Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 1.574
Filtrar
1.
Rev. colomb. cir ; 39(6): 947-957, Nov. 1, 2024. tab, fig
Artigo em Espanhol | LILACS | ID: biblio-1580141

RESUMO

Introducción. La ingestión por cáusticos es un problema de salud pública a nivel mundial debido a la alta carga de morbilidad, mortalidad y costos. Por eso, es indispensable tener conocimientos claros sobre la situación en la población adulta, sin extrapolar datos de manejo de población pediátrica. Métodos. Se realizó una revisión crítica de la información disponible con el fin de establecer los datos importantes en el manejo de la esofagitis por cáusticos en población adulta, incluyendo un análisis del tipo de ingesta, volumen, intencionalidad y edad, para ayudar a identificar de manera temprana las complicaciones susceptibles de manejo quirúrgico. Resultados. La endoscopia tiene un rol importante en las primeras 24- 48 horas para establecer la severidad del daño según la clasificación de Zargar, que combinada con la clasificación imagenológica permite alcanzar un mejor pronóstico. No hay un beneficio demostrado con el uso de inhibidores de bombas de protones, mitomicina C, sonda nasogástrica o prótesis esofágica para prevenir las estenosis. Los esteroides tienen beneficio en Zargar ≥ 2B (pero con compromiso de vía aérea) y hay datos prometedores con el uso de sucralfato a altas dosis. En complicaciones derivadas de estenosis se prefiere la dilatación con Savary-Guillard de manera temprana. Luego de 10 años de la ingesta se debe hacer seguimiento endoscópico cada 2 -3 años para tamización de cáncer escamocelular de esófago. Conclusión. La esofagitis por cáusticos es una condición con alta carga de morbilidad, cuyo pronóstico depende de las intervenciones tempranas y un manejo y seguimiento multidisciplinario.


Introduction. Caustic ingestion is a public health problem worldwide, due to a high burden of morbidity, mortality and costs. Therefore, it is essential to have clear knowledge in the adult population, without extrapolating management data from the pediatric population. Methods. A critical review of the available information was carried out in order to establish important data in the management of caustic esophagitis in the adult population, including an analysis of the type of intake, volume, intention and age, to help identify early complications susceptible to surgical management. Results. Endoscopy has an important role in the first 24-48 hours to establish the severity of the damage according to the Zargar classification, which combined with the imaging classification allows a better prognosis to be achieved. There is no demonstrated benefit from the use of PPI, mitomycin C, nasogastric tube or esophageal prosthesis to prevent strictures. Steroids have a benefit in Zargar ≥ 2B (with airway compromise) and there are promising data with the use of sucralfate at high-doses. In complications derived from stenosis, early dilation with Savary-Guillard is preferred. After 10 years of ingestion, endoscopic follow-up should be performed every 2-3 years to screen for esophageal squamous cell cancer. Conclusion. Caustic esophagitis is a condition with a high morbidity burden, whose prognosis depends on early interventions and multidisciplinary management and follow-up.


Assuntos
Humanos , Cáusticos , Estenose Esofágica , Esofagite , Esteroides , Neoplasias Esofágicas , Dilatação
2.
Ann. oncol ; 35(Suppl. 2): S421-S421, sept. 2024.
Artigo em Inglês | CONASS, Sec. Est. Saúde SP, SESSP-IDPCPROD, Sec. Est. Saúde SP | ID: biblio-1571577

RESUMO

BACKGROUND: Brain metastases (BMs) represent the most common intracranial neoplasms in adults, affecting up to 25% of patients with metastatic cancers. Primary cancers of the lung, melanoma and colorectal are responsible for the majority of diagnosed BMs. Current therapies for BMs include stereotactic radiosurgery, whole-brain radiotherapy, surgical resection, interstitial laser thermal therapy, systemic cytotoxic chemotherapy, targeted agents, and PD1/PDL-1 blockage, which play a crucial role in cancer immunotherapy. METHODS: A systematic search was conducted through PubMed, Embase and Cochrane databases for studies that assess the benefit of neoadjuvant treatment with PD-1/PD-L1 inhibitors plus steroids and the impact of this combination on treatment effectiveness. Hazard ratios (HRs) were computed for binary endpoints, with 95% confidence intervals (CIs). We performed the meta-analysis using RStudio v4.4.2 software. RESULTS: The systematic analysis, including 1,658 patients, assessed the impact of PD-1/PD-L1 inhibitors on overall survival (OS) and progression-free survival (PFS) in treating BMs from non-small cell lung cancer (NSCLC) and melanoma. For OS, eight studies with 848 patients indicated a significant improvement using steroids (HR: 1.978; 95% CI 1.308-2.992; I2 = 62%) compared to non-users. Regarding PFS, data from four studies involving 790 patients did not reach statistical significance (HR: 1.483; 95% CI: 0.843-2.608; I2 = 82%). The addition of steroids did not show a clear beneficial effect on the efficacy of PD-1/PD-L1 inhibitors in extending progression-free survival. CONCLUSIONS: The systematic analysis underscores the effectiveness of PD-1/PD-L1 blockage in improving overall survival in patients with BMs from NSCLC and melanoma, however, their impact on delaying disease progression, especially when combined with steroids, requires further investigation to clarify their role and optimize therapeutic strategies.


