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1.
J Med Vasc ; 46(1): 13-21, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33546816

RESUMO

Acute limb ischemia induced by arterial vasospasm remains an exceptional situation, favoured by the use of arterial vasoconstrictors. The risk of these substances is largely underestimated in the general population, especially with the co-administration of strong cytochrome inhibitors like human immunodeficiency virus (HIV) protease inhibitors. A 33-year-old woman, who used to take dihydroergotamine for orthostatic hypotension, was prescribed a post-exposure HIV prophylaxis including lopinavir and ritonavir. One day later, she presented an acute bilateral limb ischemia with a sudden pain in both calves, initially while walking and then at rest with bilateral ischemic toes. Angiography confirmed diffuse arterial vasospasm of the lower limb arteries. A first-line therapy with isosorbide dinitrate and amlodipine was ineffective, with rapid clinical worsening. A combination of intra-arterial injections and intra-venous infusions of vasodilators, transluminal balloon angioplasty and bilateral 4-Compartment fasciotomies permitted rapid improvement and finally resulted in both lower limbs rescue. This case and literature review illustrate ergotism due to ergotamine overdose after taking HIV protease inhibitors. It also demonstrates the benefit of an interventional procedure besides medical therapy with vasodilators in severe arterial vasospasm. All along the lower limb arterial tree, transluminal balloon angioplasty restored the blood flow, without vasospasm recurrence. CONCLUSION: In case of ergotism with acute lower limbs ischemia, combining medical vasodilator therapy with interventional procedure can restore the arterial blood flow, thus allowing to save lower limbs.


Assuntos
Angioplastia com Balão , Di-Hidroergotamina/efeitos adversos , Ergotismo/etiologia , Inibidores da Protease de HIV/efeitos adversos , Isquemia/terapia , Vasoconstritores/efeitos adversos , Doença Aguda , Adulto , Ergotismo/diagnóstico , Ergotismo/fisiopatologia , Feminino , Infecções por HIV/prevenção & controle , Humanos , Isquemia/induzido quimicamente , Isquemia/diagnóstico por imagem , Isquemia/fisiopatologia , Extremidade Inferior/irrigação sanguínea , Fatores de Risco , Resultado do Tratamento
2.
JAMA ; 324(16): 1640-1650, 2020 10 27.
Artigo em Inglês | MEDLINE | ID: mdl-33107944

RESUMO

Importance: Current guidelines recommend ticagrelor as the preferred P2Y12 platelet inhibitor for patients with acute coronary syndrome (ACS), primarily based on a single large randomized clinical trial. The benefits and risks associated with ticagrelor vs clopidogrel in routine practice merits attention. Objective: To determine the association of ticagrelor vs clopidogrel with ischemic and hemorrhagic events in patients undergoing percutaneous coronary intervention (PCI) for ACS in clinical practice. Design, Setting, and Participants: A retrospective cohort study of patients with ACS who underwent PCI and received ticagrelor or clopidogrel was conducted using 2 United States electronic health record-based databases and 1 nationwide South Korean database from November 2011 to March 2019. Patients were matched using a large-scale propensity score algorithm, and the date of final follow-up was March 2019. Exposures: Ticagrelor vs clopidogrel. Main Outcomes and Measures: The primary end point was net adverse clinical events (NACE) at 12 months, composed of ischemic events (recurrent myocardial infarction, revascularization, or ischemic stroke) and hemorrhagic events (hemorrhagic stroke or gastrointestinal bleeding). Secondary outcomes included NACE or mortality, all-cause mortality, ischemic events, hemorrhagic events, individual components of the primary outcome, and dyspnea at 12 months. The database-level hazard ratios (HRs) were pooled to calculate summary HRs by random-effects meta-analysis. Results: After propensity score matching among 31 290 propensity-matched pairs (median age group, 60-64 years; 29.3% women), 95.5% of patients took aspirin together with ticagrelor or clopidogrel. The 1-year risk of NACE was not significantly different between ticagrelor and clopidogrel (15.1% [3484/23 116 person-years] vs 14.6% [3290/22 587 person-years]; summary HR, 1.05 [95% CI, 1.00-1.10]; P = .06). There was also no significant difference in the risk of all-cause mortality (2.0% for ticagrelor vs 2.1% for clopidogrel; summary HR, 0.97 [95% CI, 0.81-1.16]; P = .74) or ischemic events (13.5% for ticagrelor vs 13.4% for clopidogrel; summary HR, 1.03 [95% CI, 0.98-1.08]; P = .32). The risks of hemorrhagic events (2.1% for ticagrelor vs 1.6% for clopidogrel; summary HR, 1.35 [95% CI, 1.13-1.61]; P = .001) and dyspnea (27.3% for ticagrelor vs 22.6% for clopidogrel; summary HR, 1.21 [95% CI, 1.17-1.26]; P < .001) were significantly higher in the ticagrelor group. Conclusions and Relevance: Among patients with ACS who underwent PCI in routine clinical practice, ticagrelor, compared with clopidogrel, was not associated with significant difference in the risk of NACE at 12 months. Because the possibility of unmeasured confounders cannot be excluded, further research is needed to determine whether ticagrelor is more effective than clopidogrel in this setting.


