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1.
Medicine (Baltimore) ; 99(3): e18585, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32011437

RESUMO

The aim of this study was to assess a correlation between avascular necrosis of femoral head and oral corticosteroids use in the general population in Taiwan. A population-based case-control study was performed to analyze the database of Taiwan National Health Insurance Program. The study consisted of 3002 subjects aged 20 to 84 with newly diagnosed avascular necrosis of femoral head between 2000 and 2013 as the cases and 11279 sex-matched and age-matched subjects without avascular necrosis of femoral head as the matched controls. Use of oral corticosteroids was defined as subjects who had at least a prescription for oral corticosteroids before the index date. No use of oral corticosteroids was defined as subjects who did not have a prescription for oral corticosteroids before the index date. The logistic regression model revealed that subjects with avascular necrosis of femoral head were 1.65 times more likely to be exposed to oral corticosteroids than those subjects without avascular necrosis of femoral head (OR 1.65, 95% CI = 1.51-1.80). A sub-analysis revealed that there was a significant association between avascular necrosis of femoral head and increasing cumulative duration of oral corticosteroids for each additional month of use (OR 1.03, 95% CI = 1.02-1.03). A significant association is detected between avascular necrosis of femoral head and oral corticosteroids use in the general population in Taiwan. There is a duration-dependent effect of oral corticosteroids use on the risk of avascular necrosis of femoral head. Clinicians should be aware of the risk of avascular necrosis of femoral head when oral corticosteroids are prescribed for a long time.


Assuntos
Corticosteroides/administração & dosagem , Necrose da Cabeça do Fêmur/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Relação Dose-Resposta a Droga , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Taiwan/epidemiologia , Fatores de Tempo , Adulto Jovem
2.
Medicine (Baltimore) ; 99(2): e18739, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31914091

RESUMO

Autoimmune hemolytic anemia (AIHA) is a rare disease in which autoantibodies target red blood cells (RBCs), leading to anemia that ranges from no symptoms to severe life-threatening hemolysis. Little is known about the severity of anemia, blood transfusion efficiency and risk of transfusion-related reactions among hospitalized AIHA patients, especially in those with incompatible RBC transfusions.A retrospective study was conducted among hospitalized AIHA patients from January 2009 to December 2015 in a large tertiary care medical center in southwest China.A total of 450 AIHA hospitalized patients were recruited, of whom 97.3% had warm AIHA, 30.3% had primary AIHA, and 90.7% were treated with corticosteroids. On admission, approximately 3% of patients had an hemoglobin (Hb) <30 g/L, 34% had an Hb between 30 and 59.9 g/L, and 46% had an Hb ranging from 60 to 89.9 g/L. A total of 2509.5 U RBCs were transfused to AIHA patients, and 14 transfusion-related adverse reactions were recorded, without any hemolytic transfusion reactions. With an average transfusion trigger of 52.0 ±â€Š9.3 g/L, 59.7% of the patients received RBCs, and 55.8% of the transfusions were viewed as effective. Least incompatible RBCs were given in 39% of the transfusions, but the transfusion efficiency did not significantly decrease with these incompatible blood transfusions (P = .253). Primary AIHA patients with a nadir Hb of approximately 40 to 50 g/L during their hospital stay had the highest rate of remission and did not require a different total number of RBC transfusions (P = .068) or length of hospitalization (P = .194) compared to other groups with nadir Hb values <30 g/L, ≥30 and <40 g/L, ≥50 and <60 g/L, and ≥60 g/L.One-third of AIHA patients suffered from severe anemia during hospitalization, and transfusions, even with incompatible RBCs, were safe and efficient. However, transfusion triggers between 40 and 50 g/L seemed to benefit the most patients by alleviating the RBC destruction caused by autoantibodies, and a restrictive transfusion strategy was beneficial in AIHA patients.