Assuntos
Esteroides , Neoplasias Encefálicas , Receptor de Morte Celular Programada 1
3.
Chembiochem ; 25(21): e202400018, 2024 Nov 04.
Artigo em Inglês | MEDLINE | ID: mdl-39159394

RESUMO

Steroid hormones are essential for the biological processes of eukaryotic organisms. The steroid endocrine system of C. elegans, which includes dafachronic acids (DA) and the nuclear receptor ceDAF-12, provides a simple model for exploring the role of steroid hormone signaling pathways in animals. In this study, we show for the first time the feasibility of designing synthetic steroids that can modulate different physiological processes, such as development, reproduction and ageing, in relation to ceDAF-12. Our results not only confirm the conclusions derived from genetic studies linking these processes but also provide new chemical tools to selectively manipulate them, as we found that different compounds produce different phenotypic results. The structures of these compounds are much more diverse than those of endogenous hormones and analogues previously described by other researchers, allowing further development of the chemical modulation of the steroid endocrine system in C. elegans and related nematodes.


Assuntos
Proteínas de Caenorhabditis elegans , Caenorhabditis elegans , Animais , Caenorhabditis elegans/metabolismo , Caenorhabditis elegans/efeitos dos fármacos , Ligantes , Proteínas de Caenorhabditis elegans/metabolismo , Colestenos/química , Colestenos/metabolismo , Colestenos/farmacologia , Esteroides/química , Esteroides/metabolismo , Receptores Citoplasmáticos e Nucleares/metabolismo , Sistema Endócrino/metabolismo , Sistema Endócrino/efeitos dos fármacos , Transdução de Sinais/efeitos dos fármacos
4.
Chem Biodivers ; 21(3): e202301779, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-38426669

RESUMO

Plant-insect interactions are a driving force into ecosystem evolution and community dynamics. Many insect herbivores enter diapause, a developmental arrest stage in anticipation of adverse conditions, to survive and thrive through seasonal changes. Herein, we investigated the roles of medium- to non-polar metabolites during larval development and diapause in a specialist insect herbivore, Chlosyne lacinia, reared on Aldama robusta leaves. Varying metabolites were determined using gas chromatography-mass spectrometry (GC-MS)-based metabolomics. Sesquiterpenes and steroids were the main metabolites putatively identified in A. robusta leaves, whereas C. lacinia caterpillars were characterized by triterpenes, steroids, fatty acids, and long-chain alkanes. We found out that C. lacinia caterpillars biosynthesized most of the identified steroids and fatty acids from plant-derived ingested metabolites, as well as all triterpenes and long-chain alkanes. Steroids, fatty acids, and long-chain alkanes were detected across all C. lacinia instars and in diapausing caterpillars. Sesquiterpenes and triterpenes were also detected across larval development, yet they were not detected in diapausing caterpillars, which suggested that these metabolites were converted to other molecules prior to the diapause stage. Our findings shed light on the chemical content variation across C. lacinia development and diapause, providing insights into the roles of metabolites in plant-insect interactions.


Assuntos
Diapausa , Lepidópteros , Sesquiterpenos , Triterpenos , Animais , Cromatografia Gasosa-Espectrometria de Massas , Ecossistema , Metabolômica/métodos , Esteroides/metabolismo , Sesquiterpenos/metabolismo , Ácidos Graxos/metabolismo , Alcanos , Triterpenos/metabolismo , Larva
6.
J Endocrinol ; 261(2)2024 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-38470178