Assuntos
Síndrome Coronariana Aguda/cirurgia , Clopidogrel/efeitos adversos , Intervenção Coronária Percutânea , Antagonistas do Receptor Purinérgico P2Y/efeitos adversos , Ticagrelor/efeitos adversos , Síndrome Coronariana Aguda/mortalidade , Adulto , Idoso , Idoso de 80 Anos ou mais , Algoritmos , Aspirina/administração & dosagem , Estudos de Casos e Controles , Causas de Morte , Clopidogrel/administração & dosagem , Bases de Dados Factuais/estatística & dados numéricos , Dispneia/induzido quimicamente , Feminino , Hemorragia/induzido quimicamente , Humanos , Isquemia/induzido quimicamente , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/epidemiologia , Metanálise em Rede , Pontuação de Propensão , Antagonistas do Receptor Purinérgico P2Y/administração & dosagem , Recidiva , República da Coreia , Estudos Retrospectivos , Acidente Vascular Cerebral/epidemiologia , Ticagrelor/administração & dosagem , Estados Unidos
3.
J Vis Exp ; (163)2020 09 16.
Artigo em Inglês | MEDLINE | ID: mdl-33016936

RESUMO

One of the commonly used models for ischemic retinopathies is the oxygen-induced retinopathy (OIR) model. Here we describe detailed protocols for the OIR model induction and its readouts in both mice and rats. Retinal neovascularization is induced in OIR by exposing rodent pups either to hyperoxia (mice) or alternating levels of hyperoxia and hypoxia (rats). The primary readouts of these models are the size of neovascular (NV) and avascular (AVA) areas in the retina. This preclinical in vivo model can be used to evaluate the efficacy of potential anti-angiogenic drugs or to address the role of specific genes in the retinal angiogenesis by using genetically manipulated animals. The model has some strain and vendor specific variation in the OIR induction which should be taken into consideration when designing the experiments.


Assuntos
Modelos Animais de Doenças , Isquemia/induzido quimicamente , Oxigênio/farmacologia , Doenças Retinianas/induzido quimicamente , Animais , Isquemia/complicações , Camundongos , Camundongos Endogâmicos C57BL , Ratos , Retina/efeitos dos fármacos , Retina/metabolismo , Retina/fisiopatologia , Doenças Retinianas/complicações , Neovascularização Retiniana/complicações
5.
Toxicon ; 180: 28-30, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32289354

RESUMO

A previously well man developed acute, marked tender bilateral gynaecomastia two months after confirmed taipan (Oxyuranus scutellatus) envenomation. He had had laboratory evidence of thrombotic microangiopathy (TMA) including microangiopathic haemolytic anaemia, thrombocytopenia and acute kidney injury. Scrotal ultrasound revealed bilateral testicular atrophy, his serum testosterone was repeatedly low, while his luteinising and follicle stimulating hormone were elevated. It is hypothesised that TMA-related testicular ischaemia was responsible for his primary gonadal failure and dramatic clinical presentation.


