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1.
Medicine (Baltimore) ; 100(2): e24231, 2021 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-33466204

RESUMO

INTRODUCTION: Thrombocytopenia (TP) is a common complication of childhood-onset systemic lupus erythematosus (SLE), and can range from mild to life-threatening. However, severe TP with multiple hemorrhagic complications is very rare and often predicts a poor prognosis. We describe a 12-year-old Chinese girl who had a history of idiopathic thrombocytopenic purpura who developed SLE that presented as subdural hemorrhage and retinal hemorrhage because of severe TP. PATIENT CONCERNS: A 12-year-old girl was admitted into our hospital because of fever, purpura, and gum bleeding lasting for 12 days. She had a history of idiopathic thrombocytopenic purpura 2 years ago previously. DIAGNOSIS: SLE was diagnosed according to American College of Rheumatology classification criteria. Subdural hemorrhage and retinal hemorrhage were diagnosed based on brain MRI and funduscopy. Severe TP was defined as platelet count <20 × 109/L. INTERVENTIONS: She was treated first with intravenous immunoglobulin, but it was not efficacious. High-dose methylprednisolone showed short-term efficacy. Then, she was given a glucocorticoid and cyclosporine A plus mycophenolate mofetil. OUTCOMES: Fever, purpura, and gum bleeding were resolved before hospital discharge. Subdural hemorrhage and left hemorrhagic retinopathy were improved remarkably. She had a durable response to refractory TP with no adverse effects during >1-year follow-up. CONCLUSION: Isolated TP may be an early symptom of childhood-onset SLE . A child with severe TP is prone to develop life-threatening hemorrhagic complications. Glucocorticoids and combined immunosuppressive drugs had a durable response to refractory TP in this patient with no adverse effects.


Assuntos
Glucocorticoides/uso terapêutico , Hematoma Subdural/tratamento farmacológico , Imunossupressores/uso terapêutico , Lúpus Eritematoso Sistêmico/complicações , Hemorragia Retiniana/tratamento farmacológico , Criança , Ciclosporina/uso terapêutico , Feminino , Hematoma Subdural/etiologia , Humanos , Imunoglobulinas Intravenosas/uso terapêutico , Metilprednisolona/uso terapêutico , Ácido Micofenólico , Púrpura Trombocitopênica Idiopática/etiologia , Hemorragia Retiniana/etiologia
2.
Zhonghua Yan Ke Za Zhi ; 56(10): 787-795, 2020 Oct 11.
Artigo em Chinês | MEDLINE | ID: mdl-33059422

RESUMO

Dry eye is the most common ocular surface disease, the core pathogenesis of which is ocular surface inflammation. Anti-inflammation is one of the important clinical treatments of dry eye. Since the definitely immunosuppressive effect, topical ophthalmic cyclosporine A (CsA) has been used in dry eye for many years. A large number of studies have been published in recent years, including its therapeutic effects, indications and applications. This article will introduce the mechanism of ophthalmic CsA, summarize its clinical treatment effects in dry eyes of different countries, different causes, and different severity. Meanwhile we will analyze the pros and cons and the applied prospects of ophthalmic CsA with various forms, and generalize the indications, treatment suggestions and safety of CsA used in dry eye, in order to provide references for the clinical applications. (Chin J Ophthalmol, 2020, 56:787-795).


Assuntos
Ciclosporina , Síndromes do Olho Seco , Ciclosporina/uso terapêutico , Síndromes do Olho Seco/tratamento farmacológico , Humanos , Inflamação , Soluções Oftálmicas/uso terapêutico
4.
F1000Res ; 92020.
Artigo em Inglês | MEDLINE | ID: mdl-32953089

RESUMO

Aplastic anemia (AA) in its severe form has historically been associated with high mortality. With limited supportive care and no effective strategy to reverse marrow failure, most patients diagnosed with severe AA (SAA) died of pancytopenia complications. Since the 1970s, hematopoietic stem cell transplantation (HSCT) and immunosuppressive therapy (IST) have changed SAA's natural history by improving marrow function and pancytopenia. Standard IST with horse anti-thymocyte globulin plus cyclosporine produces a hematologic response rate of 60 to 70%. In the long term, about one-third of patients relapse, and 10 to 15% can develop cytogenetic abnormalities. Outcomes with either HSCT or IST are similar, and choosing between these modalities relies on age, availability of a histocompatible donor, comorbidities, and patient preference. The introduction of eltrombopag, a thrombopoietin receptor agonist, improved SAA outcomes as both salvage (second-line) and upfront therapy combined with IST. As a single agent, eltrombopag in doses up to 150 mg daily improved cytopenias in 40 to 50% in those who failed initial IST, which associated with higher marrow cellularity, suggesting a pan-stimulatory marrow effect. When eltrombopag was combined with IST as upfront therapy, overall (about 90%) and complete responses (about 50%) were higher than observed extensively with IST alone of 65% and 10%, respectively. Not surprisingly, given the strong correlation between hematologic response rates and survival in SAA, most (>90%) were alive after a median follow-up of 18 months. Longer follow-up and real-word data continue to confirm the activity of this agent in AA. The use of eltrombopag in different combinations and doses are currently being explored. The activity of another thrombopoietin receptor agonist in AA, romiplostim, suggests a class effect. In the coming years, the mechanisms of their activity and the most optimal regimen are likely to be elucidated.