RESUMO

For many years, research in the field of steroid synthesis has aimed to understand the regulation of the rate-limiting step of steroid synthesis, i.e. the transport of cholesterol from the outer to the inner mitochondrial membrane, and identify the protein involved in the conversion of cholesterol into pregnenolone. The extraordinary work by B Clark, J Wells, S R King, and D M Stocco eventually identified this protein and named it steroidogenic acute regulatory protein (StAR). The group's finding was also one of the milestones in understanding the mechanism of nonvesicular lipid transport between organelles. A notable feature of StAR is its high degree of phosphorylation. In fact, StAR phosphorylation in the acute phase is required for full steroid biosynthesis. As a contribution to this subject, our work has led to the characterization of StAR as a substrate of kinases and phosphatases and as an integral part of a mitochondrion-associated multiprotein complex, essential for StAR function and cholesterol binding and mitochondrial transport to yield maximum steroid production. Results allow us to postulate the existence of a specific cellular microenvironment where StAR protein synthesis and activation, along with steroid synthesis and secretion, are performed in a compartmentalized manner, at the site of hormone receptor stimulation, and involving the compartmentalized formation of the steroid molecule-synthesizing complex.


Assuntos
Fosfoproteínas , Esteroides , Fosfoproteínas/metabolismo , Colesterol/metabolismo , Microambiente Celular
7.
Rev. cuba. med. mil ; 53(1)mar. 2024.
Artigo em Espanhol | LILACS, CUMED | ID: biblio-1569883

RESUMO

Introducción: La enfermedad de Still del adulto es una enfermedad reumática, inflamatoria, sistémica y crónica cuya prevalencia en la población caucásica se estima en 1 caso por cada 100 000 adultos Objetivo: Presentar un paciente adulto joven, con una fiebre de origen desconocido como forma de presentación de la enfermedad de Still del adulto. Caso clínico: Paciente de 29 años de edad con antecedente de fiebre reumática, con un ingreso hospitalario anterior; que presentó un cuadro febril no infeccioso, de 50 días de duración, al cual no se le determinó la causa. Un año después reapareció la fiebre, de similares características, asociada a poliartralgia, hepatoesplenomegalia, anemia, hiperferritinemia, neutrofilia, factor reumatoideo negativo y se constató un cuadro de pericarditis durante el ingreso. Se realizó el diagnóstico de enfermedad de Still del adulto, por exclusión. Se inició tratamiento con esteroides, desapareció la fiebre en las primeras 24 horas y el paciente tuvo una evolución favorable. Conclusiones: La enfermedad de Still del adulto puede presentarse como una fiebre de origen desconocido y se diagnostica por exclusión, ya que no existen manifestaciones clínicas ni pruebas de laboratorio, patognomónicas. La hiperferritinemia es útil para la sospecha diagnóstica(AU)


Introduction: Adult Still's disease is a rheumatic, inflammatory, systemic and chronic disease whose prevalence in the Caucasian population is estimated at 1 case per 100,000 adults. Objective: To present a young adult patient with a fever of unknown origin as the presentation of adult Still's disease. Clinical case: 29-year-old patient with a history of rheumatic fever, with a previous hospital admission; who presented a non-infectious febrile illness lasting 50 days, for which the cause was not determined. A year later, the fever reappeared, with similar characteristics, associated with polyarthralgia, hepatosplenomegaly, anemia, hyperferritinemia, neutrophilia, negative rheumatoid factor, and pericarditis was noted during admission. The diagnosis of adult Still's disease was made by exclusion. Treatment with steroids was started, the fever disappeared in the first 24 hours and the patient had a favorable evolution. Conclusions: Adult Still's disease can present as a fever of unknown origin and is diagnosed by exclusion, since there are no pathognomonic clinical manifestations or laboratory tests. Hyperferritinemia is useful for diagnostic suspicion(AU)


Assuntos
Humanos , Adulto , Doenças Reumáticas , Doença de Still de Início Tardio/diagnóstico , Doença de Still de Início Tardio/etiologia , Febre de Causa Desconhecida/etiologia , Hiperferritinemia , Esteroides/uso terapêutico
8.
Acta Trop ; 253: 107157, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38387772

RESUMO

Biofilms are a bacterial resistance strategy through which microorganisms organize themselves in the form of a colony fixed to a surface that is protected by a polymer matrix. Infectious diseases that result in biofilm formation have been considered a relevant public health problem due to the potential to increase patient morbidity and mortality, in addition to increasing the burden on health services. Such pathologies are treated with the use of antimicrobial drugs, the indiscriminate use of which has contributed to the process of bacterial resistance, demanding the need to invest in new alternatives to combat them. Based on this, the present work aimed to evaluate the anti-biofilm formation and eradication capacity of Hecogenin Acetate, a steroidal sapogenin of natural origin with important antibacterial properties. For this, we used strains of Streptococcus mutans INCQS 00,446 (ATCC 25,175), Enterococcus faecalis INCQS 00,018 (ATCC 14,506), Staphylococcus epidermidis INCQS 00,016 (ATCC 12,228), Staphylococcus aureus ATCC 25,923, Pseudomonas aeruginosa ATCC 9027 and Escherichia coli ATCC 259,223. The formation, formation inhibition and treatment assays were carried out in microdilution plates and revealed using the crystal violet method. Readings were carried out using absorbance at wavelengths of 492 nm. All tests were performed in triplicate and statistical analyzes were performed using Graphpad Prism v.5.0 software. It was observed that the bacterial strains used have a relevant capacity for biofilm formation, with the Gram positive ones identified in the present study as the best former. In the results of the analyzes with bacterial biofilm, it was identified that Hecogenin Acetate had a relevant antibiofilm capacity, and could therefore serve as a basis for further research into the development of new antimicrobial drugs.


Assuntos
Anti-Infecciosos , Compostos de Espiro , Esteroides , Humanos , Antibacterianos/farmacologia , Anti-Infecciosos/farmacologia , Bactérias , Biofilmes , Testes de Sensibilidade Microbiana
9.
BMC Pulm Med ; 24(1): 74, 2024 Feb 08.
Artigo em Inglês | MEDLINE | ID: mdl-38331769

RESUMO

BACKGROUND: Idiopathic chronic eosinophilic pneumonia (ICEP) is a rare disease characterized by pulmonary radiological alterations, peripheral eosinophilia, and demonstrated pulmonary eosinophilia. Oral steroids (OSs) are the standard management, but relapses occur in up to 50% of patients during the decrease or suspension of steroids, usually requiring reinitiation of treatment, exposing patients to secondary events derived from the management. Management with monoclonal antibodies has been proposed in these cases to control the disease and limit the secondary effects. The objective is to describe the extent and type of evidence regarding the use of monoclonal antibodies for ICEP. METHODS: A panoramic review of the literature was performed. Observational and experimental studies of pediatric and adult populations that managed recurrent ICEP with monoclonal antibodies were included. Data search, selection, and extraction were performed by two independent reviewers. RESULTS: 937 studies were found. After applying the inclusion and exclusion criteria, 37 titles remained for the final analysis: a retrospective, observational, real-life study, two case series publications, and 34 case reports published in academic poster sessions and letters to the editor. In general, the use of monoclonal antibodies approved for severe asthma could be useful for the control of ICEP, since most of the results show a good response for clinical and radiological outcomes. Biological drugs seem to be a safer option for controlling relapses in ICEP, allowing lowering/suspension of OSs, and sometimes replacing them in patients intolerant to them, patients with significant comorbidities, and patients who have already developed adverse events. CONCLUSION: The extent of the evidence supporting management of ICEP with monoclonal antibodies against IL-5 and IgE (omalizumab) is limited, but it could be promising in patients who present frequent relapses, in cortico-dependent individuals, or in patients in whom the use of steroids is contraindicated. The extent of the evidence for management with dupilumab is more limited. Studies with better design and structure are needed to evaluate quality of life and outcomes during a clear follow-up period. To our knowledge, this is the first scoping review of the literature showing the extent of the evidence for the management of ICEP with monoclonal antibodies.


Assuntos
Asma , Eosinofilia Pulmonar , Adulto , Humanos , Criança , Eosinofilia Pulmonar/tratamento farmacológico , Eosinofilia Pulmonar/complicações , Anticorpos Monoclonais/uso terapêutico , Qualidade de Vida , Estudos Retrospectivos , Recidiva Local de Neoplasia , Asma/complicações , Esteroides/uso terapêutico , Recidiva
10.
Metallomics ; 16(2)2024 02 07.
Artigo em Inglês | MEDLINE | ID: mdl-38337175

RESUMO

Steroids that take part in the pathways of human steroidogenesis are involved in many biological mechanisms where they interact with calcium. In the present work, the binding selectivities and affinities for calcium of progestagens, mineralocorticoids, androstagens, and estrogens were studied by Electrospray Ionization-Mass Spectrometry (ESI-MS). The adduct profile of each steroid was characterized by high resolution and tandem mass spectrometry. The relative stability of the most important adducts was studied by threshold collision induced dissociation, E1/2. Doubly-charged steroid-calcium complexes [nM + Ca]2+ with n = 1-6 were predominant in the mass spectra. The adduct [5M + Ca]2+ was the base peak for most 3-keto-steroids, while ligands bearing hindered ketones or α-hydroxy-ketones also yielded [nM + Ca + mH2O]2+ with n = 3-4 and m = 0-1. Principal component analysis allowed us to spot the main differences and similarities in the binding behavior of these steroids. The isomers testosterone and dehydroepiandrosterone, androstanolone and epiandrosterone, and 17-α-hydroxyprogesterone and 11-deoxycorticosterone showed remarkable differences in their adduct profiles. Computational modeling of representative adducts was performed by density functional theory methods. The possible binding modes at low and high numbers of steroid ligands were determined by calcium Gas Phase Affinity, and through modeling of the complexes and comparison of their relative stabilities, in agreement with the experimental results.