Assuntos
Venenos Elapídicos , Elapidae , Hipogonadismo/induzido quimicamente , Mordeduras de Serpentes , Testículo/efeitos dos fármacos , Adulto , Anemia Hemolítica , Animais , Humanos , Isquemia/induzido quimicamente , Masculino , Trombocitopenia
6.
BMJ Case Rep ; 13(2)2020 Feb 09.
Artigo em Inglês | MEDLINE | ID: mdl-32041760

RESUMO

A 50-year-old woman with a history of Crohn's disease treated with adalimumab presented with left hand pain and duskiness. Angiogram showed non-filling of the radial and digital arteries of the hand. Antiphospholipid antibody testing was positive, leading to a diagnosis of antitumour necrosis factor-induced antiphospholipid syndrome. Adalimumab was discontinued, and she was treated with the vitamin K antagonist warfarin and low-dose aspirin. Upon resolution of the antiphospholipid antibodies, she was transitioned to aspirin alone without recurrence of thrombosis.


Assuntos
Adalimumab/efeitos adversos , Anti-Inflamatórios/efeitos adversos , Síndrome Antifosfolipídica/induzido quimicamente , Mãos/irrigação sanguínea , Isquemia/induzido quimicamente , Doenças Vasculares Periféricas/induzido quimicamente , Aspirina/uso terapêutico , Doença de Crohn/tratamento farmacológico , Feminino , Humanos , Pessoa de Meia-Idade , Artéria Radial/diagnóstico por imagem , Artéria Radial/fisiopatologia , Varfarina/uso terapêutico
8.
BMJ Case Rep ; 13(1)2020 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-31948983

RESUMO

Terlipressin is a commonly used drug in hepatology practice for the two most serious complications of cirrhosis, that is, acute oesophageal variceal bleed and hepatorenal syndrome. Acute-on-chronic liver failure (ACLF) is a medical emergency and is frequently associated with acute kidney injury (AKI). Two male patients with alcohol-induced ACLF with high MELD (Model for End-Stage Liver Disease) score presented with AKI. Both were treated with terlipressin infusion. There was no response to terlipressin in these sick patients, and further both patients developed ischaemic skin necrosis and succumbed to multiorgan failure. Continuous infusion of terlipressin is superior to bolus dosing, but we noted that continuous infusion might as well be associated with severe adverse effects in patients with a high MELD score. More extensive prospective studies, including patients with high MELD score, are required to ascertain the safety of terlipressin.


Assuntos
Isquemia/induzido quimicamente , Necrose/induzido quimicamente , Dermatopatias/induzido quimicamente , Terlipressina/efeitos adversos , Lesão Renal Aguda/tratamento farmacológico , Insuficiência Hepática Crônica Agudizada/tratamento farmacológico , Diagnóstico Diferencial , Humanos , Masculino , Pessoa de Meia-Idade
9.
Environ Health ; 19(1): 1, 2020 01 02.
Artigo em Inglês | MEDLINE | ID: mdl-31898503

RESUMO

BACKGROUND: Stroke, especially ischemic stroke (IS), has been a severe public health problem around the world. However, the association between air pollution and ischemic stroke remains ambiguous. METHODS: A total of 63, 997 IS cases aged 18 years or above in Shenzhen were collected from 2008 to 2014. We used the time-stratified case-crossover design combining with distributed lag nonlinear model (DLNM) to estimate the association between air pollution and IS onset. Furthermore, this study explored the variability across gender and age groups. RESULTS: The cumulative exposure-response curves were J-shaped for SO2, NO2 and PM10, and V-shaped for O3, and crossed over the relative risk (RR) of one. The 99th, 50th (median) and 1st percentiles of concentration (µg/m3) respectively were 37.86, 10.06, 3.71 for SO2, 116.26, 41.29, 18.51 for NO2, 145.94, 48.29, 16.14 for PM10, and 111.57, 49.82, 16.00 for O3. Extreme high-SO2, high-NO2, high-PM10, high-O3, and low-O3 concentration increased the risk of IS, with the maximum RR values and 95% CIs: 1.50(1.22, 1.84) (99th vs median) at 0-12 lag days, 1.37(1.13, 1.67) (99th vs median) at 0-10 lag days, 1.26(1.04, 1.53) (99th vs median) at 0-12 lag days, 1.25(1.04, 1.49) (99th vs median) at 0-14 lag days, and 1.29(1.03, 1.61) (1st vs median) at 0-14 lag days, respectively. The statistically significant minimal RR value and 95% CI was 0.79(0.66,0.94) at 0-10 lag days for extreme low-PM10. The elderly aged over 65 years were susceptible to extreme pollution conditions. Difference from the vulnerability of males to extreme high-SO2, high-NO2 and low-O3, females were vulnerable to extreme high-PM10 and high-O3. Comparing with the elderly, adults aged 18-64 year were immune to extreme low-NO2 and low-PM10. However, no association between CO and IS onset was found. CONCLUSIONS: SO2, NO2, PM10 and O3 exerted non-linear and delayed influence on IS, and such influence varied with gender and age. These findings may have significant public health implications for the prevention of IS.


Assuntos
Poluição do Ar/efeitos adversos , Isquemia Encefálica/epidemiologia , Exposição Ambiental/efeitos adversos , Acidente Vascular Cerebral/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Poluentes Atmosféricos , Isquemia Encefálica/induzido quimicamente , China/epidemiologia , Cidades , Estudos Cross-Over , Feminino , Humanos , Incidência , Isquemia/induzido quimicamente , Isquemia/epidemiologia , Masculino , Pessoa de Meia-Idade , Dinâmica não Linear , Risco , Estações do Ano , Acidente Vascular Cerebral/induzido quimicamente , Fatores de Tempo , Adulto Jovem
10.
Biochim Biophys Acta Mol Cell Res ; 1867(3): 118462, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-30890410

RESUMO

The classical cannabinoid receptors CB1 and CB2 as well as the cannabinoid-sensitive receptor GPR55 are widely distributed throughout the mammalian body. In the cardiovascular field, CB1 and CB2 crucially impact on diseases characterized by inflammatory processes, such as atherosclerosis and acute myocardial infarction. Both receptors and their endogenous ligands anandamide and 2-arachidonoylglycerol are up-regulated in the ischaemic heart in humans and animal models. Pharmacological and genetic interventions with CB1 and CB2 vitally affect acute ischaemia-induced cardiac inflammation. Herein, CB1 rather aggravates the inflammatory response whereas CB2 mitigates inflammation via directly affecting immune cell attraction, macrophage polarization and lymphocyte clusters in the pericardial adipose tissue. Furthermore, cannabinoids and their receptors affect numerous cardiac risk factors. In this context, cannabis consumption is debated to trigger arrhythmias and even myocardial infarction. Moreover, CB1 activation is linked to impaired lipid and glucose metabolism and therefore obesity and diabetes, while its antagonism leads to the reduction of plasma triglycerides, low-density lipoprotein cholesterol, leptin, insulin and glucose. On the other hand, activation of cannabinoid-sensitive receptors can also counteract unfavourable predictors for cardiovascular diseases. In particular, hypertension can be mitigated via CB1 agonism and impaired adrenoceptor responsiveness prevented by functional GPR55. Taken together, current insights identify the cannabinoid system as promising target not only to therapeutically interfere with the vasculature, but also to affect the heart as target organ. This review discusses current knowledge regarding a direct cardiac role of the cannabinoid system and points out its feasible therapeutic manipulation in the ischaemic myocardium.