Assuntos
Anemia Aplástica/terapia , Soro Antilinfocitário/uso terapêutico , Ciclosporina/uso terapêutico , Transplante de Células-Tronco Hematopoéticas , Imunossupressores/uso terapêutico , Animais , Cavalos , Humanos , Terapia de Salvação
5.
Zhonghua Xue Ye Xue Za Zhi ; 41(8): 637-642, 2020 Aug 14.
Artigo em Chinês | MEDLINE | ID: mdl-32942816

RESUMO

Objectives: To compare the efficacy of cyclosporin A (CsA) alone and CsA combined with recombined human thrombopoietin (rhTPO) in patients with non-severe aplastic anemia (NSAA) . Methods: Data from 83 patients with NSAA between August 2014 and February 2019 were collected retrospectively. The study population included 35 men and 48 women, with a median age of 45 years (14-85 years) . Among them, 57 had been treated with CsA + rhTPO, TPO was administered at 15 000 U QD for 7 days, once a month for 3 months, and the other 26 patients with compatible baseline characters were treated with CsA alone. All the enrolled patients had been treated with CsA for at least 6 months and were followed up for at least 1 year. The efficacy and outcome were compared between the two groups. Results: Total 23 men and 34 women, with a median age of 46 years (14-85 years) were treated with CsA + rhTPO. The median duration of CsA treatment was 17 (8-28) months, and the patients were followed up for a median of 27 (12-45) months. Total 12 men and 14 women, with a median age of 40 years (20-64) were treated with CsA alone. The median duration of CsA treatment was 19 months (9-30 months) , and the median follow-up duration was 29 months (16-66 months) . There was no significant difference in the baseline characteristics of the two groups (P>0.05) . There was no significant difference in the CR and OR rates of the two groups at 1, 3, 6, 12, and 24 months of treatment (P>0.05) . The change in the platelet level for the CsA + rhTPO treated group after 1 month[8 (-12-86) ×10(9)/L vs. 3 (16-57) ×10(9)/L, P=0.029) , 3 months[24 (-6-102) ×10(9)/L vs. 7 (-9-76) ×10(9)/L, P=0.006], and 6 months[33.5 (-4-123) ×10(9)/L vs. 12.5 (-14-109) ×10(9)/L, P=0.048] of treatment was higher than that in the CsA alone group, while no significant difference was found between the two groups at other time points. There was no significant difference in the change in the megakaryocyte level between the two groups[3 (0-4) vs. 2 (0-5) , z=-0.868, P=0.385] after 6 months of treatment. Apart from 10.5% (6/57) of the patients in the CsA + rhTPO treated group who reported soreness at the injection site, there was no other significant difference between the two groups in terms of adverse effects. During the follow-up period, there were two cases of increasing paroxysmal nocturnal hemoglobinuria clone to over 10%, one in the CsA + rhTPO treated group, the other in the CsA alone group; and there was one case of progression to SAA in the CsA + rhTPO treated group; while no case of death or thromboembolic event (TEE) , fibrosis or reticulin proliferation, progression to myelodysplastic syndrome (MDS) , or acute myeloid leukemia was observed in either group. There was one case of progression to SAA in the CsA + rhTPO treated group but none in the CsA alone group. Conclusion: Compared to CsA alone, CsA + rhTPO treatment can accelerate the recovery of the platelet level with acceptable adverse effects.


Assuntos
Anemia Aplástica , Ciclosporina/uso terapêutico , Trombopoetina/uso terapêutico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Contagem de Plaquetas , Proteínas Recombinantes , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
6.
Aust Vet J ; 98(10): 491-498, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32794230

RESUMO

OBJECTIVE: To analyse outcome in dogs with a presumptive diagnosis of meningoencephalomyelitis of unknown origin (MUO) treated with prednisolone and ciclosporin and to assess the effect of a number of patient variables on survival time and rate of relapse. DESIGN: Retrospective case series. METHODS: Medical records of 40 client-owned dogs with a diagnosis of MUO treated with prednisolone and ciclosporin at one institution between June 2010 and January 2018 were reviewed retrospectively to assess survival times and prognostic indicators for death and/or relapse. The minimum follow-up time was 11 months post-diagnosis. RESULTS: Median survival was 1345 days (95% confidence interval: 487-∞). No associations with hazard of death or relapse were detected for the presence of multifocal magnetic resonance imaging (MRI) abnormalities, caudal fossa location of MRI abnormalities, value of cerebrospinal fluid total nucleated cell count or total protein at time of diagnosis, or suspected elevation in intracranial pressure at time of diagnosis. CONCLUSION: Protracted survival time may be achieved with a treatment combination of prednisolone and ciclosporin. Suspected elevation in intracranial pressure at the time of diagnosis did not affect long-term outcome in this cohort.


Assuntos
Doenças do Cão/tratamento farmacológico , Meningoencefalite/tratamento farmacológico , Meningoencefalite/veterinária , Animais , Ciclosporina/uso terapêutico , Cães , Prednisolona/uso terapêutico , Recidiva , Estudos Retrospectivos
7.
Dermatol Online J ; 26(6)2020 Jun 15.
Artigo em Inglês | MEDLINE | ID: mdl-32815686

RESUMO

Drug rash with eosinophilia and systemic symptoms (DRESS) is a rare delayed drug reaction that often occurs 2-6 weeks after initiation of therapy and may develop into a life-threatening systemic reaction. Besides immediate discontinuation of the suspected inciting drug, initiation of high dose systemic corticosteroids has long been the mainstay of treatment for severe cases. Nevertheless, significant drawbacks associated with systemic corticosteroid therapy, such as the requirement of a long tapering period post resolution and extensive adverse side effects profile, have motivated clinicians to seek alternative treatment options. Over the past decade, an undisputed increasing number of favorable case reports has highlighted cyclosporine as an emerging, safe, and effective alternative despite inconsistent dosing regimens reported. Herein, we report a severe case of vancomycin-induced DRESS syndrome in which the patient failed initial intervention with cyclosporine and needed rescue with methylprednisolone. To the best of our knowledge, this constitutes the first unsuccessful report of cyclosporine treatment for DRESS syndrome.


Assuntos
Ciclosporina/uso terapêutico , Síndrome de Hipersensibilidade a Medicamentos/etiologia , Vancomicina/efeitos adversos , Síndrome de Hipersensibilidade a Medicamentos/tratamento farmacológico , Síndrome de Hipersensibilidade a Medicamentos/patologia , Resistência a Medicamentos , Eosinofilia/induzido quimicamente , Eosinofilia/patologia , Exantema/induzido quimicamente , Feminino , Antebraço/patologia , Humanos
8.
Ann Hematol ; 99(10): 2255-2263, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32766934

RESUMO

We aimed to clarify the clinical characteristics, prognostic factors, and effectiveness of the HLH-94/2004 regimens and hematopoietic stem cell transplantation (HSCT) in pediatric patients with primary hemophagocytic lymphohistiocytosis (pHLH) in China. A retrospective analysis was performed on 38 patients with pHLH at Beijing Children's Hospital. PRF1 (34.2%) and UNC13D (31.6%) were the most common mutations in the pHLH. Thirty-eight patients were treated with the HLH-94/2004 regimens after diagnosis. Twenty-six patients (72.2%) responded to first-line treatment (complete response: 55.5%, partial response: 16.7%). The median survival time was 23 months. The overall survival (OS) rate at 3 years was 74.7%. There was no significant difference in the response rate (72% vs. 63.6%, P = 0.703) or 3-year OS (83.6% vs. 66.7%, P = 0.443) between the patients treated with the HLH-94 regimen and those treated with the HLH-2004 regimen. The incidences of all side effects in patients treated with the HLH-94 or HLH-2004 regimen were 32.0% and 18.2%, respectively (P = 0.394). Among 15 patients treated with HSCT, neither the preconditioning regimen nor the donor type affected patient prognosis (P = 0.205 and P = 0.161, respectively). The disease status (remission or nonremission) before preconditioning did not affect prognosis or the incidence of GVHD. Furthermore, a higher bilirubin level (≥ 30 µmol/L) was correlated with a poorer prognosis in pHLH patients (P = 0.026). The effectiveness rates of the HLH-94 and HLH-2004 regimens, chemotherapy, and HSCT were similar in pHLH patients. A bilirubin level ≥ 30 µmol/L might be an adverse prognostic factor in pHLH.


Assuntos
Ciclosporina/uso terapêutico , Doxorrubicina/uso terapêutico , Etoposídeo/uso terapêutico , Transplante de Células-Tronco Hematopoéticas , Linfo-Histiocitose Hemofagocítica/terapia , Metilprednisolona/uso terapêutico , Criança , Pré-Escolar , China/epidemiologia , Terapia Combinada , Intervalo Livre de Doença , Quimioterapia Combinada , Seguimentos , Doença Enxerto-Hospedeiro/epidemiologia , Doença Enxerto-Hospedeiro/etiologia , Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Humanos , Lactente , Recém-Nascido , Estimativa de Kaplan-Meier , Linfo-Histiocitose Hemofagocítica/tratamento farmacológico , Linfo-Histiocitose Hemofagocítica/epidemiologia , Linfo-Histiocitose Hemofagocítica/genética , Prognóstico , Indução de Remissão , Estudos Retrospectivos , Condicionamento Pré-Transplante , Resultado do Tratamento
10.
Gastroenterol. hepatol. (Ed. impr.) ; 43(supl.1): 1-57, ago. 2020.
Artigo em Espanhol | IBECS | ID: ibc-194601

RESUMO

INTRODUCCIÓN: Desde la publicación de la primera edición de la Guía en 2013, se ha generado mucha información en torno al tratamiento de la colitis ulcerosa, y se han introducido nuevos fármacos y protocolos de actuación. La práctica clínica ha variado substancialmente, lo que justifica nuevas aproximaciones y una revisión exhaustiva, así como la actualización de la evidencia. MATERIAL Y MÉTODOS: Se utiliza nuevamente metodología GRADE, apoyados en una herramienta electrónica (https://gradepro.org). Los escenarios clínicos son los mismos que en la versión previa (inducción y mantenimiento en brote grave y en brote leve-moderado), así como las variables y su evaluación. En la guía actualizada, en relación a la versión previa, se eliminan tres preguntas, se añaden 14 y se mantienen 30, con un total de 44 preguntas clínicas. Tras una exhaustiva revisión de la evidencia, se actualizan las recomendaciones. RESULTADOS: De las 44 preguntas analizadas, en dos de ellas no se ha podido establecer ninguna recomendación por muy baja calidad de la evidencia, mientras que en las 42 restantes, basados en diferentes grados de calidad de evidencia, se ha formulado una recomendación de acuerdo con el sistema GRADE. En 25 de estas preguntas la recomendación final es fuerte a favor; en seis, fuerte en contra; mientras que en siete es débil a favor, y en cuatro débil en contra. Siguiendo los escenarios y las recomendaciones, se proponen seis algoritmos como guía sencilla en la toma de decisiones prácticas. CONCLUSIONES: Esta actualización de la guía previa publicada en 2013 intenta dar respuesta basada en la metodología GRADE a las diferentes preguntas que nos hacemos diariamente a la hora de decidir el tratamiento más adecuado de nuestros pacientes con colitis ulcerosa en los diferentes escenarios clínicos


INTRODUCTION: Since the first edition of the Guidelines was published in 2013, much information has been generated around the treatment of ulcerative colitis, and new drugs and action protocols have been introduced. Clinical practice has changed substantially, warranting new approaches and a comprehensive review and update of the evidence. MATERIAL AND METHODS: Once again, we used the GRADE approach, supported by an electronic tool (https://gradepro.org). The clinical scenarios are the same as in the previous version (induction and maintenance in severe and mild-moderate flare-ups), as are the variables and their evaluation. However, in the updated guidelines, three questions have been deleted, 14 added and 30 maintained, making a total of 44 clinical questions. After an exhaustive review of the evidence, the recommendations are now updated. RESULTS: Of the 44 questions analysed, no recommendation could be established in two due to the very low quality of the evidence, while in the other 42, based on different degrees of quality of evidence, recommendations were made according to the GRADE system. In 25 of these questions the final recommendation is strongly in favour, in six strongly against, in seven weakly in favour and in four weakly against. According to the scenarios and recommendations, six algorithms are proposed as a simple guide for practical decision-making. CONCLUSIONS: The aim of this update of the 2013 guidelines is to provide answers, based on the GRADE approach, to the different questions we ask ourselves daily when deciding the most appropriate treatment for our patients with ulcerative colitis in the different clinical scenarios


Assuntos
Humanos , Colite Ulcerativa/terapia , Abordagem GRADE/métodos , Salicilatos/uso terapêutico , Corticosteroides/uso terapêutico , Imunossupressores/uso terapêutico , Ciclosporina/uso terapêutico
11.
J Immunother Cancer ; 8(2)2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32727811