Assuntos
Cálcio , Espectrometria de Massas por Ionização por Electrospray , Humanos , Cálcio/química , Espectrometria de Massas por Ionização por Electrospray/métodos , Espectrometria de Massas em Tandem/métodos , Esteroides , Cetonas
11.
Steroids ; 203: 109366, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-38242273

RESUMO

The adrenal gland produces steroid hormones that act in the homeostasis of organisms. During aging, alterations in the hormonal balance affect the adrenal glands, but these have not yet been fully described due to the lack of adequate animal models. The adrenal gland of the Mongolian gerbil has a morphology similar to the primate's adrenal gland, which makes it a possible animal model for endocrine studies. Therefore, the current study aimed to study the morphophysiology of the adrenal gland under the effect of aging. For this purpose, males Meriones unguiculatus, aged three, six, nine, twelve, and fifteen months were used. Morphometric, immunohistochemical, and hormonal analyses were performed. It was observed that during aging the adrenal gland presents hypertrophy of the fasciculata and reticularis zones. Lipofuscin accumulation was observed during aging, in addition to changes in proliferation, cell death, and cell receptors. The analyses also showed that the gerbil presents steroidogenic enzymes and the production of steroid hormones, such as DHEA, like that found in humans. The data provide the first comprehensive assessment of the morphophysiology of the Mongolian gerbil adrenal cortex during aging, indicating that this species is a possible experimental model for studies of the adrenal gland and aging.


Assuntos
Córtex Suprarrenal , Humanos , Animais , Masculino , Gerbillinae/anatomia & histologia , Córtex Suprarrenal/metabolismo , Glândulas Suprarrenais/metabolismo , Corticosteroides/farmacologia , Hormônios/metabolismo , Envelhecimento , Esteroides/farmacologia
12.
Liver Transpl ; 30(1): 61-71, 2024 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-37439661

RESUMO

Avoidance of steroids in pediatric liver transplantation may reduce toxicity and morbidity. The aim of this study was to analyze the feasibility of a steroid-free tacrolimus-basiliximab immunosuppression scheme, the risk factors associated with steroid requirement, and safety parameters. Patients who underwent liver transplantation for biliary atresia between 2011 and 2019 were included and followed for 6 months after transplantation. Immunosuppression consisted of tacrolimus-based treatment with basiliximab induction. Steroid-free survival was estimated, and risk factors for steroid requirement were evaluated using multivariate Cox regression analysis. A total of 76 patients were included, of whom 42 (55.3%) required steroids (>14 d) due to biopsy-proven acute rejection (47.6%, n = 20), instability in liver function tests (35.7%, n = 15), tacrolimus-related adverse drug reactions (14.3%, n = 6), or other reasons (bronchospasm episode, n = 1). Steroid-free survival was 45.9% (95% CI, 35.9-58.8). Independent factors associated with steroid requirement included tortuosity in tacrolimus trough levels (≥1.76 vs. <1.76: HR 5.8, 95% CI, 2.6-12.7; p < 0.001) and mean tacrolimus trough levels (≥ 6.4 ng/mL vs. < 6.4 ng/mL: HR 0.4, 95% CI, 0.2-0.7; p = 0.002). The rate of bacterial and viral infections was comparable between patients with and without steroids, although in the former group, cytomegalovirus infection developed earlier ( p = 0.03). Patients receiving steroids had higher total cholesterol, LDL, and HDL levels ( p < 0.05) during follow-up, but no changes in the height Z-score were observed 1 year after transplantation. Basiliximab induction in combination with tacrolimus-based treatment avoided steroid requirements in 45% of the patients. Tacrolimus variability and trough levels below 6.4 ng/mL independently increased the risk of steroid requirement. Further efforts should be focused on personalizing immunosuppressive treatment.