Assuntos
Canabinoides/efeitos adversos , Inflamação/genética , Receptor CB1 de Canabinoide/genética , Receptor CB2 de Canabinoide/genética , Receptores de Canabinoides/genética , Tecido Adiposo/metabolismo , Coração/efeitos dos fármacos , Coração/fisiopatologia , Humanos , Inflamação/induzido quimicamente , Inflamação/fisiopatologia , Isquemia/induzido quimicamente , Isquemia/genética , Isquemia/fisiopatologia , Fumar Maconha/efeitos adversos , Infarto do Miocárdio/genética , Infarto do Miocárdio/patologia
12.
Arq Bras Oftalmol ; 83(6): 543-546, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33470284

RESUMO

Central giant cell granuloma is a rare osseous tumor affecting young patients with anatomical and functional compromise of the maxilla and mandible. Steroid injection therapy constitutes a less invasive treatment modality for disease control in selected cases. Retinal ischemia is a reported complication of multiple medical procedures, including dental interventions, and may lead to loss of vision with poor prognosis. We report a case of retinal arteriolar ischemic disease following central giant cell granuloma management with local injected corticosteroids.


Assuntos
Corticosteroides/efeitos adversos , Neoplasias Ósseas , Granuloma de Células Gigantes , Adolescente , Neoplasias Ósseas/tratamento farmacológico , Feminino , Granuloma de Células Gigantes/tratamento farmacológico , Humanos , Isquemia/induzido quimicamente , Mandíbula
13.
J Toxicol Sci ; 44(12): 833-843, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31813902

RESUMO

Drug-induced liver injury is not readily detectable using conventional animal studies during pre-clinical drug development. To address this problem, other researchers have proposed the use of co-administration of lipopolysaccharide (LPS), an endotoxin produced by gram-negative bacteria, and a drug. Using this approach, liver injury that is otherwise not detected following drug administration alone can be successfully identified. Previous studies have demonstrated that such injury is suppressed by heparin; therefore, the mechanism may involve coagulation-dependent ischemia. However, it has not been established how LPS-induced ischemia might sensitize hepatocytes to a potentially hepatotoxic drug. In the present study, we aimed to determine the effect of LPS-induced ischemia on liver mitochondrial function and downstream toxicologic responses. Consistent with previous findings, plasma alanine transaminase (ALT) activity was higher in rats co-administered with LPS (1 mg/kg) and diclofenac (100 mg/kg), but reduced by heparin. Liver mRNA expression of Hmox1, encoding heme oxygenase-1, an oxidative stress indicator, was three times higher at 2 hr after LPS administration. Furthermore, respiratory activity via mitochondrial complex II, lipid peroxidation in mitochondria, and the susceptibility to mitochondrial permeability transition pore opening in response to diclofenac administration were significantly increased by LPS administration. The increase in plasma ALT activity and the sensitization to mitochondrial permeability transition pore opening were reduced by the co-administration of heparin. In conclusion, LPS-induced transient ischemia disrupts respiratory chain complex activities, enhances reactive oxygen species production, especially in mitochondria, and sensitizes mitochondria to permeability transition pore opening when testing a potentially hepatotoxic drug in vivo.


Assuntos
Doença Hepática Induzida por Substâncias e Drogas/metabolismo , Diclofenaco/toxicidade , Modelos Animais de Doenças , Endotoxinas/toxicidade , Fígado/efeitos dos fármacos , Mitocôndrias Hepáticas/efeitos dos fármacos , Animais , Sinergismo Farmacológico , Heme Oxigenase (Desciclizante)/metabolismo , Isquemia/induzido quimicamente , Isquemia/metabolismo , Fígado/irrigação sanguínea , Fígado/metabolismo , Testes de Função Hepática , Masculino , Mitocôndrias Hepáticas/metabolismo , Estresse Oxidativo/efeitos dos fármacos , Ratos , Ratos Wistar , Espécies Reativas de Oxigênio/metabolismo
14.
Artigo em Inglês | MEDLINE | ID: mdl-31842318