Assuntos
Corticosteroides/uso terapêutico , Anemia Hemolítica Autoimune/fisiopatologia , Anemia Hemolítica Autoimune/terapia , Transfusão de Eritrócitos/métodos , Corticosteroides/administração & dosagem , Corticosteroides/efeitos adversos , Adulto , Anemia Hemolítica Autoimune/epidemiologia , Transfusão de Eritrócitos/efeitos adversos , Feminino , Hemoglobinas , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de Doença , Reação Transfusional/epidemiologia
3.
Mymensingh Med J ; 29(1): 60-65, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31915337

RESUMO

In spite of the recommendation for rescue antenatal corticosteroids (ACS), the optimal time interval between primary and rescue courses has not been clearly demonstrated. The aim of this retrospective study was to determine the effects of the interval between a single ACS (Dexamethasone) course and delivery on the incidence of respiratory distress syndrome (RDS) in neonates at Mymensingh Medical College Hospital Center from 1st January 2017 to 30th June 2017. Injection Dexamethasone 2 doses (12.5mg IM 12 hourly for 2 doses) or 4 doses (6mg IM every 12 hours for 4 doses) use to arrest preterm labor as well as to prevent RDS delivered beyond 48 hours after ACS administration between 24 and 34 weeks gestation. The risk of RDS was compared between patients who delivered within seven days (Group I) and 7-14 days (Group II) after ACS administration. We included 140 and 60 patients in Group I and Group II respectively. After adjusting for confounders, the ACS delivery interval was significantly associated with RDS in Group II (adjusted odds ratio 12.8, 95% confidence interval 1.31-164.7). A longer ACS delivery interval is associated with a higher risk of RDS. Thus, the use of a rescue course could be expected to reduce the incidence of RDS in patients beyond seven days after ACS administration who remain at risk for preterm delivery within seven days, especially in cases of placenta previa and/or women bearing a male fetus.


Assuntos
Corticosteroides/administração & dosagem , Dexametasona/administração & dosagem , Nascimento Prematuro/prevenção & controle , Cuidado Pré-Natal/métodos , Síndrome do Desconforto Respiratório do Recém-Nascido/epidemiologia , Corticosteroides/efeitos adversos , Bangladesh/epidemiologia , Dexametasona/efeitos adversos , Feminino , Humanos , Incidência , Recém-Nascido , Recém-Nascido Prematuro , Masculino , Gravidez , Síndrome do Desconforto Respiratório do Recém-Nascido/prevenção & controle , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento
5.
Med Clin North Am ; 104(1): 61-76, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31757238

RESUMO

Allergic contact dermatitis is common, resulting in considerable morbidity. Diagnosis is based on a thorough history, physical examination, and patch testing. Several commercially available panels of patch testing are currently used. Allergens are found in a wide variety of daily products, occupational exposures, and foods. The mainstay of treatment is avoidance of the allergen, and databases like Contact Allergen Management Program and Contact Allergen Replacement Database help patients to select products that do not contain allergens to which they are sensitized. Topical corticosteroids can be used to treat exacerbations, but should be avoided in long-term treatment.


Assuntos
Alérgenos/análise , Dermatite Alérgica de Contato/diagnóstico , Testes do Emplastro/métodos , Administração Tópica , Corticosteroides/administração & dosagem , Dermatite Alérgica de Contato/tratamento farmacológico , Humanos
6.
Expert Opin Drug Saf ; 18(12): 1219-1235, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31801415

RESUMO

Introduction: The treatment strategies for noninfectious uveitis (NIU) aim to achieve disease remission, prevention of recurrences, and preserving vision, while minimizing the side effects associated with the therapies used.Areas covered: The index review aims to provide a detailed overview of the adverse events and safety parameters associated with the systemic therapies for the management of the NIU.Expert opinion: Despite being the cornerstone of management of acute cases of NIU, long-term corticosteroid use is associated with multi-system side effects, requiring the use of steroid-sparing agents. Adalimumab was recently approved by the FDA for the management of NIU based on the results of VISUAL studies. Similarly, newer drugs targeting various aspects of the inflammatory cascade are being developed. However, until we completely understand the molecular pathways of the inflammatory diseases, the therapeutic profile of these newer agents needs to be broad enough to suppress inflammatory cascade and narrow enough to spare normal cellular processes. Another strategy that has shown some potential in decreasing the systemic side effects is to provide local drug delivery. Therefore, the future of management of NIU is very bright with many novel therapeutic agents and strategies of drug delivery on the horizon.


Assuntos
Sistemas de Liberação de Medicamentos , Desenvolvimento de Medicamentos , Uveíte/tratamento farmacológico , Adalimumab/administração & dosagem , Adalimumab/efeitos adversos , Corticosteroides/administração & dosagem , Corticosteroides/efeitos adversos , Humanos
8.
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue ; 31(10): 1247-1251, 2019 Oct.
Artigo em Chinês | MEDLINE | ID: mdl-31771723

RESUMO

OBJECTIVE: To study the influential factor of hyperlactatemia after the brain tumor craniotomy. METHODS: Patients who underwent selective brain tumor (including glioma, meningioma and acoustic schwannoma) craniotomyin the neurosurgery intensive care unit (NSICU) of the First Affiliated Hospital, Sun Yat-sen University from December 1st 2018 to May 20th 2019 were enrolled. The incidence of hyperlactatemia after the brain tumor craniotomy was investigated. Univariate and multivariate linear regression analysis were performed to identify the association of initial artery lactate with the operation duration, the intraoperative blood loss, the total intraoperative fluid infusion, intraoperative ringer lactate fluid infusion, intraoperative urine volume, intraoperative fluid balance, the total intraoperative corticosteroids dosage and the tumor type. Pearson method was used to analyze the correlation between lactate in arterial blood and independent related factors. RESULTS: A total of 148 patients were enrolled including 45 patients (30.41%) with glioma, 64 patients (43.24%) with meningioma, and 39 patients (26.35%) with acoustic schwannoma. The initial lactate level in arterial blood increased significantly in 148 patients, with a median of 4.80 (3.68, 5.90) mmol/L. Among them, 78 patients (52.70%) had mild elevation of lactate in arterial blood (2 mmol/L < lactate ≤ 5 mmol/L), 61 patients (41.22%) had significant elevation of lactate in arterial blood (5 mmol/L < lactate ≤ 10 mmol/L), and 2 patients (1.35%) had serious elevation of artery lactate (> 10 mmol/L). And only 7 patients (4.73%) had normal level of lactate in arterial blood (≤ 2 mmol/L). Univariate analysis showed that initial postoperative artery lactate was positively correlated with the operation duration [ß = 0.556, 95% confidence interval (95%CI) was 0.257-0.855, P < 0.001] and the total intraoperative corticosteroids dosage (ß = 0.477, 95%CI was 0.174-0.779, P = 0.002). There was no significant correlation between the initial postoperative artery lactate and tumor types, the intraoperative blood loss, the total fluid infusion, the ringer lactate fluid infusion, urine volume, and the fluid balance. Further multivariate linear regression analysis showed that the operation duration (ß = 0.499, 95%CI was 0.204-0.795, P = 0.001) and the total intraoperative corticosteroids dosage (ß = 0.407, 95%CI was 0.111-0.703, P = 0.008) were independent risk factors affecting the initial postoperative artery lactate. The correlation analysis showed that there was a significant positive correlation between lactate in arterial blood and operation time and total hormone dosage during operation (r1 = 0.289, r2 = 0.248, both P < 0.01). CONCLUSIONS: Initial artery lactate after brain tumor craniotomy is associated with surgery duration and exogenous administration of corticosteroids.


Assuntos
Corticosteroides/uso terapêutico , Neoplasias Encefálicas , Craniotomia , Corticosteroides/administração & dosagem , Artérias , Humanos , Estudos Retrospectivos
9.
Pan Afr Med J ; 33: 188, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31692728

RESUMO

Brain radionecrosis is a rare but life-threatening complication of external-beam radiotherapy for ENT cancers, in particular of the nasopharynx, and for brain tumors. Very few studies were conducted on this complication in the African population as well as in the Maghreb population. Therefore our study aims to describe the demographic, clinical, paraclinical, therapeutic and evolutionary features of cerebral radionecrosis in the Department of Neurology at the Mohammed V Military Teaching Hospital in Rabat over a period of 18 years (2000-2017). The study involved 4 women and 13 men, with an average age of 50 years. The mean time between the end of the radiotherapy and the onset of neurological signs was 28 months. Systematic Brain MRI, sometimes complemented by spectro-MRI, allowed the diagnosis in 100% of cases. Etiologically, this complication occurred after radiotherapy for nasopharyngeal carcinoma and cancer of the larynx in all cases. Fifteen patients were treated with a combination of: bolus application of corticosteroids, platelet aggregation inhibitors associated with hyperbaric oxygen therapy with good evolution of two patients in whom oxygen therapy was contraindicated due to a lung problem and ENT cancer, received a combination of bolus application of corticosteroids and platelet aggregation inhibitors with unchanged evolution. These results demonstrate the importance of early diagnosis in patients with potentially serious conditions, in particular neuropsychiatric conditions, as well as of treatment combining bolus application of corticosteroids and hyperbaric oxygen therapy because this is the best guarantee of a favorable outcome, without omitting the crucial role of preventive measures.


Assuntos
Encéfalo/patologia , Oxigenação Hiperbárica/métodos , Lesões por Radiação/diagnóstico por imagem , Corticosteroides/administração & dosagem , Adulto , Idoso , Feminino , Hospitais Militares , Humanos , Neoplasias Laríngeas/radioterapia , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Marrocos , Neoplasias Nasofaríngeas/radioterapia , Necrose , Inibidores da Agregação de Plaquetas/administração & dosagem , Lesões por Radiação/terapia , Estudos Retrospectivos
10.
Rev Med Suisse ; 15(671): 2074-2079, 2019 Nov 13.
Artigo em Francês | MEDLINE | ID: mdl-31742937

RESUMO

The international recommendations of the management of asthma have been modified last years. Several therapies used since long time have no place in the management of moderate asthma today. The use of targeted immunotherapies against phenotypes of asthma are used more and more. Inhalant therapies are becoming more targeted towards the patient's wishes. This article specifies the novelties in management of asthma for de general practitioner, including the use of short acting beta2-agonists, which are no longer to be used without inhaled corticosteroid.


Assuntos
Asma/terapia , Atenção Primária à Saúde , Administração por Inalação , Corticosteroides/administração & dosagem , Corticosteroides/uso terapêutico , Agonistas Adrenérgicos beta/administração & dosagem , Agonistas Adrenérgicos beta/uso terapêutico , Asma/tratamento farmacológico , Humanos , Imunoterapia
11.
Medicine (Baltimore) ; 98(43): e17397, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31651842

