


Assuntos
Argentina , Dexametasona , Mortalidade , Infecções por Coronavirus
18.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-33281014

RESUMO

CLINICAL CASE: A 49-year-old man with diabetic macular edema refractory to antiangiogenics was treated with intravitreal dexamethasone implant (Ozurdex; Allergan, California, USA). Seven days after treatment, he showed acute endophthalmitis suggestive signs. Despite the intravitreal injection of antibiotics, the patient got worse. Vitreous sampling was repeated for Gram and cultures, and vitrectomy was performed via pars plana. The culture suggested the development of Brevibacterium species. Through an additional test, the presence of Brevibacterium casei was confirmed. Despite the treatment adjusted by antibiogram, retinal ischemia and macular atrophy was evident. DISCUSION: Brevibacterium casei is a Gram-positive bacterium, barely pathogenic, that mainly affects immunodepressed patients. Only two cases of endophthalmitis are described, one endogenous and the other one secondary to vegetal trauma. This is the first case of Brevibacterium casei endophthalmitis, secondary to an ophthalmological procedure.

19.
Rev. cuba. anestesiol. reanim ; 19(3): e629, sept.-dic. 2020. tab
Artigo em Espanhol | LILACS, CUMED | ID: biblio-1138880

RESUMO

Introducción: Las náuseas y vómitos posoperatorios son una secuela no deseada durante la etapa de recuperación anestésica. Objetivo: Evaluar la utilidad de la dexametasona en comparación con el ondansetrón para la prevención de las náuseas y vómitos posoperatorios después de procedimientos quirúrgicos ginecológicos mayores, bajo anestesia general orotraqueal. Método: Se realizó un estudio observacional analítico, prospectivo, en 84 pacientes mayores de 19 años, en el Hospital Clínico Quirúrgico Miguel Enríquez desde octubre de 2018 hasta septiembre de 2019, divididas de forma secuencial, en orden de llegada a la unidad quirúrgica, en dos grupos. Al grupo 1 se le administró dexametasona (4 mg endovenosa); al grupo 2 (4 mg de ondansetrón), 30 min antes de finalizar la cirugía. Resultados: Predominó de forma significativa el riesgo medio de náuseas y vómitos posoperatorios en los pacientes con edades comprendidas entre 41 y 50 años. Predominó la condición de excelente y buena (pgt;0,05) en cuanto a la efectividad del tratamiento profiláctico. La cefalea prevaleció de forma significativa en el grupo 2. La mayor parte de las pacientes no presentó eventos adversos. Conclusiones: El ondansetrón y la dexametasona son útiles para la profilaxis de las náuseas y vómitos posoperatorios en pacientes intervenidas de cirugía mayor ginecológica, bajo anestesia general orotraqueal por lo que se considera un tratamiento seguro, con eventos adversos leves y de fácil control(AU)


Introduction: Postoperative nausea and vomiting are an unwanted sequel during the anesthetic recovery stage. Objective: To evaluate the usefulness of dexamethasone compared with ondansetron for the prevention of postoperative nausea and vomiting after major gynecological surgical procedures, under general orotracheal anesthesia. Method: A prospective, analytical and observational study was carried out with 84 patients older than 19 years of age, at Miguel Enríquez Hospital Clinical-Surgical Hospital, from October 2018 to September 2019, divided sequentially, in order of arrival at the surgical unit, into two groups. The group 1 was administered dexamethasone (4 mg intravenously), and the group 2 was administered ondansetron (4 mg), 30 min before the end of the surgery. Results: The average risk of postoperative nausea and vomiting prevailed significantly among patients aged 41-50 years. Excellent and good conditions predominated (pgt;0.05) in terms of effectiveness of prophylactic treatment. Headache prevailed significantly in the group 2. Most of the patients did not present adverse events. Conclusions: Ondansetron and dexamethasone are useful for postoperative nausea and vomiting prophylaxis among patients who received major gynecological surgery, under general orotracheal anesthesia, a reason why it is considered a safe treatment, with mild adverse events and easy control(AU)


Assuntos
Humanos , Feminino , Ondansetron/uso terapêutico , Náusea e Vômito Pós-Operatórios/tratamento farmacológico , Anestesia Geral , Procedimentos Cirúrgicos em Ginecologia , Dexametasona/uso terapêutico , Estudos Prospectivos , Náusea e Vômito Pós-Operatórios/prevenção & controle
20.
Rev. bras. anestesiol ; 70(6): 588-594, Nov.-Dec. 2020. tab, graf
Artigo em Inglês, Português | LILACS | ID: biblio-1155777

RESUMO

Abstract Background and objectives: In shoulder arthroscopy, on an outpatient basis, the patient needs a good control of the postoperative pain that can be achieved through regional blocks. Perineural dexamethasone may prolong the effect of these blocks. The aim of this study was to evaluate the effect of perineural dexamethasone on the prolongation of the sensory block in the postoperative period for arthroscopic shoulder surgery in outpatient setting. Methods: After approval by the Research Ethics Committee and informed consent, patients undergoing arthroscopic shoulder surgery under general anesthesia and ultrasound-guided interscalene brachial plexus block were randomized into Group D - blockade performed with 30 mL of 0.5% levobupivacaine with vasoconstrictor and 6 mg (1.5 mL) of dexamethasone and Group C - 30 mL of 0.5% levobupivacaine with vasoconstrictor and 1.5 mL of 0.9% saline. The duration of the sensory block was evaluated in 4 postoperative moments (0, 4, 12 and 24 hours) as well as the need for rescue analgesia, nausea and vomiting incidence, and Visual Analog Pain Scale (VAS). Results: Seventy-four patients were recruited and 71 completed the study (Group C, n = 37; Group D, n = 34). Our findings showed a prolongation of the mean time of the sensitive blockade in Group D (1440 ± 0 min vs. 1267 ± 164 min, p < 0.001). It was observed that Group C had a higher mean pain score according to VAS (2.08 ± 1.72 vs. 0.02 ± 0.17, p < 0.001) and a greater number of patients (68.4% vs. 0%, p < 0.001) required rescue analgesia in the first 24 hours. The incidence of postoperative nausea and vomiting was not statistically significant. Conclusion: Perineural dexamethasone significantly prolonged the sensory blockade promoted by levobupivacaine in interscalene brachial plexus block, reduced pain intensity and rescue analgesia needs in the postoperative period.


Resumo Justificativa e objetivos: Na artroscopia de ombro em regime ambulatorial, o paciente necessita de um bom controle da dor pós-operatória, que pode ser conseguido por meio de bloqueios regionais. A dexametasona perineural pode prolongar o efeito desses bloqueios. O objetivo deste estudo foi avaliar o efeito da dexametasona perineural quanto ao prolongamento do bloqueio sensitivo no período pós-operatório para cirurgia artroscópica de ombro em regime ambulatorial. Métodos: Após aprovação do Comitê de Ética em Pesquisa e consentimento informado, foram incluídos no estudo pacientes submetidos a cirurgia artroscópica de ombro sob anestesia geral e bloqueio de plexo braquial interescalênico guiado por ultrassonografia. Eles foram randomizados nos Grupo D - bloqueio com 30 mL de levobupivacaína 0,5% com vasoconstritor e 6 mg (1,5 mL) de dexametasona, e Grupo C - bloqueio com 30 mL de levobupivacaína 0,5% com vasoconstritor e 1,5 mL solução salina. A duração do bloqueio sensitivo foi avaliada em quatro momentos pós-operatórios (0, 4, 12 e 24 horas), assim como a necessidade de analgesia de resgate, incidência de náuseas e vômitos e Escala Visual Analógica de Dor (EVA). Resultados: Setenta e quatro pacientes foram randomizados e 71 completaram o estudo (Grupo C, n = 37; Grupo D, n = 34). Observou-se um prolongamento do tempo médio de bloqueio sensitivo no Grupo D (1440 ± 0 min vs. 1267 ± 164 min; p< 0,001). Pacientes do Grupo C apresentaram maior média de escore de dor de acordo com a EVA (2,08 ± 1,72vs. 0,02 ± 0,17; p< 0,001) e um maior número de pacientes solicitou analgesia de resgate nas primeiras 24 horas (68,4%vs.0%; p< 0,001). A incidência de náuseas e vômitos não foi estatisticamente significante. Conclusão: A dexametasona perineural prolongou significativamente o bloqueio sensitivo da levobupivacaína no bloqueio de plexo braquial interescalênico, reduziu a intensidade de dor e a necessidade de analgesia de resgate pelo paciente no período pós-operatório.


Assuntos
Humanos , Masculino , Feminino , Artroscopia/métodos , Articulação do Ombro/cirurgia , Dexametasona/administração & dosagem , Ultrassonografia de Intervenção/métodos , Bloqueio do Plexo Braquial/métodos , Anti-Inflamatórios/administração & dosagem , Dor Pós-Operatória/diagnóstico , Dor Pós-Operatória/tratamento farmacológico , Artroscopia/efeitos adversos , Fatores de Tempo , Vasoconstritores/administração & dosagem , Medição da Dor , Método Duplo-Cego , Estudos Prospectivos , Análise de Variância , Náusea e Vômito Pós-Operatórios/epidemiologia , Solução Salina/administração & dosagem , Levobupivacaína , Analgesia , Anestésicos Locais , Pessoa de Meia-Idade
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