RESUMO

Objective: N-(2-methoxy) benzyl-phenethylamine (NBOMe) derivatives have a high affinity to the serotonin receptor 2A and emerged as new psychedelic agents. We report the case of a 30-year-old man admitted to the hospital because of acute ischemia of the left arm with clinical symptoms of pallor, pulselessness, paresthesia, and a motoric deficit. The patient had a history of schizophrenia and drug abuse and disclosed during the hospital stay the sublingual intake of a substance bought as 25I-NBOMe the night before the ischemic event. Methods: Routine clinical diagnostics including among others color-coded duplex sonography and computed tomography angiography (CTA) were performed. The remainder of the drugs was analyzed using high performance liquid chromatography. Results: Initial color-coded duplex sonography of the upper left limb showed pathological flow profiles of the axillary, brachial, ulnar, and radial artery with a reduced diameter of the ulnar (0.9 mm) and radial (1.1 mm) artery. In consequence, peripheral vasospasm, distal arterial thrombosis, or arterial embolization was anticipated. As therapeutic measures, the patient immediately received intravenous systemic vasodilators (alprostadil) and therapeutic anticoagulation with low molecular weight heparin. Instant symptom improvement was observed within the first day after therapy initiation. The subsequently performed CTA of the heart and left arm showed no signs of thrombotic material. Treatment was continued for five days and the patient was released thereafter having completely normalized perfusion in his left arm. Outpatient treatment was continued with calcium-channel blockers, as the patient had also displayed arterial hypertension. Drug analysis retrieved a composition of the isomers 25I-NBOMe, 25C-NBOMe, and 25H-NBOMe as well as traces of pentylon. Conclusion: NBOMe ingestion implicates the risk of peripheral vasospasms with severe, limb-threatening ischemia.


Assuntos
Dimetoxifeniletilamina/análogos & derivados , Alucinógenos/efeitos adversos , Isquemia/induzido quimicamente , Adulto , Dimetoxifeniletilamina/efeitos adversos , Humanos , Masculino
16.
Rev Esp Enferm Dig ; 111(12): 971-972, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31718201

RESUMO

Polypharmacy is a frequent phenomenon. For that reason, drugs side effects are increasing, including lesions in the gastrointestinal (GI) tract. Multiple drugs can induce damage to the GI mucosa. NSAIDs are the most characteristic, however there are other drugs, that can cause a harmful effect in the digestive tract, such as iron. We present the case of a 91-year-old man with hematemesis due to iron intake.


Assuntos
Compostos Ferrosos/efeitos adversos , Gastrite/induzido quimicamente , Hematemese/induzido quimicamente , Idoso de 80 Anos ou mais , Anemia/tratamento farmacológico , Gastrite/patologia , Gastroscopia , Humanos , Isquemia/induzido quimicamente , Isquemia/complicações , Masculino , Membrana Mucosa/patologia , Estômago/irrigação sanguínea
17.
CNS Drugs ; 33(12): 1223-1228, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31686406

RESUMO

INTRODUCTION: Factor Xa-inhibiting direct oral anticoagulants (FXa-DOACs) undergo hepatic metabolism via cytochrome P-450 (CYP450). Concomitant use of rifampicin, an inducer of these enzymes, with FXa-DOACs, has been shown to decrease FXa-DOAC concentrations in healthy subjects. Several common antiepileptic drugs (AEDs) are known to induce CYP450 enzymes as well. However, little is known regarding the impact of this potential interaction on treatment outcomes with FXa-DOACs. METHODS: We analyzed adverse event cases submitted to the Food and Drug Administration (FDA) Adverse Event Reporting System (FAERS) from January 2013 to December 2018. We compared the proportion of cases reporting thromboembolic and ischemic adverse events (TAIAEs) with the concomitant use of FXa-DOACs and enzyme-inducing AEDs to the proportion of cases with FXa-DOACs and other AEDs. RESULTS: During this period, 9693 adverse event cases reported concomitant use of FXa-DOACs and AEDs. Almost all reports (> 99%) involved the use of rivaroxaban or apixaban. Compared with other AEDs, enzyme-inducing AEDs were associated with an 86% increase in the odds of reporting TAIAEs [reporting odds ratio (ROR) 1.86, 95% confidence interval (CI) 1.61-2.15; p < 0.0001]. In secondary separate analyses of rivaroxaban and apixaban, enzyme-inducing AEDs were similarly associated with increased reporting of a TAIAE (ROR 1.79, 95% CI 1.50-2.12, and ROR 1.88, 95% CI 1.41-2.48, respectively). CONCLUSION: Using real world data, we observed an increase in the odds of reporting anticoagulation treatment failure among patients treated with FXa-DOACs and concomitant enzyme-inducing AEDs compared to those treated with other AEDs.


Assuntos
Anticoagulantes/efeitos adversos , Anticoagulantes/uso terapêutico , Anticonvulsivantes/efeitos adversos , Anticonvulsivantes/uso terapêutico , Inibidores do Fator Xa/efeitos adversos , Inibidores do Fator Xa/uso terapêutico , Isquemia/induzido quimicamente , Administração Oral , Sistemas de Notificação de Reações Adversas a Medicamentos , Idoso , Coagulação Sanguínea/efeitos dos fármacos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pirazóis/efeitos adversos , Pirazóis/uso terapêutico , Piridonas/efeitos adversos , Piridonas/uso terapêutico , Rivaroxabana/efeitos adversos , Rivaroxabana/uso terapêutico , Estados Unidos , United States Food and Drug Administration
19.
Facial Plast Surg Clin North Am ; 27(4): 557-564, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31587773

RESUMO

Soft tissue fillers continue to gain popularity in addressing volume loss and changes associated with facial aging. The rare but devastating complication from iatrogenic vascular occlusion can result in irreversible vision loss. This article discusses the complications of vision loss associated with fillers and reviews applicable treatment techniques and prevention methods.


Assuntos
Cegueira/induzido quimicamente , Cegueira/prevenção & controle , Técnicas Cosméticas/efeitos adversos , Preenchedores Dérmicos/efeitos adversos , Olho/irrigação sanguínea , Face/irrigação sanguínea , Isquemia/induzido quimicamente , Cegueira/diagnóstico , Cegueira/terapia , Vasos Sanguíneos/anatomia & histologia , Humanos , Oftalmologia , Encaminhamento e Consulta , Oclusão da Artéria Retiniana/induzido quimicamente
20.
Clin Adv Periodontics ; 9(1): 20-23, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-31490035

RESUMO

INTRODUCTION: Monoclonal antibodies against proprotein-convertase subtilisin/kexin type 9 (PCSK9) inhibitors are a newly-introduced therapeutic approach against hypercholesterolemia. Clinical trials have reported few adverse effects of PCSK9 inhibitors and there are no reports of oral adverse effects. We present the case of a patient that showed gingival discomfort on eating and toothbrushing, coupled with the presence of gingival ischemia and petechiae, 3 days after a subcutaneous abdominal injection of 75-mg alirocumab for hypercholesterolemia, and contemplate on their possible pathogenesis. CASE PRESENTATION: Αn 81-year-old male presented with gingival discomfort during eating and toothbrushing, 3 days after receiving a subcutaneous abdominal injection of alirocumab. Intraoral examination revealed that the anterior free and attached gingiva of both jaws appeared pale and the surrounding mucosa showed confluent petechiae that were more evident on the anterior palatal gingiva. The patient was asked to brush his teeth with a soft toothbrush and use a mouthwash containing hydrogen peroxide three times daily. At the 8-day re-examination he was symptom-free, and the mucosa appeared totally normal. At the 5-month follow-up visit he reported having the same symptoms after each one of the 12 doses of alirocumab he received. CONCLUSIONS: Adverse dugs effects associated with subcutaneous injection of alirocumab may manifest in the gingiva. Therefore, oral and periodontal examination should be included in the regular follow-up of patients medicated with this drug.


Assuntos
Anticorpos Monoclonais Humanizados/efeitos adversos , Hipercolesterolemia , Isquemia , Idoso de 80 Anos ou mais , Gengiva/diagnóstico por imagem , Humanos , Hipercolesterolemia/tratamento farmacológico , Isquemia/induzido quimicamente , Masculino , Pró-Proteína Convertase 9/antagonistas & inibidores , Púrpura
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