RESUMO

BACKGROUND: Community-acquired pneumonia (CAP) is a major global disease. Parapneumonic effusions often complicate CAP and range from uninfected (simple) to infected (complicated) parapneumonic effusions and empyema (pus). CAP patients who have a pleural effusion at presentation are more likely to require hospitalization, have a longer length of stay and higher mortality than those without an effusion. Conventional management of pleural infection, with antibiotics and chest tube drainage, fails in about 30% of cases. Several randomized controlled trials (RCT) have evaluated the use of corticosteroids in CAP and demonstrated some potential benefits. Importantly, steroid use in pneumonia has an acceptable safety profile with no adverse impact on mortality. A RCT focused on pediatric patients with pneumonia and a parapneumonic effusion demonstrated shorter time to recovery. The effects of corticosteroid use on clinical outcomes in adults with parapneumonic effusions have not been tested. We hypothesize that parapneumonic effusions develop from an exaggerated pleural inflammatory response. Treatment with systemic steroids may dampen the inflammation and lead to improved clinical outcomes. The steroid therapy and outcome of parapneumonic pleural effusions (STOPPE) trial will assess the efficacy and safety of systemic corticosteroid as an adjunct therapy in adult patients with CAP and pleural effusions. METHODS: STOPPE is a pilot multicenter, double-blinded, placebo-controlled RCT that will randomize 80 patients with parapneumonic effusions (2:1) to intravenous dexamethasone or placebo, administered twice daily for 48 hours. This exploratory study will capture a wide range of clinically relevant endpoints which have been used in clinical trials of pneumonia and/or pleural infection; including, but not limited to: time to clinical stability, inflammatory markers, quality of life, length of hospital stay, proportion of patients requiring escalation of care (thoracostomy or thoracoscopy), and mortality. Safety will be assessed by monitoring for the incidence of adverse events during the study. DISCUSSION: STOPPE is the first trial to assess the efficacy and safety profile of systemic corticosteroids in adults with CAP and pleural effusions. This will inform future studies on feasibility and appropriate trial endpoints. TRIAL REGISTRATION: ACTRN12618000947202 PROTOCOL VERSION:: version 3.00/26.07.18.


Assuntos
Corticosteroides/administração & dosagem , Infecções Comunitárias Adquiridas/tratamento farmacológico , Dexametasona/administração & dosagem , Derrame Pleural/tratamento farmacológico , Pneumonia/tratamento farmacológico , Administração Intravenosa , Adulto , Infecções Comunitárias Adquiridas/complicações , Método Duplo-Cego , Estudos de Viabilidade , Feminino , Humanos , Masculino , Projetos Piloto , Derrame Pleural/microbiologia , Pneumonia/complicações , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento
12.
Expert Opin Drug Saf ; 18(12): 1133-1144, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31657965

RESUMO

Introduction: Systemic lupus erythematosus (SLE) is a systemic autoimmune inflammatory disease with extensive clinical variability. In 2011, the anti-BAFF monoclonal antibody, belimumab, became the first FDA-approved drug for SLE in 50+ years. As with all immunomodulating medications, the benefits must be weighed against the adverse side effects. This is especially pertinent for SLE patients, given the chronic nature of their disease and their need for long-term treatment. The focus of the present review is the safety of belimumab, including data gleaned from clinical trials, their open-label extensions, and 'real-world' clinical settings.Areas covered: Safety data from phase I, phase II, phase III, extension open-label trials, and 'real-world' observational studies of belimumab are reviewed and discussed.Expert opinion: As the only FDA-approved treatment for SLE in the past 60+ years, belimumab has demonstrated significant, albeit modest, efficacy and a reassuring safety profile. Long-term data to date show that it is well-tolerated with a low risk of side effects, even when administered for up to 13 years. Given that belimumab allows providers to decrease daily corticosteroid doses over time (and, thereby, decrease the serious risks associated with chronic corticosteroid use), it should be seen as a valuable tool in the rheumatologist's arsenal.


Assuntos
Anticorpos Monoclonais Humanizados/administração & dosagem , Imunossupressores/administração & dosagem , Lúpus Eritematoso Sistêmico/tratamento farmacológico , Corticosteroides/administração & dosagem , Animais , Anticorpos Monoclonais Humanizados/efeitos adversos , Anticorpos Monoclonais Humanizados/imunologia , Humanos , Imunossupressores/efeitos adversos , Fatores de Tempo
13.
Clin Exp Rheumatol ; 37 Suppl 120(5): 118-123, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31621561

RESUMO

Osteoarthritis (OA) is the most common form of arthritis. Pain and its related function and stiffness are currently the major symptoms and primary outcomes for treatment. However, the treatment in the past has been primarily targeting on the peripheral changes in the joint that has led to suboptimal outcomes. Recently, we find that people with OA respond better to treatment which targets on both peripheral and central pain abnormalities. We also find that placebo per se is very effective for OA. On average 75% pain reduction, 71% functional improvement and 83% stiffness improvement in the treatment of OA are attributable to the placebo/contextual effect. The effect varies between treatments, for example for pain, from 47% with intra-articular corticosteroid injection to 91% with joint lavage. This begs a question on how to improve the overall treatment effect of an OA therapy in clinical practice by enhancing the contextual effect, rather than to separate a specific treatment effect from the contextual effect as we normally do in clinical trials. The enhancement may be achieved by improving contextual factors such as patient-physician interaction or quality of care. Further research on the development of a simple contextual enhancement package that may be delivered by all physicians according to individual needs would be very helpful.


Assuntos
Corticosteroides/uso terapêutico , Osteoartrite do Joelho , Osteoartrite , Corticosteroides/administração & dosagem , Humanos , Injeções Intra-Articulares , Medição da Dor , Efeito Placebo
15.
BMC Infect Dis ; 19(1): 864, 2019 Oct 21.
Artigo em Inglês | MEDLINE | ID: mdl-31638905

RESUMO

BACKGROUND: While Legionella is a common cause of pneumonia, extrapulmonary infections like arthritis are scarce. Here, we describe a case of monoarthritis due to Legionella bozemanii, with no history of pneumonia. We provide a literature review of the 9 previously published Legionella arthritis and highlight a dichotomous epidemiology suggesting different physiopathological pathways leading to joint infection. CASE PRESENTATION: A 56-year old woman under immunosuppressive treatment by oral and intra-articular corticosteroids, methotrexate, and tocilizumab for an anti-synthetase syndrome was hospitalized for worsening pain and swelling of the left wrist for 3 days. Clinical examination showed left wrist synovitis and no fever. The arthritis occurred a few days after an accidental fall on wet asphalt responsible for a cutaneous wound followed by a corticosteroid intra-articular injection. Due to both the negativity of conventional culture of articular fluid and suspicion of infection, 16S rRNA and specific PCRs were performed leading to the identification of L. bozemanii. Legionella-specific culture of the articular fluid was performed retrospectively and isolated L. bozemanii. The empiric antibiotic therapy was switched for oral levofloxacin and rifampin and the patient recovered after a 12-week treatment. CONCLUSION: We report a case of L. bozemanii monoarthritis in an immunosuppressed woman, following a fall on wet asphalt and intra-articular corticosteroid injection. The review of the literature found that the clinical presentation reveals the mode of infection and the bacterial species. Monoarthritis more likely occurred after inoculation in patients under immunosuppressive therapy and were associated with non-Legionella pneumophila serogroup 1 (Lp1) strains that predominate in the environment. Polyarthritis were more likely secondary legionellosis localizations after blood spread of Lp1, the most frequently found in pneumonia. In both settings, 16S rRNA and Legionella-specific PCR were key factors for the diagnosis.


Assuntos
Artrite Infecciosa/imunologia , Artrite Infecciosa/microbiologia , Legionellaceae/isolamento & purificação , Legionelose/microbiologia , Acidentes por Quedas , Administração Oral , Corticosteroides/administração & dosagem , Corticosteroides/efeitos adversos , Corticosteroides/uso terapêutico , Artrite Infecciosa/tratamento farmacológico , Feminino , Humanos , Hidrocarbonetos , Hospedeiro Imunocomprometido , Injeções Intra-Articulares , Legionellaceae/genética , Levofloxacino/uso terapêutico , Pessoa de Meia-Idade , Reação em Cadeia da Polimerase , RNA Ribossômico 16S/genética , Rifampina/uso terapêutico , Resultado do Tratamento
16.
Medicine (Baltimore) ; 98(41): e17425, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31593095