Assuntos
Transplante de Fígado , Tacrolimo , Humanos , Criança , Basiliximab/efeitos adversos , Tacrolimo/efeitos adversos , Transplante de Fígado/efeitos adversos , Anticorpos Monoclonais/efeitos adversos , Estudos de Viabilidade , Imunossupressores/efeitos adversos , Terapia de Imunossupressão/efeitos adversos , Esteroides/efeitos adversos , Rejeição de Enxerto/epidemiologia , Rejeição de Enxerto/prevenção & controle , Rejeição de Enxerto/tratamento farmacológico
13.
Neurologist ; 29(2): 106-108, 2024 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-37611403

RESUMO

INTRODUCTION: Severe and less common neurological manifestations of SARS-CoV-2 infection include acute ischemic stroke, intracerebral hemorrhage, central venous sinus thrombosis, and vasculitis. In this report, we present a case of a 42-year-old man with acute ischemic stroke due to SARS-CoV-2 infection-associated central nervous system vasculitis that improved with steroid therapy. CASE REPORT: A 42-year-old man with SARS-CoV-2 infection presented with non-fluent aphasia and right-sided hemiparesis. Computed tomography angiography revealed an occlusion of the proximal left middle cerebral artery (MCA), with acute infarcts in the left posterior parietal, lentiform nucleus, and cortical frontal cortex on magnetic resonance imaging (MRI). Patient developed pulmonary emboli and was discharged on apixaban and atorvastatin. Four weeks later, the patient presented with recurring symptoms and was found to have worsening left MCA stenosis. MRI and MR angiography revealed a penumbra within the left MCA territory and pruning of the distal branches with severe stenosis. Laboratory workup for autoimmune causes of vasculitis was unrevealing. High-dose intravenous steroid treatment was initiated. Subsequent MRI and MR angiography revealed improved flow in the left cerebral vasculature and no novel ischemic infarcts. CONCLUSION: Central nervous system vasculitis is a rare manifestation of SARS-CoV-2 infection. This case suggests that high-dose intravenous steroids may have a therapeutic role in this patient population. Steroid use, in combination with vasopressor support to augment cerebral blood flow, may prevent further stroke burden.


Assuntos
COVID-19 , AVC Isquêmico , Vasculite do Sistema Nervoso Central , Masculino , Humanos , Adulto , Constrição Patológica , COVID-19/complicações , SARS-CoV-2 , Vasculite do Sistema Nervoso Central/complicações , Vasculite do Sistema Nervoso Central/diagnóstico por imagem , Vasculite do Sistema Nervoso Central/tratamento farmacológico , Infarto , Esteroides/uso terapêutico
15.
Pediatr Pulmonol ; 59(1): 121-128, 2024 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-37818776

RESUMO

OBJECTIVES: Guidelines for asthma management recommend, before establishing additional therapeutic behaviors, to confirm correct use and adequate therapeutic adherence to treatment. Evidence exists on the use of fractional exhaled nitric oxide (FeNO) values for monitoring therapeutic adherence in adults. It is important to establish whether there is a correlation between FeNO and therapeutic adherence in children. This study aims to provide new knowledge about the relationship between FeNO and therapeutic adherence in asthmatic children. MATERIALS AND METHODS: Analytical cross-sectional study including asthma patients 5-18 years of age, attending follow-up at Hospital Militar Central (HMC) between May and November 2022 in Colombia. A sociodemographic survey was carried out, followed by the Pediatric Inhaler Adherence Questionnaire (PIAQ), and asthma control test (ACT) or childhood asthma control test (cACT). We defined adequate therapeutic adherence as not missing a single application of inhaled steroids in the last 15 days according to PIAQ. A poisson regression model was carried out including relevant predictors for therapeutic adherence such as FeNO values, age, tobacco exposure at home, atopy, and time since initiation of use of inhaled controller. RESULTS: Eighty-two children with a median age of 10 years (interquartile range: 7-12 years) were included. Adequate therapeutic adherence was reported by 68.3%. After adjusting for age, sex, exposure to cigarette smoke, duration of controller therapy, and atopy, FeNO < 20 ppb was independently associated with adequate therapeutic adherence (RR = 1.5, p = .04, 95% confidence interval: 1.03-2.19). CONCLUSIONS: FeNO values seem to be useful to identify pediatric patients with asthma who have adequate adherence to inhaled steroids in a MIC.


Assuntos
Asma , Hipersensibilidade Imediata , Adulto , Humanos , Criança , Teste da Fração de Óxido Nítrico Exalado , Estudos Transversais , Óxido Nítrico/uso terapêutico , Testes Respiratórios , Asma/tratamento farmacológico , Esteroides/uso terapêutico , Expiração
17.
Cir Cir ; 91(6): 816-823, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-38096857

RESUMO

BACKGROUND: Sudden Sensorineural Hearing Loss was described by Mc. Cabe in 1979 and, since then, many authors have tried to define, explain and correctly treat this disease. The National Institute on Deafness and Other Communication Disorders defines it as sudden sensorineural hearing loss of at least 30 dB in three contiguous audiometric frequencies in a period of 72 hours. Among the therapeutic strategies, corticosteroids have been shown to have the greatest benefit due to their anti-inflammatory and anti-cellular stress effects. OBJECTIVE: To determine the hearing results with combined steroid therapy in patients with sudden sensorineural hearing loss (SSHL), according to the Siegel recovery criteria scale. METHOD: Study carried out in the otorhinolaryngology and head and neck surgery service of the Centro Médico Naval, Ciudad de México, where 150 patients diagnosed with SSHL and who received combined therapy with intratympanic dexamethasone and systemic prednisone were included. RESULTS: Therapeutic effectiveness was demonstrated by correlating therapeutic success in 82% of cases and therapeutic failure in 18% of cases, by correlating it with the Siegel recovery criteria scale. When evaluating the general average of the pure tone average levels at the beginning and 6 weeks after treatment, a statistically significant difference was obtained (p = 0.001). The average of the speech audiometry at the beginning and 6 weeks later had a statistically significant difference (p = 0.001). CONCLUSIONS: Initial combined steroid treatment for SSHL has been shown to have beneficial results according to Siegel recovery criteria scale.


ANTECENDENTES: La Hipoacusia Neurosensorial Súbita Idiopática fue descrita por Mc. Cabe en 1979 y, desde entonces, muchos autores han tratado de definir, explicar y tratar correctamente esta enfermedad. El Nacional Institute on Deafness and Other Communication Disorders la define como pérdida auditiva neurosensorial brusca de al menos 30 dB en tres frecuencias audiométricas contiguas en un periodo de 72 horas. Entre las estrategias terapéuticas, los corticosteroides han demostrado tener mayor beneficio por sus efectos antiinflamatorios y antiestrés celular. OBJETIVO: Determinar los resultados auditivos con la terapia de esteroides combinados en pacientes con hipoacusia neurosensorial súbita idiopática (HNSI), de acuerdo a la escala de criterios de recuperación de Siegel. MÉTODO: Estudio realizado en el servicio de otorrinolaringología y cirugía de cabeza y cuello del Centro Médico Naval, en Ciudad de México, en el que se incluyeron 150 pacientes con diagnóstico de HNSI y que recibieron terapia combinada con dexametasona intratimpánica y prednisona sistémica. RESULTADOS: Se demostró una efectividad terapéutica al correlacionar el éxito terapéutico en el 82% de los casos y un fracaso terapéutico en el 18% de los casos según la escala de criterios de recuperación de Siegel. Al evaluar el promedio general de los niveles de promedio de tonos puros al inicio y 6 semanas posterior al tratamiento se obtuvo una diferencia estadísticamente significativa (p = 0.001). El promedio de las logoaudiometrías al inicio y 6 semanas posterior al tratamiento tuvo una diferencia estadísticamente significativa (p = 0.001). CONCLUSIONES: El tratamiento combinado con esteroides de manera inicial para la HNSI ha demostrado tener resultados benéficos de acuerdo con la escala de criterios de recuperación de Siegel.


Assuntos
Perda Auditiva Neurossensorial , Perda Auditiva Súbita , Humanos , Resultado do Tratamento , Anti-Inflamatórios/uso terapêutico , Perda Auditiva Súbita/tratamento farmacológico , Perda Auditiva Súbita/diagnóstico , Perda Auditiva Neurossensorial/tratamento farmacológico , Perda Auditiva Neurossensorial/induzido quimicamente , Audição , Esteroides/uso terapêutico , Audiometria de Tons Puros , Dexametasona/uso terapêutico , Glucocorticoides/uso terapêutico , Estudos Retrospectivos
19.
Braz J Biol ; 83: e273614, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37937623

RESUMO

Bauhinia pulchella Benth. (Fabaceae), is native to Brazil and popularly known as pata-de-bode. In folk medicine, it is used to treat diabetes. Pharmacological studies have demonstrated different properties, such as cytotoxic and antioxidant, and different chemical constituents, such as essential oil, triterpenoids, steroids, among others. In order to highlight the morphological differences of the species B. pulchella from the others of the genus, and its pharmacological potential, the present study aimed to carry out the anatomical and histochemical characterization of the stem and leaves of B. pulchella. Usual methods in plant anatomy were used in the preparation of semi-permanent slides containing cross sections of the stem, petiole and leaf blade and paradermal sections of the leaf blade for analysis in light microscopy and polarized light. Histochemical tests were also performed to localize the metabolites in the stem and leaf blade. The stem of B. pulchella has a cylindrical outline, the bark is composed of 7-8 layers of cells and discontinuously distributed sclerenchyma; petiole presents flat convex contour, prominences in the adaxial region, concentric amphicrivral vascular bundle, surrounding a small concentric anfivasal intramedullary bundle, adaxially two accessory bundles and tector trichomes; leaf blade with anisocytic and tetracytic stomata on the adaxial surface and anisocytic, tetracytic and anomocytic on the abaxial surface; and midrib with plain-convex outline, 1-2 layers of collenchyma and covering trichomes. Characteristics that differ from other species of the genus Bauhinia. Alkaloids, phenolic compounds, lipophilic compounds, lignin, triterpenes, steroids and tannins were observed in the species. The results are fundamental for the pharmacobotanical standardization of the studied species.


Assuntos
Bauhinia , Fabaceae , Folhas de Planta/anatomia & histologia , Tricomas , Esteroides
20.
Rev Alerg Mex ; 70(4): 201, 2023 Sep.
Artigo em Espanhol | MEDLINE | ID: mdl-37933942

RESUMO

Background: DRESS syndrome (Drug reaction with eosinophilia and systemic symptoms) is an idiosyncratic reaction characterized by peripheral eosinophilia and systemic symptoms: fever, exanthema, lymphadenopathy, hepatitis, atypical lymphocytes and elevated liver enzymes. The incidence is 1 per 10,000 exposures, mortality 10-20%. Treatment is based on suspension of the suspected drug and steroids. Case report: A 42-year-old male with the following important antecedents. AHF: mother and father with Diabetes Mellitus type 2. APP: Arterial Hypertension, Diabetes Mellitus type 2, and bee sting allergy. Current Condition: He started 8 days after ingestion of hydroxychloroquine for probable SARS-COV-2 infection, with headache, facial and neck edema, desquamative dermatosis on trunk and upper extremities, went to private clinic with torpid evolution sent to third level for increased facial and neck edema, which merited orotracheal intubation, management with intravenous steroids and antihistamines. Labs on admission: Leukocytes 20090, platelets 322 thousand, eosinophilia (5%), elevated liver enzymes and acute kidney injury, fulfilling J-SCAR criteria. The patient was discharged due to adequate evolution with follow-up by Allergy and Clinical Immunology, the patient persists with desquamative lesions after 4 weeks and normalization of laboratory parameters. Conclusions: DRESS is a delayed adverse reaction. It is important the diagnostic presumption and the causal relationship with the drugs due to the high mortality rate.


Antecedentes: El síndrome DRESS (Drug reaction with eosinophilia and systemic symptoms) es una reacción idiosincrática, se caracteriza por eosinofilia perifé- rica y síntomas sistémicos: fiebre, exantema, linfadenopatía, hepatitis, linfocitos atípicos y elevación de enzimas hepáticas. La incidencia es de 1 por cada 10,000 exposiciones, mortalidad de 10 a 20%. El tratamiento se basa en la suspensión del fármaco sospechoso y en la aplicación de esteroides. Reporte de caso: Masculino de 42 años con los siguientes antecedentes de importancia. AHF: madre y padre con Diabetes Mellitus tipo 2. APP: Hipertensión Arterial, Diabetes Mellitus tipo 2, y alergia a picadura de abeja. Padecimiento Actual: Lo inicia posterior a 8 días tras la ingesta de hidroxicloroquina por probable infección por SARS-COV-2, con cefalea, edema facial y de cuello, dermatosis descamativa en tronco y extremidades superiores, acude a clínica particular con evolución tórpida enviado a tercer nivel por aumento de edema facial y cuello, que amerito intubación orotraqueal, manejo con esteroides intravenosos y anti- histamínicos. Laboratorios a su ingreso: Leucocitos 20090, plaquetas 322 mil, eosinofilia (5%), elevación de enzimas hepáticas y lesión renal aguda, cumpliendo criterios J-SCAR. Se egresa por adecuada evolución con seguimiento por Alergia e Inmunología Clínica, el paciente persiste con lesiones descamativas posterior a 4 semanas y normalización de parámetros de laboratorios. Conclusión: DRESS es una reacción adversa retardada. Es importante la presunción diagnóstica y la relación causal con los fármacos por la alta tasa de morta- lidad.


Assuntos
Síndrome de Hipersensibilidade a Medicamentos , Eosinofilia , Adulto , Humanos , Masculino , Síndrome de Hipersensibilidade a Medicamentos/diagnóstico , Edema , Eosinofilia/diagnóstico , Hidroxicloroquina , Esteroides
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA