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1.
Undersea Hyperb Med ; 46(5): 665-672, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31683366

RESUMO

We compared the efficacy of hyperbaric oxygen (HBO2) therapy used in the treatment of sudden sensorineural hearing loss (SSNHL) as a supplementary therapy to the first-line medical treatment according to the different applied pressures used in HBO2 treatment while maintaining the same number of sessions, periodicity and exposure times. We evaluated data from 115 patients suffering from SSNHL within seven days of hearing loss: 35 patients received the standard treatment protocol (control group), and 80 individuals were treated with additional application of HBO2 therapy pressured to 2.0 ATA (H2.0; n=49) or 2.5 ATA (H2.5; n=31), respectively. Treatment success was assessed using pre- and post-treatment audiograms. We found significant differences in both HBO2 groups compared to the control group. In low frequencies the most significant differences can be seen in both H2.0 and H2.5. In spoken speech frequencies only the H2.0 group was statistically significant. In high frequencies the therapeutic benefits were the lowest. Furthermore, we found a notable difference in the therapeutic effect of HBO2 therapy according to the different applied pressure. At low frequencies, the use of 2.5 ATA pressure was more efficient. However, in the higher frequency ranges, the better hearing gains were obtained at the 2.0 ATA pressure. Our results support the possibility of optimizing treatments individually, depending on the type and frequency range of hearing impairment (shape of the audiogram) in favor of using the 2.0 ATA. This is important in terms of an individual approach to each patient as well as to minimize the burden of a patient in order to obtain the maximum therapeutic effect.


Assuntos
Perda Auditiva Neurossensorial/terapia , Perda Auditiva Súbita/terapia , Oxigenação Hiperbárica/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Pressão Atmosférica , Estudos de Casos e Controles , Feminino , Glucocorticoides/administração & dosagem , Perda Auditiva Neurossensorial/tratamento farmacológico , Perda Auditiva Súbita/tratamento farmacológico , Humanos , Masculino , Hemissuccinato de Metilprednisolona/administração & dosagem , Pessoa de Meia-Idade , Prednisona/administração & dosagem , Estudos Prospectivos , Adulto Jovem
2.
Undersea Hyperb Med ; 46(5): 709-712, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31683371

RESUMO

We describe the emergency management of a man who experienced acute vision loss diagnosed as direct traumatic optic neuropathy (TON) in his right eye (no light perception) after falling from a height. TON is caused by a high-impact mechanism of injury. Clinical findings include acute vision loss, which is typically immediate, afferent pupillary defect, decreased color vision, and visual field defects. Treatment is controversial because of the lack of strong evidence supporting intervention over observation. In this case report, our treatment strategy comprised immediate hyperbaric oxygen (HBO2) and daily high doses of a steroid. On the second day, minocycline was added to the treatment regimen for its neuroprotective effects. The patient was discharged after receiving six HBO2 treatments and six days of intravenous solumedrol transitioned to oral prednisone. After the third HBO2 treatment, his vision improved to 20/100; after the fourth treatment, it was 20/40 and plateaued. At the time of discharge, it was 20/40. At two-month follow-up, his corrected visual acuity was 20/60+2 in the affected eye. Immediate HBO2 for ischemic and mechanical injury to the optic nerve following trauma is a therapeutic option.


Assuntos
Cegueira/terapia , Glucocorticoides/administração & dosagem , Hemissuccinato de Metilprednisolona/administração & dosagem , Minociclina/uso terapêutico , Fármacos Neuroprotetores/uso terapêutico , Traumatismos do Nervo Óptico/terapia , Acidentes por Quedas , Doença Aguda , Adulto , Cegueira/etiologia , Terapia Combinada/métodos , Tratamento de Emergência/métodos , Humanos , Masculino , Traumatismos do Nervo Óptico/complicações , Prednisona/administração & dosagem , Recuperação de Função Fisiológica
3.
AAPS PharmSciTech ; 19(5): 2195-2202, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-29725902

RESUMO

In order to explore a novel high efficacy drug delivery system for membranous glomerulonephritis (MGN), a complex chronic inflammation, methylprednisolone bovine serum albumin nanoparticles (ME BSA NPs) were designed. The nanoparticles were prepared by desolvation-chemical crosslinking method and its physicochemical characterizations were conducted. The experimental MGN rat models induced by cationic bovine serum albumin were established by a modified Border's method and applied in the pharmacodynamics study of ME BSA NPs. The results showed that the particle size, particle dispersion index, and entrapment efficiency of ME BSA NPs were 131.1 ± 3.4 nm, 0.159 ± 0.036, and 71.51 ± 1.74%, respectively. In addition, the image of transmission electron microscopy showed that the ME BSA NPs were the relatively uniform spherical particles. In the in vivo pharmacodynamics study, compared with saline group and SOLU-MEDROL® group, that the ME BSA NPs group was significantly reduced the levels of 24 h urinary protein (P < 0.01) and serum creatinine (P < 0.05). Consequently, these outcomes indicated that the nanoparticles we studied were a promising drug delivery system for the MGN disease, and it may be also useful for other complex chronic inflammations.