RESUMO

To evaluate whether the adult patients with acquired pure red cell aplasia (PRCA) could benefit more from cyclosporine A (CsA) combined with corticosteroids (CS) than CsA or CS alone.Seventy-three patients were evaluated in 2 institutions (6 patients lost to follow-up).The induction therapy included CsA (n = 21), CS (n = 21), or CsA combined with CS (n = 31), and remission was achieved in 16/21 (76.2%), 10/21 (47.6%), and 21/31 (71.0%) patients, respectively. Higher complete remission (CR) rate was achieved in CsA combined with CS group than in CS group (61.3% vs 19.0%, P = .003). Patients achieved CR faster in CsA combined with CS group than in CS group or CsA group (median time, 1 month vs 2 month vs 3 month, P = .010). By multivariate analysis, CsA combined with CS therapy and primary PRCA were the influence factors for CR rate. Twenty-seven patients relapsed due to discontinuation or tapering therapy, and 19 patients regained response by increasing the dose of original regimens or changing to other immunosuppressive therapy. Complete remission to induction therapy was a correlative factor for death (P = .035).CsA combined with CS produced faster and higher CR rate in treating adult patients with PRCA than did CsA or CS alone.


Assuntos
Corticosteroides/administração & dosagem , Ciclosporina/administração & dosagem , Imunossupressores/administração & dosagem , Quimioterapia de Indução/métodos , Aplasia Pura de Série Vermelha/tratamento farmacológico , Adulto , Idoso , Idoso de 80 Anos ou mais , Quimioterapia Combinada , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento
17.
Lakartidningen ; 1162019 Oct 07.
Artigo em Sueco | MEDLINE | ID: mdl-31593288

RESUMO

Late and moderately preterm infants, born between 32+0/7 and 36+6/7 gestational weeks, comprise more than 80 % of all preterm infants and account for almost 40 % of all days of neonatal care. While their total number of days of care has not changed, an increasing part of their neonatal stay (from 29 % in 2011 to 41 % in 2017) is now within home care programmes. Late and moderate preterm birth is often complicated by respiratory disorders, hyperbilirubinemia, hypothermia and feeding difficulties. These infants also have an increased risk of perinatal death and neurologic complications. In the long run, they have higher risks of cognitive impairment, neuropsychiatric diagnoses and need for asthma medication. As young adults, they have a lower educational level and a lower average salary than their full-term counterparts. They also have an increased risk of long-term sick leave, disability pension and need for economic assistance from society.


Assuntos
Nascimento Prematuro , Corticosteroides/administração & dosagem , Transtorno do Deficit de Atenção com Hiperatividade/epidemiologia , Transtornos Cognitivos/epidemiologia , Educação Especial/estatística & dados numéricos , Feminino , Humanos , Lactente , Mortalidade Infantil , Fenômenos Fisiológicos da Nutrição do Lactente , Recém-Nascido Prematuro , Tempo de Internação , Pneumopatias/epidemiologia , Masculino , Transtornos Mentais/epidemiologia , Gravidez , Nascimento Prematuro/economia , Nascimento Prematuro/epidemiologia , Nascimento Prematuro/mortalidade , Nascimento Prematuro/prevenção & controle , Síndrome do Desconforto Respiratório do Recém-Nascido/diagnóstico , Síndrome do Desconforto Respiratório do Recém-Nascido/terapia , Fatores de Risco , Tempo
18.
Lakartidningen ; 1162019 Oct 08.
Artigo em Sueco | MEDLINE | ID: mdl-31593290

RESUMO

Due to a low level of understanding of mechanisms involved in spontaneous preterm delivery there is a lack of reliable biomarkers. Existing biomarkers have a low positive predictive value but a high negative predictive value. Use of tests with high negative predictive value will reduce unnecessary interventions and hospitalization of women with threatening preterm delivery. When given to the right pregnant women, antenatal corticosteroid treatment are still the most important obstetrical intervention and reduces both neonatal mortality and short- and long-term morbidity.Several ongoing national Swedish multicenter studies may increase the understanding of the roles of cervical length, preeclampsia screening and magnesium sulfate dosage in the context of preterm delivery in a Nordic setting. Major development has been achieved in prediction and prevention of preterm preeclampsia at the cost of a 10% screen positive rate.


Assuntos
Nascimento Prematuro , Corticosteroides/administração & dosagem , Biomarcadores/análise , Cerclagem Cervical , Medida do Comprimento Cervical , Colo do Útero/anatomia & histologia , Feminino , Fibronectinas/análise , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Sulfato de Magnésio/administração & dosagem , Pessários , Pré-Eclâmpsia/diagnóstico , Pré-Eclâmpsia/prevenção & controle , Gravidez , Nascimento Prematuro/diagnóstico , Nascimento Prematuro/prevenção & controle , Nascimento Prematuro/terapia , Cuidado Pré-Natal/métodos , Progesterona/administração & dosagem , Suécia , Tocolíticos/administração & dosagem
19.
Expert Rev Clin Pharmacol ; 12(10): 973-980, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31550941

RESUMO

Introduction: Pemphigus, an autoimmune disease group characterized by blisters and erosions of the skin and/or mucosal membranes has been treated with systemic corticosteroids (CS) and immunosuppressive therapies for the past few decades. Areas Covered: However, common adverse effects and complications of long-term CS and immunosuppressive drugs are limiting their long-term use. The disease results in death if not treated. Thus, currently, researchers are trying to develop new and safer therapeutic approaches. Specifically, targeted therapies to pathogenic immune pathways are under investigation. The B cell inhibitors which block CD20 and CD19 are the main new drugs investigated in clinical trials as alternatives to systemic steroids. Expert Opinion: Randomized controlled trial (RCT) Level evidence shows that rituximab and short course CSs are more effective and safer than standard CS treatment. Specific BTK inhibitors have shown promise in data from a phase II international open-label study. Further studies are ongoing.


Assuntos
Corticosteroides/administração & dosagem , Imunossupressores/administração & dosagem , Pênfigo/tratamento farmacológico , Corticosteroides/efeitos adversos , Corticosteroides/farmacologia , Tirosina Quinase da Agamaglobulinemia/antagonistas & inibidores , Animais , Desenvolvimento de Medicamentos/métodos , Humanos , Imunossupressores/efeitos adversos , Imunossupressores/farmacologia , Terapia de Alvo Molecular , Pênfigo/imunologia , Pênfigo/patologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Rituximab/administração & dosagem , Rituximab/efeitos adversos , Fatores de Tempo
20.
Pan Afr Med J ; 33: 97, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31489075

RESUMO

Libman-Sacks endocarditis is a rare cardiac manifestation systemic lupus erythematosus, in which there is a sterile vegetation in the heart valves. There is a significant risk of infective endocarditis. Our patient was a 38 year old woman with persistent fever from two months with inflammatory polyarthralgia, fixed at the wrists and ankles. She was febrile at 39 ° C, had a mitral systolic murmur 2/6 and painful swelling of the wrists and ankles. We have objectified an inflammatory syndrome, blood cultures were negative. The dosage of anti-nuclear antibody was positive with a mottled appearance, as well as anti-DNA antibodies. The Doppler echocardiography had objectified vegetations in the mitral and aortic valves. Clinical, biological and morphological improvements were obtained after antibiotic and corticosteroid combination. We can conclude that Libman-Sacks endocarditis evolution is favorable in the absence of an associated antiphospholipid syndrome (APS). Always fear in all cases a surinfection. The treatment is based on the combination antibiotic-corticosteroid-synthetic antimalarial.


Assuntos
Anticorpos Antinucleares/imunologia , Endocardite/diagnóstico , Lúpus Eritematoso Sistêmico/diagnóstico , Corticosteroides/administração & dosagem , Adulto , Antibacterianos/administração & dosagem , Antimaláricos/administração & dosagem , Ecocardiografia Doppler/métodos , Endocardite/etiologia , Endocardite/imunologia , Feminino , Humanos , Lúpus Eritematoso Sistêmico/complicações , Lúpus Eritematoso Sistêmico/imunologia , Superinfecção/diagnóstico
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