RESUMO

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic placed unprecedented pressure on various healthcare systems, including departments that use immunotherapies such as chimeric antigen receptor (CAR) T-cell therapy and immunosuppression therapy in organ transplantation units. The true impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection on immunocompromised CAR T-cell therapy recipients and kidney transplant recipients (KTRs) has not yet been established. CASE PRESENTATION: In this report, we compare two patients with severe COVID-19 pneumonia in either the humoral or cell-mediated immunodeficient states. The first patient was a man in his early 30s who was diagnosed with refractory multiple myeloma. He received fully humanized, anti-B-cell maturation antigen, CAR T-cell therapy before 4 months and achieved strict complete remission. He was infected with SARS-CoV-2 starting on January 26, 2019 and gradually progressed to severe pneumonia. Throughout the clinical progression of the disease, SARS-CoV-2 could not be cleared due to his humoral immunodeficient state. During this period of his severe COVID-19 pneumonia, elevated cytotoxic T-cells were observed in this patient's peripheral blood while elevated plasma levels of interleukin (IL)-2R, IL-6, tumor necrosis factor α, and ferritin were observed in his cytokine profiles. This patient eventually progressed into acute respiratory distress syndrome and recieved non-invasive ventilatory support. He failed to generate specific SARS-CoV-2 antibodies and died of respiratory failure on day 33 (d33). The second patient was a 52-year-old kidney transplant recipient (KTR) who took ciclosporin after renal transplantation for more than 7 years. He confirmed SARS-CoV-2 infection on January 20, 2019 and gradually progressed into severe pneumonia on d16 with a slightly elevated B-cell percentage and normal T-lymphocyte subsets. Viral clearance occurred together with the generation of specific anti-immunoglobulin G-SARS-CoV-2 antibodies after 2 weeks of treatment. He was symptom-free and discharged from the hospital on d42. CONCLUSION: We report a CAR T-cell therapy recipient diagnosed with COVID-19 for the first time. His virus clearance failure and life-threating cytokine storm during SARS-CoV-2 infection suggested that any decision to proceed CAR T-cell therapy during COVID-19 pandemics will require extensive discussion of potential risks and benefits. Immunosuppressant treatment based on ciclosporin could be relatively safe for KTRs diagnosed with COVID-19. TRIAL REGISTRATION NUMBER: ChiCTR-OPN-1800018137.


Assuntos
Betacoronavirus/imunologia , Infecções por Coronavirus/imunologia , Hospedeiro Imunocomprometido , Pneumonia Viral/imunologia , Linfócitos T Citotóxicos/imunologia , Adulto , Anticorpos Antivirais/metabolismo , Ciclosporina/uso terapêutico , Citocinas/metabolismo , Evolução Fatal , Humanos , Imunidade Celular , Imunidade Humoral , Masculino , Pessoa de Meia-Idade , Pandemias
12.
Rinsho Shinkeigaku ; 60(8): 533-537, 2020 Aug 07.
Artigo em Japonês | MEDLINE | ID: mdl-32641627

RESUMO

A 41-year-old man noticed numbness of the fingers and toes, and gradually developed limb weakness and sensory impairment. The patient was diagnosed with typical chronic inflammatory demyelinating polyradiculoneuropathy. Over the course of clinical diagnosis, the limb and trunk ataxia, and finger tremor became prominent, and the presence anti-neurofascin-155 antibody was examined and confirmed positive. The effects of corticosteroids, intravenous immunoglobulin, and plasma apheresis were limited, and the disease progressed slowly and noticeably. Therefore, cyclosporine was introduced as treatment, and the patient's weakness and ataxia significantly improved. Rituximab treatment is expected to be effective in patients with the same antibody and immunosuppressant treatment may be useful in intractable cases.


Assuntos
Autoanticorpos/sangue , Moléculas de Adesão Celular/imunologia , Ciclosporina/uso terapêutico , Imunossupressores/uso terapêutico , Fatores de Crescimento Neural/imunologia , Polirradiculoneuropatia Desmielinizante Inflamatória Crônica/tratamento farmacológico , Adulto , Biomarcadores/sangue , Humanos , Imunoglobulinas Intravenosas/administração & dosagem , Masculino , Polirradiculoneuropatia Desmielinizante Inflamatória Crônica/diagnóstico , Polirradiculoneuropatia Desmielinizante Inflamatória Crônica/imunologia
13.
Medicine (Baltimore) ; 99(28): e20829, 2020 Jul 10.
Artigo em Inglês | MEDLINE | ID: mdl-32664077

RESUMO

INTRODUCTION: Anabolic steroids are widely administered to patients with aplastic anemia (AA) and are associated with numerous medical complications. To assist with future diagnoses, we report about a young boy with multiple hepatocellular adenomas (HAs) induced by long-term use of anabolic androgenic steroids (AAS) for AA and present a related literature review. PATIENT CONCERN: A 15-year-old boy who was diagnosed with AA in 2011 had been treated with stanozolol (6 mg per day) and ciclosporin A (120-150 mg per day) for almost 4 years. He presented with epigastric pain and fever, and abdominal computed tomography showed a lesion of heterogenous density measuring 13.5 × 13.0 × 8.0 cm in the left hepatic lobe, which was initially misdiagnosed as a liver abscess. DIAGNOSIS: The patient went into hemorrhagic shock twice after invasive manipulation that aimed at diagnosis and was finally diagnosed with HA using fine needle aspiration. INTERVENTIONS: The patient discontinued AAS and only reserved ciclosporin A for AA treatment. OUTCOMES: Follow-up abdominal computed tomography performed 4 years after AAS discontinuation showed obvious regression of the hepatic lesions. CONCLUSION: It is of great importance for hematologists to completely understand that the long-term use of AAS may cause HA, which carries a great risk of hemorrhage and malignant transformation.


Assuntos
Adenoma de Células Hepáticas/induzido quimicamente , Anemia Aplástica/complicações , Neoplasias Hepáticas/patologia , Estanozolol/efeitos adversos , Congêneres da Testosterona/efeitos adversos , Dor Abdominal/etiologia , Adenoma de Células Hepáticas/patologia , Adolescente , Adulto , Assistência ao Convalescente , Idoso , Anemia Aplástica/tratamento farmacológico , Biópsia por Agulha Fina/métodos , Ciclosporina/uso terapêutico , Erros de Diagnóstico , Feminino , Febre/etiologia , Humanos , Imunossupressores/uso terapêutico , Abscesso Hepático/diagnóstico por imagem , Neoplasias Hepáticas/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Choque Hemorrágico/diagnóstico , Choque Hemorrágico/etiologia , Estanozolol/uso terapêutico , Congêneres da Testosterona/uso terapêutico , Tomografia Computadorizada por Raios X/métodos
14.
Dermatol Online J ; 26(5)2020 May 15.
Artigo em Inglês | MEDLINE | ID: mdl-32621708

RESUMO

SAPHO syndrome is a rare entity, composed of dermatologic and osteoarticular manifestations. There are no validated diagnostic criteria and treatment is empirical, with a recent focus on biologics. Herein, we present a 50-year-old woman who developed palmoplantar pustulosis and sternoclavicular osteitis, with typical findings on bone scintigraphy. Treatment with bisphosphonate, low-dose systemic corticosteroid, and cyclosporine allowed complete resolution of the articular and dermatologic manifestations with no side effects.


Assuntos
Síndrome de Hiperostose Adquirida/tratamento farmacológico , Anti-Inflamatórios/uso terapêutico , Conservadores da Densidade Óssea/uso terapêutico , Imunossupressores/uso terapêutico , Osso e Ossos/diagnóstico por imagem , Ciclosporina/uso terapêutico , Quimioterapia Combinada , Feminino , Humanos , Ácido Ibandrônico/uso terapêutico , Pessoa de Meia-Idade , Prednisolona/uso terapêutico , Cintilografia
17.
Gulf J Oncolog ; 1(33): 27-30, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32476647

RESUMO

OBJECTIVE: We evaluate the seeding step of peritoneal carcinomatosis cancer as a surrogate for the role of the omentum in colorectal tumors. METHODS: The study included 5 groups of adult male Sprague Dawley rats: immunocompetent rats (group 1), immunosuppressed rats without omentectomy (group 2), immunosuppressed rats with omentectomy (group 3), immunosuppressed rats with omentectomy receiving NSAID (group 4), and immunosuppressed rats without omentectomy receiving NSAID (group 5). Except for group 1, the rats were immunosuppressed using cyclosporine orally at a dose of 25 mg/kg/day that was started 48 hours before tumor cell infiltration in the peritoneum. All the rats received an intraperitoneal suspension of 10 million Caco-2 cancer cells. Rats in groups 1, 2, and 3 were followed up without further interventions and rats in groups 4 and 5 received naproxen 180mg/kg until rat sacrifice. Cyclosporine and naproxen were continued in the corresponding groups until the killing after 21 days of tumor cell infiltration. RESULTS: Fourteen rats survived the experiment during the observation period and remained in good clinical condition except for one rat (from group 4) that deceased at week 2. At day 21 before sacrifice, mean weight variations showed a +4% in group 0, -9% in group 1, -18% in group 2, -31% in group 3 and -36% in group 4. Light microscopy did not identify any tumor cells in the abdominal cavity or thorax solid organs but showed a granulomatous reaction that involved the majority of the organs. CONCLUSION: The conclusions of this study are limited by the small number of rats as it is a pilot study to design an animal model with peritoneal carcinomatosis. Further steps in this study will include more aggressive cancer cell lines such as HT29 and more aggressive immunosuppression in a larger number of rats.


Assuntos
Carcinoma/tratamento farmacológico , Ciclosporina/uso terapêutico , Neoplasias Peritoneais/tratamento farmacológico , Animais , Ciclosporina/farmacologia , Modelos Animais de Doenças , Humanos , Masculino , Ratos , Ratos Sprague-Dawley
18.
Brasília; s.n; 15 jun. 2020.
Não convencional em Português | LILACS, BRISA/RedTESA, PIE | ID: biblio-1100400

RESUMO

O Informe Diário de Evidências é uma produção do Ministério da Saúde que tem como objetivo acompanhar diariamente as publicações científicas sobre tratamento farmacológico e vacinas para a COVID-19. Dessa forma, são realizadas buscas estruturadas em bases de dados biomédicas, referente ao dia anterior desse informe. Não são incluídos estudos pré-clínicos (in vitro, in vivo, in silico). A frequência dos estudos é demonstrada de acordo com a sua classificação metodológica (revisões sistemáticas, ensaios clínicos randomizados, coortes, entre outros). Para cada estudo é apresentado um resumo com avaliação da qualidade metodológica. Essa avaliação tem por finalidade identificar o grau de certeza/confiança ou o risco de viés de cada estudo. Para tal, são utilizadas ferramentas já validadas e consagradas na literatura científica, na área de saúde baseada em evidências. Cabe ressaltar que o documento tem caráter informativo e não representa uma recomendação oficial do Ministério da Saúde sobre a temática. Foram encontrados 15 artigos.


Assuntos
Humanos , Pneumonia Viral/tratamento farmacológico , Infecções por Coronavirus/tratamento farmacológico , Betacoronavirus/efeitos dos fármacos , Sistema Renina-Angiotensina , Avaliação da Tecnologia Biomédica , Ceftriaxona/uso terapêutico , Imunoglobulinas/uso terapêutico , Metilprednisolona/uso terapêutico , Ciclosporina/uso terapêutico , Azitromicina/uso terapêutico , Ritonavir/uso terapêutico , Oseltamivir/uso terapêutico , Lopinavir/uso terapêutico , Natalizumab/uso terapêutico , Glucocorticoides/uso terapêutico , Hidroxicloroquina/uso terapêutico
19.
s.l; s.n; 3 jun. 2020.
Não convencional em Português | LILACS, BRISA/RedTESA, PIE | ID: biblio-1099470

RESUMO

O Informe Diário de Evidências é uma produção do Ministério da Saúde que tem como objetivo acompanhar diariamente as publicações científicas sobre tratamento farmacológico e vacinas para a COVID-19. Dessa forma, são realizadas buscas estruturadas em bases de dados biomédicas, referente ao dia anterior desse informe. Não são incluídos estudos pré-clínicos (in vitro, in vivo, in silico). A frequência dos estudos é demonstrada de acordo com a sua classificação metodológica (revisões sistemáticas, ensaios clínicos randomizados, coortes, entre outros). Para cada estudo é apresentado um resumo com avaliação da qualidade metodológica. Essa avaliação tem por finalidade identificar o grau de certeza/confiança ou o risco de viés de cada estudo. Para tal, são utilizadas ferramentas já validadas e consagradas na literatura científica, na área de saúde baseada em evidências. Cabe ressaltar que o documento tem caráter informativo e não representa uma recomendação oficial do Ministério da Saúde sobre a temática. Foram encontrados 16 artigos.


Assuntos
Pneumonia Viral/tratamento farmacológico , Infecções por Coronavirus/tratamento farmacológico , Betacoronavirus/efeitos dos fármacos , Ribavirina/uso terapêutico , Avaliação da Tecnologia Biomédica , Imunoglobulinas/uso terapêutico , Cloroquina/uso terapêutico , Anti-Inflamatórios não Esteroides/uso terapêutico , Interferons/uso terapêutico , Ciclosporina/uso terapêutico , Corticosteroides/uso terapêutico , Azitromicina/uso terapêutico , Ritonavir/uso terapêutico , Dexmedetomidina/uso terapêutico , Lopinavir/uso terapêutico , Rituximab/uso terapêutico , Leflunomida/uso terapêutico , Hidroxicloroquina/uso terapêutico
20.
Farm. hosp ; 44(3): 87-91, mayo-jun. 2020. tab
Artigo em Espanhol | IBECS | ID: ibc-192339

RESUMO

OBJETIVO: Medir la adherencia a la profilaxis del fallo secundario del implante (ciclosporina, tacrolimus, sirolimus), de la enfermedad injerto contra receptor (ciclosporina, tacrolimus, sirolimus, micofenolato) y de las infecciones (posaconazol, voriconazol, valganciclovir) en el paciente sometido a trasplante alogénico de progenitores hematopoyéticos. Compa-rar la incidencia de complicaciones agudas en función de la adherencia.MÉTODO: Estudio observacional retrospectivo en pacientes sometidos a trasplante alogénico de progenitores hematopoyéticos desde mayo de 2017 hasta mayo de 2018, entre el día 0 y +100 postrasplante. La adherencia a micofenolato, tacrolimus, sirolimus, posaconazol, voriconazol y valganciclovir se evaluó mediante los registros de dispensación del servicio de farmacia, siempre que fuera posible. Se definió como paciente adherente aquel con un porcentaje de adherencia igual o superior al 95%. La evaluación de la adherencia a ciclosporina se realizó mediante medida de los niveles plasmáticos. Se definió como paciente no adherente aquel cuyos niveles plasmáticos de ciclosporina fueran inferiores a 100 ng/ml en alguna medida entre los días 0 y +100, en ausencia de factores asociados que lo justificaran. La asociación entre adherencia e incidencia de complicaciones agudas (fallo secundario del implante, enfermedad injerto contra receptor aguda e infección) se estimó mediante la odds ratio y su intervalo de confianza del 95%. RESULTADOS: Se incluyó a 46 pacientes. Todos comenzaron profilaxis inmunosupresora con ciclosporina; en el 8,7% se cambió a tacrolimus o sirolimus por toxicidad. Todos los pacientes recibieron ciclosporina para la profilaxis de la enfermedad injerto contra receptor. En el 41,3% de los casos también se administró micofenolato. El 82,6% fueron adherentes a la profilaxis del fallo de injerto. En cuanto a la profilaxis de enfermedad injerto contra receptor, resultó adherente el 80,4%. Todos los pacientes resultaron adherentes a la profilaxis infecciosa. La incidencia de enfermedad injerto contra receptor aguda de los pacientes adherentes a la profilaxis fue del 45,9% frente al 55,6% en los no adherentes (odds ratio 0,68; intervalo de confianza del 95% 0,157-2,943; p = 0,718). CONCLUSIONES: Los pacientes sometidos a trasplante alogénico de progenitores hematopoyéticos presentan una aceptable adherencia a la profilaxis de complicaciones agudas, pero existe un considerable porcentaje de pacientes que no toman su tratamiento adecuadamente. La correcta adherencia a los inmunosupresores parece disminuir el riesgo de sufrir enfermedad injerto contra receptor aguda


OBJECTIVE: To measure adherence to cyclosporine, tacrolimus and siroli-mus prophylaxis against secondary graft failure; cyclosporine, tacrolimus, sirolimus and mycophenolate prophylaxis against graft-versus-host disease; and posaconazole, voriconazole, valganciclovir prophylaxis against infec-tion in patients undergo to transplantation of haematopoietic stem cells; and to analise the incidence of acute complications based on adherence.METHOD: Retrospective observational study of patients who underwent allo-geneic haematopoietic stem cell transplantation between May 2017 and May 2018. Analyses were carried out between 0 and +100 days post-engraftment.Whenever possible, adherence to mycophenolate, tacrolimus, sirolimus, posaconazole, voriconazole and valganciclovir was evaluated by means of the dispensation records of the Pharmacy Department of our hospital. To be considered adherent, patients should have proved an adherence rate equal to or higher than 95%. Adherence to cyclosporine was determi-ned based on serum levels. Patients were considered to be non-adherent if their cyclosporine serum concentrations dropped below 100 ng/mL at any time between days 0 and +100, in the absence of any specific justifying circumstances. The association between adherence and the incidence of acute complications (secondary graft failure, acute graft-versus-host disease and infection) was determined by means of the odds ratio (confidence interval: 95%). RESULTS: The study sample was made up by 46 patients, all of whom were started on immunosuppressive cyclosporine prophylaxis; 8.7% needed to be switched to tacrolimus or sirolimus due to toxicity issues. All the pa-tients received cyclosporine as prophylaxis against graft-versus-host disea-se. Mycophenolate was also administered in 41.3% of cases. A total of 82.6% patients were found to be adherent to their prophylaxis treatment against graft failure and 80.4% were found to be adherent to prophylaxis against graft-versus-host disease. All patients were adherent to anti-infection prophylaxis. The incidence of acute graft-versus-host disease in prophylaxis-adherent patients was 45.9%, compared with 55.6% for non-adherent pa-tients (odds ratio 0.68; confidence interval: 95% 0.157-2.943; p = 0.718). CONCLUSIONS: Patients undergoing allogeneic haematopoietic stem cell transplantation demonstrated acceptable adherence to prophylaxis aga-inst acute complications, although a considerable percentage of patients was found not to take their medication as prescribed. Correct adherence to immunosuppressants seems to reduce the risk of developing acute graft-versus-host disease


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Cooperação e Adesão ao Tratamento , Transplante Homólogo , Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Doença Enxerto-Hospedeiro/tratamento farmacológico , Ciclosporina/uso terapêutico , Estudos Retrospectivos , Tacrolimo/uso terapêutico , Sirolimo/uso terapêutico , Assistência Farmacêutica , Razão de Chances , Intervalos de Confiança , Imunossupressores/uso terapêutico , Antibioticoprofilaxia
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