Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 7.677
Filtrar
1.
Medicina (B Aires) ; 79 Suppl 3: 66-70, 2019.
Artigo em Espanhol | MEDLINE | ID: mdl-31603847

RESUMO

The two main demyelinating diseases in children are reviewed. Acute disseminated encephalomyelitis (ADEM) and multiple sclerosis (MS). For its physiopathological characteristics, probable etiologies, clinical manifestations, diagnosis, treatment, prognosis, evolution, as well as atypical alterations that complicate its diagnosis, the smaller the child is, more study is needed before reaching the diagnosis. The International Study Group of Multiple Pediatric Sclerosis, published the operating definitions for demyelinating diseases acquired from the central nervous system in children: the ADEM is monophasic, polysymptomatic and with encephalopathy. Its duration is up to 3 months, with fluctuating symptoms and magnetic resonance findings. MS is an isolated monofocal or polyfocal syndrome, without encephalopathy. Currently, two different and distinguishable diseases are considered from the onset of symptoms.


Assuntos
Encefalomielite Aguda Disseminada/diagnóstico por imagem , Esclerose Múltipla/diagnóstico por imagem , Encéfalo/diagnóstico por imagem , Encéfalo/fisiopatologia , Criança , Quimioterapia Combinada , Encefalomielite Aguda Disseminada/tratamento farmacológico , Humanos , Imunoterapia , Imagem por Ressonância Magnética , Esclerose Múltipla/tratamento farmacológico , Esteroides/uso terapêutico , Síndrome
2.
Medicina (B Aires) ; 79 Suppl 3: 71-76, 2019.
Artigo em Espanhol | MEDLINE | ID: mdl-31603848

RESUMO

Juvenile myasthenia gravis is a rare autoimmune disease, which has made it difficult to collect data from prospective randomized controlled trials to evaluate the efficacy and results of different treatments. Although there are differences between the juvenile myasthenia gravis and that of the adult, the data provided by some researches in adults in the treatment of juvenile myasthenia gravis have been used. The different therapeutic options will be evaluated, with the different evidences that sustain it and a treatment algorithm will be elaborated keeping always in mind that each patient offers us different challenges.


Assuntos
Miastenia Gravis/terapia , Criança , Inibidores da Colinesterase/uso terapêutico , Humanos , Imunossupressores/classificação , Imunossupressores/uso terapêutico , Miastenia Gravis/cirurgia , Esteroides/uso terapêutico , Timectomia
3.
Internist (Berl) ; 60(11): 1201-1208, 2019 Nov.
Artigo em Alemão | MEDLINE | ID: mdl-31511906

RESUMO

This article reports about a 73-year-old woman of Bosnian descent who presented with acute renal failure. A renal biopsy was diagnostic for a postinfect necrotizing and extracapillary proliferative glomerulonephritis. The patient reported a febrile infection fever 2 weeks previously. The diagnostics did not reveal any indications of an ongoing infection. The glomerulonephritis responded to treatment with systemic steroids. The patient was readmitted to hospital 6 weeeks later in a severely ill condition. A gastric biopsy revealed a Strongyloides stercoralis infestation. Due to the systemic steroid therapy the patient had developed a so-called hyperinfection syndrome and died despite treatment on the intensive care unit. This case illustrates the need for awareness of this rare parasitosis, particularly in patients from endemic areas. A likely causal relationship with the glomerulonephritis is discussed and an overview of the diagnostics, course of the disease and treatment of this parasitosis is given.


Assuntos
Lesão Renal Aguda/etiologia , Glomerulonefrite/tratamento farmacológico , Prednisolona/efeitos adversos , Esteroides/efeitos adversos , Strongyloides stercoralis/isolamento & purificação , Estrongiloidíase/diagnóstico , Idoso , Animais , Antiparasitários/uso terapêutico , Evolução Fatal , Feminino , Glomerulonefrite/diagnóstico , Humanos , Ivermectina/uso terapêutico , Prednisolona/uso terapêutico , Esteroides/uso terapêutico , Estômago/microbiologia , Estômago/patologia , Estrongiloidíase/complicações , Estrongiloidíase/tratamento farmacológico
4.
Medicine (Baltimore) ; 98(35): e16830, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31464908

RESUMO

RATIONALE: Amyloidosis accounts for 2% of head and neck tumors. Amyloidosis that develops in the head and neck region is localized amyloidosis. Multifocal amyloidosis in the head and neck region is extremely rare. PATIENT CONCERNS: The patient presented to the clinic of otolaryngology with nasal obstruction, anosmia and left neck mass for several months. DIAGNOSIS: A left nasopharynx tumor was revealed under nasopharyngeal scope. Eosinophilic, proteinaceous material was revealed under a pathology scope in the nasopharynx tissue and neck tumor. Congo red staining demonstrated pale congophilic amorphous material with apple-green birefringence under cross-polarized light, and multifocal amyloidosis was diagnosed. Amyloidosis secondary to systemic lupus erythematosus (SLE) was confirmed after a series of investigations. INTERVENTIONS: The patient underwent local excision for multifocal amyloidosis without following management. To control underlying SLE, the patient accepted steroid pulse therapy and immunosuppressants. The patient eventually achieved disease remission. OUTCOMES: During the 6 months of follow-up in the outpatient department of otolaryngology and rheumatology, complications, recurrence of nasopharyngeal amyloidosis, and SLE flare-up were not observed. LESSONS: Head and neck amyloidosis involving the nasopharynx is a rare presentation of this disease. Head and neck multifocal amyloidosis should be taken as a hint of systemic disease. In head and neck amyloidosis, a comprehensive survey should be performed to clarify the underlying disease predisposing to amyloidosis and organ involvement.


Assuntos
Amiloidose/etiologia , Neoplasias de Cabeça e Pescoço/diagnóstico , Lúpus Eritematoso Sistêmico/diagnóstico , Neoplasias Nasofaríngeas/diagnóstico , Adulto , Amiloidose/cirurgia , Feminino , Neoplasias de Cabeça e Pescoço/patologia , Neoplasias de Cabeça e Pescoço/cirurgia , Humanos , Imunossupressores/uso terapêutico , Lúpus Eritematoso Sistêmico/tratamento farmacológico , Neoplasias Nasofaríngeas/patologia , Neoplasias Nasofaríngeas/cirurgia , Indução de Remissão , Esteroides/uso terapêutico , Resultado do Tratamento
5.
Medicine (Baltimore) ; 98(27): e16339, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31277186

RESUMO

BACKGROUND: This study was performed to systematically review the efficacy of Salvia miltiorrhiza injection combined with steroids in the treatment of oral submucous fibrosis. METHODS: We searched 9 databases: Web of Science, PubMed, Medline, EBSCO, Embase, The Cochrane Library, WanFang Data, the China National Knowledge Infrastructure (CNKI), and Chinese Scientific Journals Full-text Database (VIP). Randomized controlled trials were collected to study the treatment of oral submucous fibrosis by S miltiorrhiza injection combined with steroids. Each database was searched from inception to November 2018. RevMan 5.3 software was used for the meta-analysis. RESULTS: In total, 13 randomized controlled trials involving 1190 patients were included. The results of the meta-analysis showed that compared with conventional treatment, S miltiorrhiza injection combined with steroids could significantly increase the maximal mouth opening [mean difference (MD), 0.23; 95% confidence interval (CI), 0.16-0.30; P <.0001], decrease the oral mucosal lesion area (MD, -1.35; 95% CI, -2.46 to -0.25; P = .02), improve the subjective symptom burning sensation (MD, -0.77; 95% CI, -1.38 to -0.16; P = .01), and reduce adverse drug reactions (risk ratio, 0.27; 95% CI, 0.14-0.49; P <.0001). CONCLUSIONS: The results of this meta-analysis from current evidence showed that compared with conventional treatment, S miltiorrhiza injection combined with steroid could significantly improve the maximal mouth opening and the subjective symptom burning sensation as well as decrease the oral mucosal lesion area without increasing adverse effects.


Assuntos
Medicamentos de Ervas Chinesas/uso terapêutico , Fibrose Oral Submucosa/tratamento farmacológico , Salvia miltiorrhiza , Esteroides/uso terapêutico , Humanos , Injeções
6.
Medicine (Baltimore) ; 98(28): e16372, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31305435

RESUMO

BACKGROUND: Acute graft-vs-host disease (aGVHD) is a common complication of allogenic hematopoietic stem-cell transplantation (allo-HSCT) and skin is the most common and often the 1st site at which aGVHD develops. Cutaneous aGVHD is usually treated with oral and/or topical corticosteroids as the 1st-line treatment; however, steroid-refractory aGVHD not only impairs patients' quality of life but also causes significant morbidity and mortality after allo-HSCT. Narrow-band ultraviolet B (NB-UVB) phototherapy has been utilized for a wide range of immunologic inflammatory skin diseases, but there is limited information on the efficacy, safety, and biomarkers for response prediction of NB-UVB for cutaneous aGVHD. AIMS: The purpose of this study is to investigate the efficacy and safety of NB-UVB phototherapy for steroid-refractory cutaneous aGVHD. PATIENTS AND METHODS: A total of 40 subjects aged from 16 to 70 years with steroid-refractory cutaneous aGVHD after allo-HSCT will be included in the trial. Patients with worse than stage 2 intestine/liver aGVHD will be excluded. Eligible patients will undergo NB-UVB phototherapy until resolution or further worsening of rash or occurrence of an unmanageable adverse event. The primary endpoint is the overall response rate. The secondary outcomes include rates for complete response, partial response, stable disease, progressive disease, duration of response, sparing effect on calcineurin inhibitors and/or corticosteroids, safety, and predictive biomarkers for treatment response. ETHICS AND DISSEMINATION: The protocol has been approved by the institutional Clinical Research Review Board of Kyoto Prefectural University of Medicine. Written informed consent will be obtained from all patients before registration, in accordance with the Declaration of Helsinki. Results of the study will be disseminated via publications in peer-reviewed journals. TRIAL REGISTRATION: Trial registration numbers UMIN000032426 and jRCTs052180005.


Assuntos
Ensaios Clínicos Fase II como Assunto , Doença Enxerto-Hospedeiro/terapia , Dermatopatias/terapia , Transplante de Células-Tronco , Terapia Ultravioleta , Doença Aguda , Adolescente , Adulto , Idoso , Anti-Inflamatórios/uso terapêutico , Resistência a Medicamentos , Humanos , Pessoa de Meia-Idade , Retratamento , Dermatopatias/etiologia , Esteroides/uso terapêutico , Transplante Homólogo , Terapia Ultravioleta/efeitos adversos , Terapia Ultravioleta/métodos , Adulto Jovem
7.
Anticancer Res ; 39(7): 3945-3947, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31262925

RESUMO

BACKGROUND/AIM: Malignant melanoma is a rare disease in the pediatric population and there are no recommendations regarding its management in children, while the current standard of care in metastatic or unresectable melanoma in adult patients includes immunotherapy (anti-CTLA-4 and anti-PD-1 antibodies). Advances in the management of adults with melanoma offer the prospect of promising therapeutic options for children. CASE REPORT: We describe a case of a 7-year-old patient with recurrent metastatic melanoma, for whom pembrolizumab was used as an adjuvant therapy on compassionate use basis. CONCLUSION: Due to adverse events, the treatment was discontinued after 5 months of pembrolizumab, but with 12-months of follow-up, patient remains in complete remission.


Assuntos
Anticorpos Monoclonais Humanizados/uso terapêutico , Antineoplásicos Imunológicos/uso terapêutico , Melanoma/tratamento farmacológico , Recidiva Local de Neoplasia/tratamento farmacológico , Neoplasias de Tecidos Moles/tratamento farmacológico , Antirreumáticos/uso terapêutico , Artrite Juvenil/induzido quimicamente , Artrite Juvenil/tratamento farmacológico , Criança , Feminino , Humanos , Metotrexato/uso terapêutico , Esteroides/uso terapêutico , Resultado do Tratamento , Uveíte/induzido quimicamente
8.
J Laryngol Otol ; 133(7): 566-570, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31182177

RESUMO

BACKGROUND: There are no definite guidelines regarding the most adequate steroid regimens for acute acoustic trauma. OBJECTIVE: To elucidate the dose-dependent differing benefits of oral steroids on hearing improvement following acute acoustic trauma. METHODS: Twenty-nine patients treated with oral steroids following a diagnosis of unilateral acute acoustic trauma were retrospectively reviewed. Patients were sorted into two groups with an oral steroid regimen. Group 1 received a 14-day course of treatment: 60 mg prednisolone daily for 10 days, tapering off over days 11-14. Group 2 received prednisolone for a total of 10 days: 60 mg for 5 days, tapering down each day for the remainder. Multivariable linear regression analysis was performed to evaluate the factors associated with the hearing gain. RESULTS: In the multivariable regression (R2 = 0.51, p < 0.001), patients in group 1 showed more significant improvement in the degree of hearing gain compared to group 2 (p = 0.03). CONCLUSION: After comparing the differing benefits of oral steroids on hearing improvement by dosage, we recommend a high dose of prednisolone (60 mg per day) for 10 days, tapering over the remaining 4 days, for better hearing recovery following acute acoustic trauma.


Assuntos
Perda Auditiva Provocada por Ruído/tratamento farmacológico , Prednisolona/administração & dosagem , Esteroides/administração & dosagem , Administração Oral , Esquema de Medicação , Feminino , Violência com Arma de Fogo , Testes Auditivos , Humanos , Masculino , Prednisolona/uso terapêutico , Estudos Retrospectivos , Esteroides/uso terapêutico , Resultado do Tratamento
10.
Int Arch Allergy Immunol ; 179(4): 281-289, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31091524

RESUMO

BACKGROUND: Based on endoscopic examination, chronic rhinosinusitis (CRS) is divided into chronic inflammation with (CRSwNP) or without nasal polyps (CRSsNP). On the basis of the pathomechanism of inflammation, CRS is divided into endotypes. Eosinophilic CRSwNP with coexisting bronchial asthma and hypersensitivity to non-steroidal anti-inflammatory drugs (NSAIDs) is a real therapeutic challenge. AIM: Comparative analysis of the results of treatment of patients with CRSwNP, bronchial asthma, or hypersensitivity to NSAIDs (NSAID-exacerbated respiratory disease, NERD), using antileukotrienes (leukotriene receptor antagonists, LTRAs) or intranasal glucocorticoids or both drugs together after endoscopic sinus surgery (ESS). MATERIAL AND METHODS: 33 patients (11 male, 33%) with NERD divided into three groups treated with LTRAs or intranasal glucocorticoids or both drugs together were assessed in terms of general well-being, state of pathological changes, and olfactory disorders using the following tools: Sino-Nasal Outcome Test, Visual Analogue Scale, Brief Identification Smell Test, and Lund-Kennedy score before and at 12 months after surgery. CT assessments were made prior to surgery using the Lund-MacKay scale. RESULTS: Comparable efficacy of treatment with nasal steroids and antileukotrienes was found after 12 months of observation of patients. CONCLUSIONS: The results suggest comparable efficacy of treatment with nasal steroids and antileukotrienes in patients with NERD after ESS. Treatment with montelukast and mometasone has not been shown to be superior to both drugs administered separately.


Assuntos
Asma Induzida por Aspirina/tratamento farmacológico , Antagonistas de Leucotrienos/uso terapêutico , Pólipos Nasais/tratamento farmacológico , Seios Paranasais/efeitos dos fármacos , Rinite/tratamento farmacológico , Sinusite/tratamento farmacológico , Adulto , Idoso , Asma Induzida por Aspirina/complicações , Asma Induzida por Aspirina/cirurgia , Doença Crônica , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Pólipos Nasais/cirurgia , Seios Paranasais/cirurgia , Período Pós-Operatório , Rinite/cirurgia , Sinusite/cirurgia , Esteroides/uso terapêutico , Resultado do Tratamento
11.
Expert Opin Pharmacother ; 20(11): 1397-1404, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31090462

RESUMO

INTRODUCTION: Sarcoidosis is a granulomatous systemic disease of unknown cause where the lungs are the most frequently affected. Therapeutic management of the disease is challenging as clinical presentation and prognosis are very heterogeneous. AREAS COVERED: This review summarizes the current knowledge of synthetic therapies for pulmonary sarcoidosis. The most commonly used medication for the treatment of sarcoidosis with lung involvement are glucocorticoids. Nevertheless, not all patients reach an acceptable response or tolerate them and the use of second-line treatments like immunosuppressive agents are necessary. Other kind of drugs could be used but there is no solid evidence and most of them are currently under investigation. EXPERT OPINION: The majority of patients with pulmonary sarcoidosis do not require treatment and their sarcoidotic lung lesions could regress. However, it is important to treat the disease in those cases that could develop organ failure. Although the number of studies of therapies for pulmonary sarcoidosis have increased in recent years, the information available is still limited and there is no consensus on how to monitor the activity of the disease.


Assuntos
Glucocorticoides/uso terapêutico , Imunossupressores/uso terapêutico , Sarcoidose Pulmonar/tratamento farmacológico , Antimaláricos/uso terapêutico , Humanos , Tecido Parenquimatoso/diagnóstico por imagem , Remissão Espontânea , Sarcoidose Pulmonar/patologia , Esteroides/uso terapêutico
12.
J Clin Neurosci ; 66: 156-164, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31088767

RESUMO

BACKGROUND: We studied patients with chronic lymphocytic inflammation with pontine perivascular enhancement responsive to steroids (CLIPPERS) associated with or without lymphoma and measured risk factors suggestive of an underlying lymphoma and follow-up outcomes. METHODS: CLIPPERS patients associated with or without lymphoma were included into this study. Clinical presentations were documented, risk factors suggestive of an underlying lymphoma were tested, and prognostic differences in terms of death were compared. RESULTS: Ten patients had a diagnosis of CLIPPERS associated with lymphoma, with 6 B-cell non-Hodgkin lymphoma, 2 T-cell non-Hodgkin lymphoma and 2 Hodgkin lymphoma. Using multivariate logistic analysis, the following 3 independent risk factors were found to be related to a final diagnosis of lymphoma: hyperreflexia (HR 16.56; 95% CI 1.03-265.29; p = 0.032), elevated protein in CSF (HR 11.59; 95% CI 1.24-108.39; p = 0.047), and recurrences between 2 months and 1 year after treatment (HR 29.27; 95% CI 2.09-409.58; p = 0.012). The model calibration was satisfactory (p = 0.392 with the Hosmer-Lemeshow test), and the discrimination power was good (area under the receiver operating characteristic curve 0.921; p < 0.001, 95% CI 0.826-1.000). Patients with CLIPPERS associated with lymphoma had higher mortality rate and lymphoma was a significant predictor of total mortality (HR 0.040; 95% CI 0.006-0.262; p = 0.001). CONCLUSIONS: Hyperreflexia, elevated protein in CSF and recurrences between 2 months and 1 year after treatment are risk factors suggesting an underlying lymphoma. Relapses during high-dose steroids maintenance therapy can be indicative of lymphoma, too. Patients having CLIPPERS associated with lymphoma have a worse prognosis than those without lymphoma.


Assuntos
Encefalopatias/diagnóstico , Linfoma/diagnóstico , Ponte/patologia , Adulto , Encefalopatias/tratamento farmacológico , Encefalopatias/etiologia , Feminino , Humanos , Inflamação , Linfoma/complicações , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Ponte/diagnóstico por imagem , Esteroides/uso terapêutico
13.
Rev. neurol. (Ed. impr.) ; 68(9): 389-397, 1 mayo, 2019. ilus, tab, graf
Artigo em Espanhol | IBECS | ID: ibc-180676

RESUMO

Los corticoides se utilizan ampliamente en la práctica clínica habitual en neurooncología. Sin embargo, pese a lo extendido de su uso, no existe un consenso establecido sobre sus indicaciones, dosis y posología. En este artículo se realiza una revisión bibliográfica del mecanismo de acción de los corticoides, sus indicaciones de uso, efectos secundarios y manejo adecuado, dosis y duración de la terapia, así como el papel de nuevos tratamientos actuales para el edema cerebral. El corticoide con un uso mas extendido en neurooncología es la dexametasona, probablemente por su escaso efecto mineralocorticoide y por su elevada vida media. Su efecto sobre el edema cerebral es fundamental en el control sintomático de los pacientes con tumores cerebrales. Se recomienda iniciar tratamiento únicamente en pacientes sintomáticos, en dosis de 4-8 mg/24 h, buscando siempre la mínima dosis eficaz. Los efectos secundarios asociados al uso de corticoides son frecuentes e impactan negativamente en la calidad de vida de los pacientes


Corticosteroids are widely used in routine clinical practice in neuro-oncology. However, despite their widespread use, there is no established consensus on their indications, dosages and dosage schedule. This article reviews the mechanism of action of corticosteroids, their indications for use, side effects and the appropriate management, dosage and duration of therapy, as well as the role of new treatments currently being use to treat cerebral oedema. The most widely used corticosteroid in neuro-oncology is dexamethasone, probably due to its low mineralocorticoid effect and its long half-life. Its effect on cerebral oedema is fundamental in the symptomatic control of patients with brain tumours. It is recommended to start treatment only in symptomatic patients, in doses of 4-8 mg/24 h, always seeking the minimum effective dosage. Side effects associated with corticosteroid use are common and have a negative impact on patients' quality of life


Assuntos
Humanos , Esteroides/uso terapêutico , Neoplasias Encefálicas/tratamento farmacológico , Edema Encefálico/tratamento farmacológico , Esteroides/efeitos adversos , Imagem por Ressonância Magnética
14.
An Bras Dermatol ; 94(2): 133-146, 2019 Mar-Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31090818

RESUMO

Bullous pemphigoid is the most frequent autoimmune bullous disease and mainly affects elderly individuals. Increase in incidence rates in the past decades has been attributed to population aging, drug-induced cases and improvement in the diagnosis of the nonbullous presentations of the disease. A dysregulated T cell immune response and synthesis of IgG and IgE autoantibodies against hemidesmosomal proteins (BP180 and BP230) lead to neutrophil chemotaxis and degradation of the basement membrane zone. Bullous pemphigoid classically manifests with tense blisters over urticarial plaques on the trunk and extremities accompanied by intense pruritus. Mucosal involvement is rarely reported. Diagnosis relies on (1) the histopathological evaluation demonstrating eosinophilic spongiosis or a subepidermal detachment with eosinophils; (2) the detection of IgG and/or C3 deposition at the basement membrane zone using direct or indirect immunofluorescence assays; and (3) quantification of circulating autoantibodies against BP180 and/or BP230 using ELISA. Bullous pemphigoid is often associated with multiple comorbidities in elderly individuals, especially neurological disorders and increased thrombotic risk, reaching a 1-year mortality rate of 23%. Treatment has to be tailored according to the patient's clinical conditions and disease severity. High potency topical steroids and systemic steroids are the current mainstay of therapy. Recent randomized controlled studies have demonstrated the benefit and safety of adjuvant treatment with doxycycline, dapsone and immunosuppressants aiming a reduction in the cumulative steroid dose and mortality.


Assuntos
Penfigoide Bolhoso/diagnóstico , Idoso , Autoimunidade/fisiologia , Diagnóstico Diferencial , Imunofluorescência/métodos , Humanos , Penfigoide Bolhoso/classificação , Penfigoide Bolhoso/tratamento farmacológico , Penfigoide Bolhoso/etiologia , Esteroides/uso terapêutico
15.
BMC Infect Dis ; 19(1): 369, 2019 May 02.
Artigo em Inglês | MEDLINE | ID: mdl-31046689

RESUMO

BACKGROUND: Urinary tract infections (UTIs) are one of the most common bacterial infections. High recurrence rates and the increasing antibiotic resistance among uropathogens constitute a large social and economic problem in current public health. We assumed that combination of treatment that includes the administration ceragenins (CSAs), will reinforce the effect of antimicrobial LL-37 peptide continuously produced by urinary tract epithelial cells. Such treatment might be an innovative approach to enhance innate antibacterial activity against multidrug-resistant E. coli. METHODS: Antibacterial activity measured using killing assays. Biofilm formation was assessed using crystal violet staining. Viability of bacteria and bladder epithelial cells subjected to incubation with tested agents was determined using MTT assays. We investigated the effects of chosen molecules, both alone and in combinations against four clinical strains of E. coli, obtained from patients diagnosed with recurrent UTI. RESULTS: We observed that the LL-37 peptide, whose concentration increases at sites of urinary infection, exerts increased bactericidal effect against E. coli when combined with ceragenins CSA-13 and CSA-131. CONCLUSION: We suggest that the employment of combination of natural peptide LL-37 with synthetic analogs might be a potential solution to treat urinary tract infections caused by drug-resistant bacteria.


Assuntos
Antibacterianos/uso terapêutico , Esteroides/uso terapêutico , Infecções Urinárias/tratamento farmacológico , Peptídeos Catiônicos Antimicrobianos/farmacologia , Peptídeos Catiônicos Antimicrobianos/uso terapêutico , Biofilmes/efeitos dos fármacos , Linhagem Celular , Sobrevivência Celular/efeitos dos fármacos , Farmacorresistência Bacteriana Múltipla/efeitos dos fármacos , Escherichia coli/efeitos dos fármacos , Escherichia coli/fisiologia , Humanos , Esteroides/farmacologia , Infecções Urinárias/microbiologia
16.
BMJ Case Rep ; 12(4)2019 Apr 23.
Artigo em Inglês | MEDLINE | ID: mdl-31015250

RESUMO

Joubert syndrome (JS) and JS-related disorders are a group of developmental delay, multiple congenital anomalies and complex midbrain-hindbrain malformations. A few cases of JS with multiple pituitary hormone deficiency (MPHD) have been reported in literature. Here, we presented an unusual presentation of JS in a newborn with MPHD. This case is intended to draw attention to the rare association of JS and MDPH by increasing the awareness of this syndrome.


Assuntos
Cerebelo/anormalidades , Anormalidades do Olho/complicações , Terapia de Reposição Hormonal/métodos , Doenças Renais Císticas/complicações , Hormônios Hipofisários/deficiência , Retina/anormalidades , Anormalidades Múltiplas/diagnóstico , Anormalidades Múltiplas/tratamento farmacológico , Anormalidades Múltiplas/etiologia , Anormalidades Múltiplas/genética , Assistência ao Convalescente , Encéfalo/diagnóstico por imagem , Deficiências do Desenvolvimento/diagnóstico , Deficiências do Desenvolvimento/etiologia , Deficiências do Desenvolvimento/genética , Diagnóstico Diferencial , Anormalidades do Olho/diagnóstico , Anormalidades do Olho/tratamento farmacológico , Doenças dos Genitais Masculinos/diagnóstico , Doenças dos Genitais Masculinos/etiologia , Humanos , Hipoglicemia/diagnóstico , Hipoglicemia/etiologia , Recém-Nascido , Doenças Renais Císticas/diagnóstico , Doenças Renais Císticas/tratamento farmacológico , Imagem por Ressonância Magnética , Masculino , Pênis/anormalidades , Hormônios Hipofisários/metabolismo , Esteroides/administração & dosagem , Esteroides/uso terapêutico , Resultado do Tratamento
17.
BMJ Case Rep ; 12(4)2019 Apr 05.
Artigo em Inglês | MEDLINE | ID: mdl-30954955

RESUMO

An elderly Caucasian woman developed bullous pemphigoid (BP) overlying the site of total knee arthroplasty for osteoarthritis 2 days after surgery. The clinical findings were consistent with blistering due to soft tissue swelling, bullous impetigo or allergic contact dermatitis. The blistering spread over weeks to months down the ipsilateral leg and then to the other leg and hips. A biopsy for H&E and direct immunofluorescence established the diagnosis of BP. A concomitantly occurring wound infection was identified and treated. The blistering responded well to superpotent topical steroids and local care.


Assuntos
Artroplastia do Joelho/efeitos adversos , Osteoartrite do Joelho/cirurgia , Penfigoide Bolhoso/patologia , Complicações Pós-Operatórias/patologia , Esteroides/uso terapêutico , Administração Tópica , Idoso de 80 Anos ou mais , Feminino , Técnica Direta de Fluorescência para Anticorpo , Humanos , Osteoartrite do Joelho/patologia , Penfigoide Bolhoso/tratamento farmacológico , Penfigoide Bolhoso/imunologia , Complicações Pós-Operatórias/tratamento farmacológico , Complicações Pós-Operatórias/imunologia , Resultado do Tratamento
18.
Agri ; 31(2): 93-100, 2019 Apr.
Artigo em Turco | MEDLINE | ID: mdl-30995324

RESUMO

OBJECTIVES: The aim of this retrospective study was to evaluate the efficacy of transforaminal anterior epidural steroid and local anesthetic injections (TAESE) and the effects on quality of life in patients with low back pain. METHODS: The study patients (n=191) were divided into 3 groups: disc herniation (DH), failed back surgery (FBS), and spinal stenosis (SS). A visual analog scale (VAS) and verbal pain scale (VPS) were used to assess patient pain. Scores were measured before treatment (VAS 0), in the first month of application (VAS 1), 3 months (VAS 3), and 6 months (VAS 6). Patient quality of life was examined using the 36-Item Short Form Health Survey (SF-36). RESULTS: In all 3 groups, there was a statistically significant reduction in pain compared with the VAS 0 score at 1, 3, and 6 months (p<0.001). The reduction in VAS/VPS was greatest in the DH group, followed by the FBS and SS groups, respectively. All of the parameters of the SF-36 measurement were lower in the SS patients compared with the DH patients. The quality of life score was lowest in the SS patients, though the physical health and social functioning scores were lowest in the FBS group. CONCLUSION: TAESE is effective and can be safely performed in patients who have low back pain due to DH, FBS, or SS. The quality of life result was less successful in SS patients, particularly in the parameter of physical role limitations.


Assuntos
Deslocamento do Disco Intervertebral/tratamento farmacológico , Dor Lombar/tratamento farmacológico , Qualidade de Vida , Esteroides/uso terapêutico , Adulto , Idoso , Idoso de 80 Anos ou mais , Síndrome Pós-Laminectomia/tratamento farmacológico , Síndrome Pós-Laminectomia/psicologia , Feminino , Humanos , Injeções Epidurais , Deslocamento do Disco Intervertebral/psicologia , Dor Lombar/psicologia , Vértebras Lombares , Masculino , Pessoa de Meia-Idade , Manejo da Dor , Estudos Retrospectivos , Estenose Espinal/tratamento farmacológico , Estenose Espinal/psicologia , Esteroides/administração & dosagem , Resultado do Tratamento , Adulto Jovem
19.
Agri ; 31(2): 104-106, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30995325

RESUMO

Transforaminal epidural steroid injections are a common intervention in the treatment of radicular pain. Complications are rare, but can be catastrophic. One of the potentially devastating complications is occlusion of the artery of Adamkiewicz (AKA). This report is a description of an approach to avoid the complication of injury to the AKA related to transforaminal epidural injection. A 71-year-old male patient presented at the clinic with radiculopathy secondary to lumbar disc hernia. A transforaminal epidural steroid injection was planned. After a radiocontrast injection, vascular filling was detected. The needle was repositioned and an inferior entrance to the epidural space was used. No vascularity was seen and dexamethasone was administered to the patient. A transforaminal epidural steroid injection is an effective interventional treatment for radicular pain, but it requires careful attention due to the possible complications. The AKA was located in the upper half of the foramen. Keeping the wide variation in the anatomy of the AKA in mind is very important in order to prevent spinal cord ischemia.


Assuntos
Dexametasona/uso terapêutico , Deslocamento do Disco Intervertebral/cirurgia , Vértebras Lombares , Radiculopatia/cirurgia , Esteroides/uso terapêutico , Idoso , Dexametasona/administração & dosagem , Humanos , Injeções Epidurais , Deslocamento do Disco Intervertebral/complicações , Masculino , Medição da Dor , Radiculopatia/complicações , Esteroides/administração & dosagem
20.
Semin Ophthalmol ; 34(3): 125-130, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30931685

RESUMO

Purpose: To survey the opinion of oculoplastic surgeons on the assessment and management of lower eyelid retraction (LLR). Methods: A web-based survey queried oculoplastic surgeon members of Ojoplast, Spanish and Brazilian Oculoplastic Societies on the management of LLR. The frequency and percentage proportions of the responses were analyzed. Results: One hundred ninety-six oculoplastic surgeons participated in the survey. The main cause of LLR is post-blepharoplasty (62;31.6%). The most used sign to detect LLR is scleral show. The most common approaches to managing LLR are lateral canthal surgery (164/593;27.6%), autogenous spacers (148/593; 24.9%) and retractor release (131/593;22.1%). The preferred autogenous graft material includes ear cartilage (102/260;39.2%). The majority of surgeons (161/314; 51.3%) recommend massage or steroids injection (80/314;25.5%) for early post-blepharoplasty LLR, while, 54.1% (106/196) of participants suggested waiting for at least six months prior to surgical intervention. Frost suture is used after most LLR surgeries (154/196;91.1%). Incomplete correction is the main complication (111/310;35.8%) of LLR surgery. For mild LLR, 48% of the responders prefer clinical treatment; conversely, severe cases routinely require combined surgical techniques. Conclusions: Oculoplastic surgeons frequently diagnose LLR based on scleral show. LLR management depends on the cause and severity of lid retraction. Mild cases, in general, receive clinical treatment and severe cases need a combination of surgical techniques and grafts.


Assuntos
Blefaroplastia/métodos , Doenças Palpebrais/cirurgia , Pálpebras/cirurgia , Padrões de Prática Médica , Adulto , Cartilagem da Orelha/transplante , Doenças Palpebrais/diagnóstico , Doenças Palpebrais/etiologia , Feminino , Pesquisas sobre Serviços de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Esteroides/uso terapêutico , Transplante Autólogo/métodos
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA