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5.
Kardiologiia ; 61(1): 72-77, 2021 Feb 10.
Artigo em Russo, Inglês | MEDLINE | ID: mdl-33734057

RESUMO

Aim To analyze cases of idiopathic recurrent pericarditis (IRP) in the structure of pericardial diseases of various origins from patient visits to the Multidisciplinary Federal Center.Material and methods A retrospective analysis of case records was performed for patients admitted to the V.A. Almazov National Medical Research Center from January 1, 2015 through January 1, 2020 for pericardial effusion of different etiologies.Results For the study period, 4 981 new cases of pericardial damage of different etiologies were found. Among these cases, postpericardiotomy syndrome accounted for 4 360 cases and pericarditis for 621 cases. IRP was detected in 34 cases, which amounted to 5.4 %. Based on the study data, the estimated IRP prevalence in the Russian Federation can be 1.1 cases per 100 thousand population.Conclusion IRP should be regarded as a new autoinflammatory disease, the prevalence of which borders on that of adult Still disease and should be addressed within the concept of orphan diseases. Current knowledge of the pathogenesis and data from recent studies demonstrated a great importance of interleukin-1 blockade as a leading mechanism for achieving remission. This has justified conduction of a randomized clinical study at the Center.


Assuntos
Doenças Hereditárias Autoinflamatórias , Pericardite , Adulto , Humanos , Pericardite/tratamento farmacológico , Pericardite/epidemiologia , Doenças Raras , Recidiva , Estudos Retrospectivos , Federação Russa/epidemiologia
6.
Am J Cardiol ; 146: 115-119, 2021 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-33539856

RESUMO

Exercise restriction is a nonpharmacological treatment of pericarditis that could reduce symptoms by slowing heart rate (HR). Beta-blockers allow pharmacological control of HR. Aim of this paper is to explore the possible efficacy of beta-blockers to improve control of symptoms in patients with pericarditis. We analyzed consecutive cases with pericarditis referred to our center. Beta-blockers were prescribed on top of standard anti-inflammatory therapy in symptomatic patients (chest pain and palpitations) with rest HR>75 beats/min. The primary end point was the persistence of pericardial pain at 3 weeks. The secondary end point was the occurrence of recurrent pericarditis at 18 months. Propensity score matching was used to generate 2 cohorts of 101 patients with and without beta-blockers with balanced baseline features. A clinical and echocardiographic follow-up was performed at 3 weeks, 1, 3, 6 months and then every 12 months. A total of 347 patients (mean age 53 years, 58% females, 48% with a recurrence, 81% with idiopathic/viral etiology) were included. Among them, 128 patients (36.9%) were treated with beta-blockers. Peak C-reactive protein values were correlated with heart rate on first observation (r=0.48, p<0.001). Using propensity-score matched cohorts, patients treated with beta-blockers had a lower frequency of symptoms persistence at 3 weeks (respectively 4% vs. 14%; p = 0.024) and a trend towards a reduction of recurrences at 18 months (p = 0.069). In conclusion the use of beta-blockers on top of standard anti-inflammatory therapies was associated with improved symptom control.


Assuntos
Antagonistas Adrenérgicos beta/uso terapêutico , Frequência Cardíaca/efeitos dos fármacos , Pericardite/tratamento farmacológico , Pontuação de Propensão , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Pericardite/diagnóstico , Estudos Retrospectivos , Resultado do Tratamento
7.
BMJ Case Rep ; 14(1)2021 Jan 28.
Artigo em Inglês | MEDLINE | ID: mdl-33509870

RESUMO

Anti-interferon-gamma (IFN-γ) autoantibodies has been recognised as an adult-onset immunodeficiency in the past decade in people who originate from Southeast Asia. These patients are susceptible to particular opportunistic infections, especially non-tuberculous mycobacteria (NTM). We present the case of a woman whom originally came from Thailand with disseminated Mycobacterium avium complex infection (pleural, pericardium, bloodstream and lung parenchymal involvement). Her infection continued to progress while receiving proper antibiotic treatment. Once high titre neutralising anti-IFN-γ autoantibodies were detected, rituximab was added as adjunctive treatment. The patient had remarkable clinical improvement against persistence of anti-IFN-γ autoantibodies. Although her lung disease has improved, the patient continues on triple therapy for NTM. The kinetics of anti-IFN-γ autoantibodies in the context of clinical progression, indication and length for rituximab and triple therapy is discussed in view of the current literature.


Assuntos
Autoanticorpos/imunologia , Síndromes de Imunodeficiência/imunologia , Interferon gama/imunologia , Infecção por Mycobacterium avium-intracellulare/imunologia , Adulto , Antibacterianos/uso terapêutico , Grupo com Ancestrais do Continente Asiático , Azitromicina/uso terapêutico , Bacteriemia/tratamento farmacológico , Bacteriemia/imunologia , Progressão da Doença , Etambutol/uso terapêutico , Feminino , Humanos , Síndromes de Imunodeficiência/diagnóstico , Síndromes de Imunodeficiência/tratamento farmacológico , Fatores Imunológicos/uso terapêutico , Complexo Mycobacterium avium , Infecção por Mycobacterium avium-intracellulare/tratamento farmacológico , Pericardite/tratamento farmacológico , Pericardite/imunologia , Pleurisia/tratamento farmacológico , Pleurisia/imunologia , Pneumonia Bacteriana/tratamento farmacológico , Pneumonia Bacteriana/imunologia , Recidiva , Rifampina/uso terapêutico , Rituximab/uso terapêutico , Tailândia/etnologia
8.
Am Heart J ; 228: 81-90, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32866928

RESUMO

Recurrent pericarditis (RP) occurs in 15% to 30% of patients following a first episode, despite standard treatment with nonsteroidal anti-inflammatory drugs, colchicine, and corticosteroids; many patients become dependent on corticosteroids. Rilonacept (KPL-914), an interleukin-1α and ß inhibitor, is in development for the treatment of RP. RHAPSODY, a double-blind, placebo-controlled, randomized-withdrawal (RW) pivotal Phase 3 trial (NCT03737110), enrolls patients 12 years or older presenting with at least a third pericarditis episode, pericarditis pain score ≥4 (11-point numeric rating scale [NRS]), and C-reactive protein ≥1 mg/dL at screening. After a subcutaneous loading dose (adults, 320 mg; children, 4.4 mg/kg), all patients receive blinded weekly subcutaneous rilonacept (adults, 160 mg; children, 2.2 mg/kg) during the run-in period. Patients must taper and discontinue concomitant pericarditis medications during the blinded run-in period and achieve clinical response (C-reactive protein ≤0.5 mg/dL and weekly average NRS ≤2.0 during the 7 days prior to and including the day of randomization) by end of the run-in (while on rilonacept monotherapy) to be randomized to either continued rilonacept or placebo in the RW period. Primary efficacy end point was time to adjudicated pericarditis recurrence during the RW period; secondary efficacy end points were proportion of patients maintaining clinical response, percentage of days with NRS ≤2, and percentage of patients with no-to-minimal pericarditis symptoms at week 16 of the RW period. Safety evaluations include adverse event monitoring, physical examinations, and laboratory tests. The RHAPSODY trial will evaluate the efficacy and safety of rilonacept in the treatment of RP to improve outcomes and patient health-related quality of life.


Assuntos
Monitoramento de Medicamentos/métodos , Pericardite , Qualidade de Vida , Proteínas Recombinantes de Fusão , Prevenção Secundária/métodos , Adolescente , Adulto , Anti-Inflamatórios/administração & dosagem , Anti-Inflamatórios/efeitos adversos , Ensaios Clínicos Fase III como Assunto , Método Duplo-Cego , Esquema de Medicação , Feminino , Humanos , Injeções Subcutâneas , Interleucina-1alfa/antagonistas & inibidores , Interleucina-1beta/antagonistas & inibidores , Masculino , Pericardite/diagnóstico , Pericardite/tratamento farmacológico , Pericardite/fisiopatologia , Pericardite/psicologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Proteínas Recombinantes de Fusão/administração & dosagem , Proteínas Recombinantes de Fusão/efeitos adversos
11.
J Cardiovasc Med (Hagerstown) ; 21(9): 625-629, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32658005

RESUMO

: The COVID-19 pandemic is challenging our cardiovascular care of patients with heart diseases. In the setting of pericardial diseases, there are two possible different scenarios to consider: the patient being treated for pericarditis who subsequently becomes infected with SARS-CoV-2, and the patient with COVID-19 who develops pericarditis or pericardial effusion. In both conditions, clinicians may be doubtful regarding the safety of nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroids, colchicine, and biological agents, such as anti-IL1 agents (e.g. anakinra), that are the mainstay of therapy for pericarditis.For NSAIDs, there is no clear scientific evidence linking ibuprofen and other NSAIDs to worsening of COVID-19; however, it seems prudent to continue them, if necessary to control pericarditis, and on the other hand, to prefer paracetamol for fever and systemic symptoms related to COVID-19. Treatments with corticosteroids, colchicine, and anakinra appear well tolerated in the context of COVID-19 infection and are currently actively evaluated as potential therapeutic options for COVID infection at different stages of the disease. On this basis, currently most treatments for pericarditis do not appear contraindicated also in the presence of possible COVID-19 infection and should not be discontinued, and some (corticosteroids, colchicine, and anakinra) can be considered to treat both conditions.


Assuntos
Colchicina/uso terapêutico , Infecções por Coronavirus , Glucocorticoides/uso terapêutico , Proteína Antagonista do Receptor de Interleucina 1/uso terapêutico , Pandemias , Pericardite , Pneumonia Viral , Anti-Inflamatórios/uso terapêutico , Betacoronavirus , Comorbidade , Infecções por Coronavirus/tratamento farmacológico , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/imunologia , Duração da Terapia , Humanos , Inflamação/tratamento farmacológico , Inflamação/imunologia , Pericardite/tratamento farmacológico , Pericardite/epidemiologia , Pericardite/imunologia , Pneumonia Viral/tratamento farmacológico , Pneumonia Viral/epidemiologia , Pneumonia Viral/imunologia , Receptores de Interleucina-1/antagonistas & inibidores
12.
Rev. cir. (Impr.) ; 72(3): 236-240, jun. 2020. ilus
Artigo em Espanhol | LILACS | ID: biblio-1115548

RESUMO

Resumen Introducción: La pericarditis es la enfermedad del pericardio más presente en la práctica médica. La pericarditis purulenta representa el 5% de ellas, con una mortalidad de hasta el 40%. Caso Clínico: Se presenta un paciente masculino, de 27 años de edad, con antecedentes de hipotiroidismo que ingresa con tos y expectoración amarillenta, asociado a fiebre, que resolvió con tratamiento antibiótico. Un mes después, reingresa con dolor abdominal, astenia y disnea intensa que no tolera el decúbito. Se indica ecocardiograma, que diagnostica derrame pericárdico severo, con colapso de cavidades derechas. Se procedió a pericardiocentesis de emergencia, donde se extrajeron 450 mililitros de líquido purulento. En el seguimiento ecocardiográfico a las 48 h, se observa aumento del derrame, por lo que se decide tratamiento quirúrgico, mediante toracotomía anterolateral izquierda, encontrando derrame purulento y engrosamiento pericárdico de 6 mm, con múltiples adherencias. Se indica pericardiectomía parcial. El paciente evolucionó favorablemente, egresándose 7 días posteriores a la cirugía.


Introduction: Pericarditis is frecuent pericardial disease in medical practice. The purulent pericarditis represents 5%, with a mortality of up to 40%. Case Report: We present a male patient, 27 years old, with a history of hypothyroidism that enters with cough and yellowish expectoration, associated with fever, resolved with antibiotic treatment. One month later, he reenters with abdominal pain, asthenia and intense dyspnea that does not tolerate decubitus. Echocardiogram diagnosed severe pericardial effusion, with collapse of right cavities. Emergency pericardiocentesis was performed and 450 milliliters of purulent fluid were extracted. In the echocardiographic follow-up at 48 hours, an increase in the effusion was observed, was decided surgical treatment by left anterolateral thoracotomy, finding purulent effusion and pericardial thickening of 6 mm, with multiple adhesions. Partial pericardiectomy is indicated. The patient evolved favorably, leaving 7 days after surgery.


Assuntos
Humanos , Masculino , Adulto , Pericardite/cirurgia , Pericardite/complicações , Pericardiectomia/métodos , Pericardiocentese/métodos , Pericardite/etiologia , Pericardite/tratamento farmacológico , Pericárdio/patologia , Prognóstico , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Antibacterianos/uso terapêutico
14.
Am J Cardiol ; 127: 184-190, 2020 07 15.
Artigo em Inglês | MEDLINE | ID: mdl-32416963

RESUMO

Nonsteroidal anti-inflammatory drugs and colchicine remain the standard of care as the initial treatment of acute pericarditis. Corticosteroids and traditional immunosuppressive medications are often added if patients develop recurrent symptoms and remain medically refractory. There has been growing interest in the use of interleukin-1 receptor antagonists (IL-1RAs) in managing pericarditis, especially, in medically refractory cases. Anakinra-Treatment for Recurrent Idiopathic Pericarditis is a recent pilot trial showing a benefit of using the IL-1RA, anakinra, in recurrent pericarditis. Publications remain limited and more outcomes trials are needed. This review focuses on the mechanism of action, clinical utility, current, and future studies that investigate the role of IL-1RAs in the management of recurrent pericarditis.


Assuntos
Proteína Antagonista do Receptor de Interleucina 1/uso terapêutico , Pericardite/tratamento farmacológico , Humanos , Pericardite/sangue , Recidiva , Resultado do Tratamento
17.
G Ital Cardiol (Rome) ; 21(3): 224-227, 2020 Mar.
Artigo em Italiano | MEDLINE | ID: mdl-32100735

RESUMO

We report a case of acute myocarditis associated with pericarditis in a patient hospitalized for urinary tract infection due to Escherichia coli. To the best of our knowledge, there are no prior descriptions of acute myocarditis associated with pericarditis during Escherichia coli infections in the absence of sepsis. In our patient, myocardial damage has been accurately documented by electrocardiography, echocardiography and magnetic resonance imaging. Inclusion of magnetic resonance imaging allows detection of myocardial inflammatory lesions that otherwise would have remained undiagnosed. The basic mechanisms of myocardial damage during Escherichia coli infection are unclear. Endotoxins might cause inflammatory reactions in the myocardium leading to myocyte damage. After initiation of antibiotic therapy, there was a rapid improvement of contractile function, with concomitant normalization of clinical and biochemical abnormalities. We discussed our findings in the context of the limited information available from the literature.


Assuntos
Infecções por Escherichia coli/complicações , Escherichia coli , Miocardite/etiologia , Pericardite/etiologia , Infecções Urinárias/microbiologia , Antibacterianos/uso terapêutico , Anti-Inflamatórios/uso terapêutico , Infecções por Escherichia coli/tratamento farmacológico , Humanos , Masculino , Pessoa de Meia-Idade , Miocardite/tratamento farmacológico , Pericardite/tratamento farmacológico , Resultado do Tratamento , Infecções Urinárias/tratamento farmacológico
18.
Adv Emerg Nurs J ; 42(1): 17-29, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32000187

RESUMO

Acute pericarditis is an inflammatory disorder that contributes to chest pain admissions in the emergency department (ED). Nursing professionals can play a vital role in the differential, triage and management of acute pericarditis in the ED. First-line pharmacotherapy to specifically treat acute pericarditis of viral or idiopathic origin is paramount in improving patients' quality of life and reducing the risk of further recurrences of pericarditis and consists of combination therapy with aspirin (acetylsalicylic acid [ASA]) or a nonsteroidal anti-inflammatory drug (NSAID), in combination with colchicine. Corticosteroids should not be initiated as first-line therapy in idiopathic (viral) pericarditis, as they increase the risk of recurrences. Nursing professionals are also pivotal in monitoring pharmacotherapy with respect to safety and efficacy. Overall, the nursing professional can facilitate timely administration and monitoring of medications, provide patient education, promote adherence, and assist in transitions of care for patients diagnosed with acute idiopathic (viral) pericarditis in the ED.


Assuntos
Serviço Hospitalar de Emergência/organização & administração , Recursos Humanos de Enfermagem no Hospital , Pericardite/tratamento farmacológico , Viroses/tratamento farmacológico , Doença Aguda , Corticosteroides/uso terapêutico , Anti-Inflamatórios não Esteroides/uso terapêutico , Aspirina/uso terapêutico , Dor no Peito/diagnóstico , Dor no Peito/etiologia , Diagnóstico Diferencial , Humanos , Pericardite/enfermagem , Pericardite/virologia , Triagem , Viroses/complicações , Viroses/enfermagem
20.
Ann Pharmacother ; 54(5): 486-495, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-31744311

RESUMO

Objective: To describe the various pharmacotherapeutic strategies in managing thyroid disease-induced pericarditis (TDIP). Considerations for both hypothyroid-induced and hyperthyroid-induced pericarditis will be discussed. Data Sources: A literature search of MEDLINE, including PubMed, was performed inclusive of all years, using the following search terms: thyroid disease, pericardial diseases, pericarditis, acute pericarditis, cholesterol pericarditis, hypothyroidism, hyperthyroidism, colchicine, corticosteroids, nonsteroidal anti-inflammatory drugs (NSAIDs), aspirin, methimazole, propylthiouracil, and P-glycoprotein. Product monographs were reviewed as well. Study Selection and Data Extraction: Relevant English-language studies and data as well as the most current guidelines for diagnosis and management of thyroid and pericardial diseases were considered. Because of limited data regarding the subject matter, no date range limits were established during literature search. Data Synthesis: It is well documented that thyroid dysfunction can adversely affect cardiovascular function. Additionally, there are published guidelines on the diagnosis and management of pericarditis and, separately, thyroid disease. There are limited data, however, on managing TDIP. The sequela of untreated TDIP can be detrimental. Relevance to Patient Care and Clinical Practice: Strategies on managing TDIP are scarcely reported in the literature. This review provides clinicians with a single reference source for treatment strategies toward managing hypothyroidism-induced and hyperthyroidism-induced pericarditis as well as significant drug interactions that can potentially confound the management of hypothyroidism- and hyperthyroidism-induced pericarditis. Conclusions: Treatment of TDIP involves addressing both the thyroid disease as well as the pericarditis. Along with treatment strategies, clinicians should also consider potential drug-drug and drug-disease interactions that can potentially worsen clinical outcomes.


Assuntos
Anti-Inflamatórios não Esteroides/uso terapêutico , Aspirina/uso terapêutico , Colchicina/uso terapêutico , Pericardite/tratamento farmacológico , Doenças da Glândula Tireoide/tratamento farmacológico , Corticosteroides/administração & dosagem , Corticosteroides/uso terapêutico , Anti-Inflamatórios não Esteroides/administração & dosagem , Aspirina/administração & dosagem , Colchicina/administração & dosagem , Interações Medicamentosas , Humanos , Hipertireoidismo/complicações , Hipertireoidismo/tratamento farmacológico , Hipotireoidismo/complicações , Hipotireoidismo/tratamento farmacológico , Pericardite/diagnóstico , Pericardite/etiologia , Doenças da Glândula Tireoide/complicações
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