Assuntos
Anti-Inflamatórios/administração & dosagem , Sistemas de Liberação de Medicamentos/métodos , Glomerulonefrite Membranosa/tratamento farmacológico , Hemissuccinato de Metilprednisolona/administração & dosagem , Nanopartículas/administração & dosagem , Soroalbumina Bovina/toxicidade , Animais , Anti-Inflamatórios/química , Anti-Inflamatórios/metabolismo , Cátions , Bovinos , Portadores de Fármacos/administração & dosagem , Portadores de Fármacos/química , Portadores de Fármacos/metabolismo , Feminino , Glomerulonefrite Membranosa/induzido quimicamente , Glomerulonefrite Membranosa/metabolismo , Hemissuccinato de Metilprednisolona/química , Hemissuccinato de Metilprednisolona/metabolismo , Microscopia Eletrônica de Transmissão , Nanopartículas/química , Nanopartículas/metabolismo , Tamanho da Partícula , Ratos , Ratos Sprague-Dawley , Resultado do Tratamento
4.
JAMA Neurol ; 75(6): 690-696, 2018 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-29507942

RESUMO

Importance: Intravenous (IV) administration of corticosteroids is the standard of care in the treatment of acute optic neuritis. However, it is uncertain whether a bioequivalent dose of corticosteroid administered orally, which may be more cost-efficient and convenient for patients, is as effective as IV administration in the treatment of acute optic neuritis. Objective: To determine whether recovery of vision following treatment of acute optic neuritis with a high-dose IV corticosteroid is superior to that with a bioequivalent dose of an oral corticosteroid. Design, Setting, and Participants: This single-blind (participants unblinded) randomized clinical trial with 6-month follow-up was conducted at a single tertiary care center in London, Ontario, Canada. Participants were enrolled from March 2012 to May 2015, with the last participant's final visit occurring November 2015. Patients 18 to 64 years of age presenting within 14 days of acute optic neuritis onset, without any recovery at time of randomization and without history of optic neuritis in the same eye, were screened. Inclusion criteria included best-corrected visual acuity (BCVA) of 20/40 or worse and corticosteroids deemed required by treating physician. In total, 89 participants were screened; 64 were eligible, but 9 declined to participate. Thus, 55 participants were enrolled and randomized. Primary analysis was unadjusted and according to the intention-to-treat principle. Interventions: Participants were randomized 1:1 to the IV methylprednisolone sodium succinate (1000-mg) or oral prednisone (1250-mg) group. Main Outcomes and Measures: Primary outcome was recovery of the latency of the P100 component of the visual evoked potential at 6 months. Secondary outcomes were the P100 latency at 1 month and BCVA as assessed with Early Treatment Diabetic Retinopathy Study letter scores on the alphabet chart and scores on low-contrast letters at 1 and 6 months. Results: Of 55 randomized participants, the final analyzed cohort comprised 23 participants in the IV and 22 in the oral treatment groups. The mean (SD) age of the cohort was 34.6 (9.5) years, and there were 28 women (62.2%). At 6 months' recovery, P100 latency in the IV group improved by 62.9 milliseconds (from a mean [SD] of 181.9 [53.6] to 119.0 [16.5] milliseconds), and the oral group improved by 66.7 milliseconds (from a mean [SD] of 200.5 [67.2] to 133.8 [31.5] milliseconds), with no significant difference between groups (P = .07). Similarly, no significant group difference was found in the mean P100 latency recovery at 1 month. For BCVA, recovery between the groups did not reach statistical significance at 1 month or 6 months. In addition, improvements in low-contrast (1.25% and 2.5%) BCVA were not significantly different between treatment groups at 1 or 6 months' recovery. Conclusions and Relevance: This study finds that bioequivalent doses of oral corticosteroids may be used as an alternative to IV corticosteroids to treat acute optic neuritis. Trial Registration: clinicaltrials.gov Identifier: NCT01524250.


Assuntos
Corticosteroides/administração & dosagem , Hemissuccinato de Metilprednisolona/administração & dosagem , Neurite Óptica/diagnóstico , Neurite Óptica/tratamento farmacológico , Prednisona/administração & dosagem , Doença Aguda , Administração Intravenosa , Administração Oral , Corticosteroides/farmacocinética , Adulto , Potenciais Evocados Visuais/efeitos dos fármacos , Potenciais Evocados Visuais/fisiologia , Feminino , Humanos , Masculino , Hemissuccinato de Metilprednisolona/farmacocinética , Pessoa de Meia-Idade , Neurite Óptica/metabolismo , Prednisona/farmacocinética , Método Simples-Cego , Equivalência Terapêutica , Resultado do Tratamento
5.
Pharm Res ; 35(5): 94, 2018 Mar 13.
Artigo em Inglês | MEDLINE | ID: mdl-29536186

RESUMO

PURPOSE: Acute lung injury (ALI) is a fatal syndrome in critically ill patients. It is characterized by lung edema and inflammation. Numerous pro-inflammatory mediators are released into alveoli. Among them, interleukin-1beta (IL-1ß) causes an increase in solute permeability across the alveolar-capillary barrier leading to edema. It activates key effector cells (alveolar epithelial and endothelial cells) releasing inflammatory chemokines and cytokines. The purpose of the study was to demonstrate that nebulized liposomes inhibit ALI in vivo. METHODS: In vivo ALI model was simulated through intra-tracheal instillation of IL-1ß solution (100 µg/mL in PBS, pH 7.2, 200 µL) in male Sprague-Dawley rats. Various formulations were tested in ALI induced rats. These formulations include plain liposomes (PL), methylprednisolone sodium succinate solution (MPS solution), cRGD-peptide grafted liposomes (LcRGD) and methylprednisolone sodium succinate encapsulated and cRGD-peptide grafted liposomes (MPS-LcRGD). Formulations were nebulized in vivo in rats using micro-pump nebulizer. RESULTS: Liposome formulations exhibited higher levels of drug concentration in lungs. The physicochemical parameters demonstrated that the liposome formulations were stable. On the basis of aerodynamic droplet-size, nebulized formulations were estimated to deposit in different regions of respiratory tract, especially alveolar region, Among the formulations, MPS-LcRGD caused significant reduction of edema, neutrophil infiltration and inflammation biochemical marker levels. CONCLUSION: From the results, it can be inferred that nebulization of targeted liposomes had facilitated spatial and temporal modulation of drug delivery resulting in alleviation of ALI.


Assuntos
Lesão Pulmonar Aguda/tratamento farmacológico , Hemissuccinato de Metilprednisolona/administração & dosagem , Peptídeos Cíclicos/administração & dosagem , Lesão Pulmonar Aguda/imunologia , Lesão Pulmonar Aguda/patologia , Administração por Inalação , Animais , Capilares/metabolismo , Modelos Animais de Doenças , Humanos , Interleucina-1beta/administração & dosagem , Interleucina-1beta/imunologia , Interleucina-1beta/metabolismo , Lipossomos , Masculino , Nebulizadores e Vaporizadores , Neutrófilos/efeitos dos fármacos , Neutrófilos/imunologia , Permeabilidade/efeitos dos fármacos , Alvéolos Pulmonares/citologia , Alvéolos Pulmonares/metabolismo , Ratos , Ratos Sprague-Dawley , Resultado do Tratamento
6.
J Neurosurg Pediatr ; 20(6): 567-574, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-28984538

RESUMO

OBJECTIVE Methylprednisolone sodium succinate (MPSS) has been studied as a pharmacological adjunct that may be given to patients with acute spinal cord injury (ASCI) to improve neurological recovery. MPSS treatment became the standard of care in adults despite a lack of evidence supporting clinical benefit. More recently, new guidelines from neurological surgeon groups recommended no longer using MPSS for ASCI, due to questionable clinical benefit and known complications. However, little information exists in the pediatric population regarding MPSS use in the setting of ASCI. The aim of this paper was to describe steroid use and side effects in patients with ASCI at the authors' Level 1 pediatric trauma center in order to inform other hospitals that may still use this therapy. METHODS A retrospective chart review was conducted to determine adherence in ordering and delivery according to the guideline of the authors' institution and to determine types and frequency of complications. Inclusion criteria included age < 17 years, blunt trauma, physician concern for ASCI, and admission for ≥ 24 hours or treatment with high-dose intravenous MPSS. Exclusion criteria included penetrating trauma, no documentation of ASCI, and incomplete medical records. Charts were reviewed for a predetermined list of complications. RESULTS A total of 602 patient charts were reviewed; 354 patients were included in the study. MPSS was administered in 59 cases. In 34 (57.5%) the order was placed correctly. In 13 (38.2%) of these 34 cases, MPSS was administered according to the recommended timeline protocol. Overall, only 13 (22%) of 59 patients received the therapy according to protocol with regard to accurate ordering and administration. Among the patients with ASCI, 20 (55.6%) of the 36 who received steroids had complications, which was a significantly higher rate than in those who did not receive steroids (8 [24.2%] of 33, p = 0.008). Among the patients without ASCI, 10 (43.5%) of the 23 who received steroids also experienced significantly more complications than patients who did not receive steroids (50 [19.1%] of 262, p = 0.006). CONCLUSIONS High-dose MPSS for ASCI was not delivered to pediatric patients according to protocol with a high degree of reliability. Patients receiving steroids for pediatric ASCI were significantly more likely to experience complications than patients not receiving steroids. The findings presented, including complications of steroid use, support removal of high-dose MPSS as a treatment option for pediatric ASCI.


Assuntos
Hemissuccinato de Metilprednisolona/administração & dosagem , Hemissuccinato de Metilprednisolona/efeitos adversos , Fármacos Neuroprotetores/administração & dosagem , Fármacos Neuroprotetores/efeitos adversos , Traumatismos da Medula Espinal/tratamento farmacológico , Doença Aguda , Adolescente , Criança , Pré-Escolar , Estudos de Coortes , Estudos Transversais , Relação Dose-Resposta a Droga , Feminino , Humanos , Hiperglicemia/induzido quimicamente , Lactente , Recém-Nascido , Masculino , Náusea/induzido quimicamente , Estudos Retrospectivos , Traumatismos da Medula Espinal/diagnóstico
7.
Pan Afr Med J ; 26: 136, 2017.
Artigo em Francês | MEDLINE | ID: mdl-28533859

RESUMO

Cicatricial Pemphigoid is a subepithelial bullous dermatosis which essentially involves the mucous membranes with cicatricial evolution We report the case of a 66-year old patient hospitalized with erosive gingivitis associated with dysphagia, dyspnea and blurred vision. Dermatologic examination showed erosive lesions involving the palate and the pharynx. Ophthalmologic examination showed symblepharons, ectropion and bilateral cataract. Gingival biopsy revealed a necrotic detachment of the buccal epithelium. Direct immunofluorescence showed linear IgA deposit at the dermo-epidermal junction. Indirect immunofluorescence test was negative. The diagnosis of cicatricial pemphigoid was confirmed. Esophagogastroduodenoscopy objectified double stenosis of the esophagus. Nasopharyngeal and bronchial endoscopy showed ulceration of the epiglottis, hypopharynx, pharynx and bronchial tree. The patient was treated with Solumedrol bolus corresponding to 0.5mg/kg/day prednisone associated with 100mg/day disulone. The patient showed a favorable early clinical outcome complicated because of the aggravation of dysphagia and esophageal stenosis after 2 months. Our case study is singular due to the occurrence of a cicatricial pemphigoid in a male patient with a serious clinical picture due to lesions extending to conjunctival, oral, nasal, esophageal and bronchial mucous membranes associated with direct immunofluorescence only showing IgA deposit.


Assuntos
Dapsona/administração & dosagem , Imunoglobulina A/imunologia , Hemissuccinato de Metilprednisolona/administração & dosagem , Penfigoide Mucomembranoso Benigno/fisiopatologia , Idoso , Transtornos de Deglutição/etiologia , Endoscopia do Sistema Digestório , Estenose Esofágica/etiologia , Técnica Direta de Fluorescência para Anticorpo , Humanos , Masculino , Penfigoide Mucomembranoso Benigno/diagnóstico , Penfigoide Mucomembranoso Benigno/imunologia
8.
Eur Ann Otorhinolaryngol Head Neck Dis ; 134(6): 383-386, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-28483645

RESUMO

OBJECTIVES: The aim of our study was to see whether the neutrophil/lymphocyte ratio (NLR) and the platelet/lymphocyte ratio (PLR) are the markers of idiopathic sudden hearing loss to be used in prognosis or not. MATERIALS AND METHODS: This study is a retrospective, case-control clinical trial. Forty-five patients diagnosed with idiopathic sudden hearing loss and treated with the same treatment protocol between March 2014 and December 2015 and 47 healthy volunteers coming to the hospital for a routine health check and accepting audiological and laboratory tests were included in our study. NLR and PLR values were calculated in consequence of complete blood count results obtained from the study and control groups. In addition, the study group was classified as treatment responsive and treatment unresponsive groups as a result of audiological examination performed after three months according to the Siegel criteria. NLR and PLR ratios between the groups were statistically evaluated. RESULTS: Average NLR and PLR values were significantly higher in the study group compared to the control group (P<0.001). Average NLR ratio of the group, which was treated with the same protocol but did not respond to treatment was found to be significantly higher compared to the group which responded to the treatment (P<0.001). There was no significant change in average PLR ratio. CONCLUSION: Although NLR and PLR are two important markers that can be detected from peripheral blood samples of patients developing idiopathic sudden hearing loss and can be calculated easily, increased NLR values were also found to be related to poor prognosis.


Assuntos
Plaquetas/citologia , Glucocorticoides/administração & dosagem , Perda Auditiva Súbita/diagnóstico , Perda Auditiva Súbita/tratamento farmacológico , Linfócitos/citologia , Hemissuccinato de Metilprednisolona/administração & dosagem , Neutrófilos/citologia , Administração Oral , Adulto , Biomarcadores/sangue , Estudos de Casos e Controles , Feminino , Perda Auditiva Súbita/sangue , Humanos , Contagem de Leucócitos , Masculino , Prognóstico , Estudos Retrospectivos , Resultado do Tratamento
11.
Arch Iran Med ; 20(1): 60-64, 2017 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-28112534

RESUMO

A 23 year-old man was admitted to the hospital with chief complaints of pain, edema and spasm of the left lower limb, as well as mottling of dorsal and plantar aspects of the foot.  One week before the current admission, he was treated with oral co-amoxiclave and intramuscular penicillin 6.3.3. Immediately after the third injection, he experienced burning and yellowish discoloration at the site of the injection wich then progressed to his leg and foot. Pain, significant edema, spasm and mottling occurred within 30 minutes of the injection. The patient was referred to the hospital after 36 hours from the beginning of the symptoms. Color Doppler sonography revealed no impairment in the lower extremity flow and the common femoral artery, superficial femoral, popliteal, dorsalis pedis and posterior tibialis arteries were normal. Superficial probe sonography detected mild effusion in the left ankle without collection.


Assuntos
Glucocorticoides/administração & dosagem , Hemissuccinato de Metilprednisolona/administração & dosagem , Síndrome de Nicolau/etiologia , Penicilinas/efeitos adversos , Anlodipino/administração & dosagem , Tornozelo/diagnóstico por imagem , Edema/etiologia , Heparina/administração & dosagem , Humanos , Injeções Intramusculares/efeitos adversos , Masculino , Síndrome de Nicolau/tratamento farmacológico , Dor/etiologia , Penicilinas/administração & dosagem , Ultrassonografia Doppler em Cores , Adulto Jovem
12.
Pharm Dev Technol ; 22(8): 972-981, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-26895158

RESUMO

With important social and economic consequences, spinal cord injuries (SCIs) still exist among major health problems. Although many therapeutic agents and methods investigated for the treatment of acute SCI, only high dose methylprednisolone (MP) is being used currently in practice. Due to the serious side effects, high dose systemic MP administration after SCI is a critical issue that is mostly considered controversial. In our study, it is aimed to develop a nanoparticle-gel combined drug delivery system for localization of MP on trauma site and eliminating dose-dependent side effects by lowering the administered dose. For this purpose, methyl prednisolone sodium succinate (MPSS) loaded polycaprolactone based nanoparticles were developed and embedded in an implantable fibrin gel. The effects of MPSS delivery system are evaluated on an acute SCI rat model, by quantification the levels of three inflammatory cytokines (interleukin-1ß, interleukin-6 and caspase-3) and assessment of the damage on ultrastructural level by transmission electron microscopy. Developed NP-gel system showed very similar results with systemic high dose of MPSS. It is believed that developed system may be used as a tool for the safe and effective localized delivery of several other therapeutic molecules on injured spinal cord cases.


Assuntos
Sistemas de Liberação de Medicamentos , Hemissuccinato de Metilprednisolona/administração & dosagem , Fármacos Neuroprotetores/administração & dosagem , Traumatismos da Medula Espinal/tratamento farmacológico , Animais , Nanopartículas , Ratos
14.
J Cutan Pathol ; 43(11): 1031-1035, 2016 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-27433827

RESUMO

We describe a 65-year-old Caucasian female with well-controlled Hailey-Hailey disease (HHD) who developed acute generalized exanthematous pustulosis (AGEP) with severe systemic symptoms. Despite sparing of the patient's intertriginous skin, histopathologic evidence of HHD was observed in all biopsies, suggestive of a unique koebernization phenomenon of HHD to areas of cutaneous drug eruption. While internal organ involvement is less commonly reported in AGEP, there are an increasing number of patients with signs and symptoms suggestive of an AGEP/drug reaction with eosinophilia and systemic symptoms (DRESS) spectrum of cutaneous drug disorders. Early diagnosis of patients with AGEP and systemic symptoms is critical so that these patients may receive prompt and aggressive systemic therapy to decrease the risk of end organ damage and improve overall morbidity and mortality.


Assuntos
Pustulose Exantematosa Aguda Generalizada/diagnóstico , Síndrome de Hipersensibilidade a Medicamentos/diagnóstico , Pênfigo Familiar Benigno/complicações , Pustulose Exantematosa Aguda Generalizada/tratamento farmacológico , Idoso , Síndrome de Hipersensibilidade a Medicamentos/tratamento farmacológico , Diagnóstico Precoce , Feminino , Humanos , Hemissuccinato de Metilprednisolona/administração & dosagem , Hemissuccinato de Metilprednisolona/uso terapêutico , Pênfigo Familiar Benigno/tratamento farmacológico , Prednisolona/administração & dosagem , Prednisolona/uso terapêutico , Resultado do Tratamento , Triancinolona/administração & dosagem , Triancinolona/uso terapêutico , Vancomicina/administração & dosagem
15.
Angiol Sosud Khir ; 22(2): 145-51, 2016.
Artigo em Russo | MEDLINE | ID: mdl-27336347

RESUMO

Described herein is a case report of a severe lesion of the arterial system in non-specific aortoarteritis: lesion of the aortic arch branches, thoracoabdominal segment of the aorta, abdominal aorta, visceral and renal arteries, thus underlining a multiple nature of the lesion of the aorta and its branches in the pathology concerned. Diagnosis of lesions of the aorta and its branches was made by means of multispiral computed tomography (MSCT), being the most informative method of examination in this cohort of patients, making it possible to accurately diagnose both the degree of the lesion and its extension, to choose an optimal surgical policy, to carry out dynamic follow up of the condition of the reconstructed arterial segments.


Assuntos
Aortite , Arterite , Implante de Prótese Vascular , Metotrexato/administração & dosagem , Hemissuccinato de Metilprednisolona/administração & dosagem , Antirreumáticos/administração & dosagem , Aorta Abdominal/diagnóstico por imagem , Aorta Torácica/diagnóstico por imagem , Aorta Torácica/cirurgia , Aortite/diagnóstico , Aortite/tratamento farmacológico , Aortite/fisiopatologia , Aortite/cirurgia , Arterite/diagnóstico , Arterite/tratamento farmacológico , Arterite/fisiopatologia , Arterite/cirurgia , Implante de Prótese Vascular/efeitos adversos , Implante de Prótese Vascular/métodos , Terapia Combinada , Feminino , Humanos , Artérias Mesentéricas/diagnóstico por imagem , Artérias Mesentéricas/cirurgia , Recidiva , Artéria Renal/diagnóstico por imagem , Artéria Renal/cirurgia , Reoperação/métodos , Artéria Subclávia/diagnóstico por imagem , Artéria Subclávia/cirurgia , Tomografia Computadorizada Espiral/métodos , Resultado do Tratamento , Adulto Jovem
16.
Lupus ; 25(11): 1266-8, 2016 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-26936892

RESUMO

Systemic lupus erythematosus (SLE) is a chronic disease caused by an aberrant autoimmune response, with a large spectrum of clinical manifestations. It strikingly affects women. Recent papers reveal that the men with Klinefelter syndrome (47, XXY) have a higher incidence of lupus than the men in the general population, similar with that of genotypic females. On the other hand, there is a great lack of information regarding the association of SLE with Turner syndrome, but it seems to be a lower risk for females with Turner to develop SLE. We present a rare association of a Turner syndrome with SLE, with negative immunology for SLE and with diagnosis made on renal biopsy. These data suggest that the presence of two X chromosomes may predispose to SLE, the ligand (CD40 ligand) for one of the genes that contributes to the pathogenesis of SLE being located on the X chromosome.


Assuntos
Ciclofosfamida/administração & dosagem , Hemissuccinato de Metilprednisolona/administração & dosagem , Síndrome Nefrótica/complicações , Síndrome de Turner/complicações , Síndrome de Turner/genética , Adulto , Cromossomos Humanos X , Ciclofosfamida/uso terapêutico , Feminino , Predisposição Genética para Doença , Humanos , Lúpus Eritematoso Sistêmico/complicações , Lúpus Eritematoso Sistêmico/tratamento farmacológico , Lúpus Eritematoso Sistêmico/genética , Hemissuccinato de Metilprednisolona/uso terapêutico , Síndrome Nefrótica/tratamento farmacológico , Resultado do Tratamento
17.
Lupus ; 25(11): 1209-16, 2016 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-26957351

RESUMO

BACKGROUND: Glucocorticoids have been known for years to be the most effective therapy in systemic lupus erythematosus. Their use, however, is limited by the need for high doses due to their unfavorable pharmacokinetics and biodistribution. We have previously developed a novel liposome-based steroidal (methylprednisolone hemisuccinate (MPS)) nano-drug and demonstrated its specific accumulation in inflamed tissues, as well as its superior therapeutic efficacy over that of free glucocorticoids (non-liposomal) in the autoimmune diseases, including the adjuvant arthritis rat model and the experimental autoimmune encephalomyelitis mouse model. OBJECTIVES: In the present work we have evaluated the therapeutic effect of the above liposome-based steroidal (MPS) nano-drug in the MRL-lpr/lpr murine model of SLE and compared it with similar doses of the free MPS. METHODS: MRL-lpr/lpr mice were treated with daily injections of free MPS or weekly injections of 10% dextrose, empty nano-liposomes or the steroidal nano-drug and the course of their disease was followed up to the age of 24 weeks. RESULTS: Treatment with the steroidal nano-drug was found to be significantly superior to the free MPS in suppressing anti-dsDNA antibody levels, proliferation of lymphoid tissue and renal damage, and in prolonging survival of animals. CONCLUSION: This significant superiority of our liposome based steroidal nano-drug administered weekly compared with daily injections of free methylprednisolone hemisuccinate in suppressing murine lupus indicates this glucocorticoid nano-drug formulation may be a good candidate for the treatment of human SLE.


Assuntos
Lúpus Eritematoso Sistêmico/tratamento farmacológico , Hemissuccinato de Metilprednisolona/administração & dosagem , Nanopartículas/administração & dosagem , Animais , Anticorpos Antinucleares/metabolismo , Modelos Animais de Doenças , Esquema de Medicação , Feminino , Lipossomos/administração & dosagem , Lúpus Eritematoso Sistêmico/imunologia , Lúpus Eritematoso Sistêmico/metabolismo , Camundongos , Camundongos Endogâmicos MRL lpr , Resultado do Tratamento
18.
J Vet Intern Med ; 30(1): 206-14, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-26520829

RESUMO

BACKGROUND: Acute intervertebral disk herniation (IVDH) is a common cause of spinal cord injury in dogs and currently there is no proven medical treatment to counter secondary injury effects. Use of methylprednisolone sodium succinate (MPSS) or polyethylene glycol (PEG) as neuroprotectants is advocated but controversial because neither treatment has been tested in placebo-controlled, randomized, blinded trials in dogs. HYPOTHESIS: Polyethylene glycol will improve the outcome of severe spinal cord injury caused by IVDH compared to MPSS or placebo. ANIMALS: Client-owned dogs with acute onset of thoracolumbar IVDH causing paralysis and loss of nociception for <24 hours. METHODS: Dogs were randomized to receive MPSS, PEG, or placebo; drugs appeared identical and group allocation was masked. Drug administration was initiated once the diagnosis of IVDH was confirmed and all dogs underwent hemilaminectomy. Neurologic function was assessed 2, 4, 8, and 12 weeks postoperatively using an open field gait score (OFS) as the primary outcome measure. Outcomes were compared by the Wilcoxon rank sum test. RESULTS: Sixty-three dogs were recruited and 47.6% recovered ambulation. 17.5% developed progressive myelomalacia but there was no association with group. There was no difference in OFS among groups. Although full study power was not reached, conditional power analyses indicated the futility of continued case recruitment. CONCLUSIONS: This clinical trial did not show a benefit of either MPSS or PEG in the treatment of acute, severe thoracolumbar IVDH when used as adjunctive medical treatment administered to dogs presenting within 24 hours of onset of paralysis.


Assuntos
Anti-Inflamatórios/uso terapêutico , Doenças do Cão/tratamento farmacológico , Deslocamento do Disco Intervertebral/veterinária , Hemissuccinato de Metilprednisolona/uso terapêutico , Polietilenoglicóis/uso terapêutico , Animais , Anti-Inflamatórios/administração & dosagem , Cães , Feminino , Deslocamento do Disco Intervertebral/tratamento farmacológico , Masculino , Hemissuccinato de Metilprednisolona/administração & dosagem , Nociceptividade/efeitos dos fármacos , Polietilenoglicóis/administração & dosagem
19.
Headache ; 55(10): 1397-403, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26345726

RESUMO

OBJECTIVE: To evaluate factors that influence migraine recurrence after outpatient infusion or inpatient treatment for intractable migraine. BACKGROUND: Recurrence of migraine after acute treatment in an infusion center or an inpatient setting is not well documented in children and adolescents. Given the multifactorial pathogenesis of migraines, multiple factors may influence migraine recurrence. It has been reported that treatment with steroids may reduce the risk of migraine recurrence. The efficacy of steroids as a therapeutic adjunct has not been established. Studies in the adult population have yielded conflicting results. METHODS: This study is a retrospective chart review of patients presenting for treatment of an intractable migraine to the outpatient infusion unit or inpatient unit at Cincinnati Children's Hospital Medical Center (CCHMC). Data collected included: age, gender, location of treatment (outpatient, inpatient), migraine duration, diagnosis, severity, the addition of steroids to treatment protocols, and recurrence of migraine at 48 and 72 hours after discharge. Data were analyzed using Fisher's exact tests, logistic regression with backward elimination for variable selection, and least squares means slicing with associated odds ratios. RESULTS: Charts from 207 pediatric patients were analyzed. Using logistic regression analysis: location, gender, diagnosis, and age were all found to be significant predictors of migraine recurrence (P < .05). Patients treated in the inpatient setting were significantly less likely to experience recurrence compared to patients treated in an outpatient infusion unit (OR = 0.32; 95% CI 0.17-0.61, P = .0002). Male patients with a diagnosis of episodic migraine were significantly less likely to experience recurrence than male patients with chronic migraine (OR 0.17; 95% CI 0.04-0.73; P = .0074). The inclusion of steroids in this study population showed no significant reduction in migraine recurrence. The probability of recurrence decreased with age for episodic migraine patients, while the probability increased with age for chronic migraine patients. CONCLUSIONS: Recurrence is an important consideration when treating intractable migraines. Age, gender, diagnosis, and location of treatment correlate with migraine recurrence, but the inclusion of steroids does not. Considering these factors in the management of migraines may improve the outcome of these patients and reduce the risk of recurrence.


Assuntos
Dexametasona/administração & dosagem , Hospitalização/tendências , Hemissuccinato de Metilprednisolona/administração & dosagem , Transtornos de Enxaqueca/diagnóstico , Transtornos de Enxaqueca/tratamento farmacológico , Adolescente , Adulto , Criança , Feminino , Humanos , Infusões Intravenosas , Masculino , Recidiva , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
20.
Rev Neurol (Paris) ; 171(8-9): 669-73, 2015 Sep.
Artigo em Francês | MEDLINE | ID: mdl-26318899

RESUMO

The prescription of methylprednisolone for multiple sclerosis acute relapse involves sterilization of urine. An observational study was conducted to clarify the benefit of antibiotic prophylaxis in case of asymptomatic bacteriuria found before methylprednisolone. Ninety-seven patients were included; 32 patients had asymptomatic bacteriuria. Seventeen patients were treated and 15 were not. The number of urinary tract infections in the month following the methylprednisolone was the same in the two groups. The results seem in favor of a therapeutic abstention. A larger study will be performed to confirm these results and determine appropriate recommendations.


Assuntos
Antibacterianos/uso terapêutico , Antibioticoprofilaxia/estatística & dados numéricos , Bacteriúria/tratamento farmacológico , Imunossupressores/uso terapêutico , Hemissuccinato de Metilprednisolona/uso terapêutico , Esclerose Múltipla Recidivante-Remitente/tratamento farmacológico , Procedimentos Desnecessários/estatística & dados numéricos , Infecções Urinárias/prevenção & controle , Adulto , Doenças Assintomáticas , Bacteriúria/complicações , Bacteriúria/microbiologia , Progressão da Doença , Feminino , Bactérias Gram-Negativas/isolamento & purificação , Infecções por Bactérias Gram-Negativas/tratamento farmacológico , Infecções por Bactérias Gram-Negativas/prevenção & controle , Bactérias Gram-Positivas/isolamento & purificação , Infecções por Bactérias Gram-Positivas/tratamento farmacológico , Infecções por Bactérias Gram-Positivas/prevenção & controle , Humanos , Imunossupressores/administração & dosagem , Imunossupressores/efeitos adversos , Infusões Intravenosas , Masculino , Hemissuccinato de Metilprednisolona/administração & dosagem , Hemissuccinato de Metilprednisolona/efeitos adversos , Pessoa de Meia-Idade , Esclerose Múltipla Recidivante-Remitente/complicações , Resultado do Tratamento , Infecções Urinárias/epidemiologia
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