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1.
BMJ Case Rep ; 14(1)2021 Jan 28.
Artigo em Inglês | MEDLINE | ID: mdl-33509859

RESUMO

A high functioning 74-year-old man with systemic lupus erythematosus presented to the emergency department with acute anxiety. He was found to have elevated cardiac enzymes and admitted to the cardiology service for investigation. In hospital, he developed an erythematous papular rash, and deteriorated to being somnolent and bedridden. He was found to have new multiterritory ischaemic strokes. It was eventually noted that he had persistent eosinophilia, present even on admission, which had been overlooked as the total leucocyte count was normal. Serology for antiphospholipid antibody syndrome (APS) was positive. He was diagnosed with hypereosinophilic syndrome (HES) secondary to new APS, and responded to high-dose steroids. This case highlights the importance of fully evaluating a leucocyte differential to make a diagnosis of HES. We discuss the definition, clinical manifestations, diagnostic approach and management of this important condition.


Assuntos
Síndrome Antifosfolipídica/diagnóstico , Cardiomiopatias/diagnóstico , Síndrome Hipereosinofílica/diagnóstico , Diagnóstico Ausente , Idoso , Síndrome Antifosfolipídica/complicações , Síndrome Antifosfolipídica/tratamento farmacológico , Síndrome Antifosfolipídica/fisiopatologia , Cardiomiopatias/sangue , Cardiomiopatias/tratamento farmacológico , Cardiomiopatias/etiologia , Creatina Quinase/sangue , Estado Terminal , Exantema/etiologia , Glucocorticoides/uso terapêutico , Humanos , Síndrome Hipereosinofílica/tratamento farmacológico , Síndrome Hipereosinofílica/etiologia , Síndrome Hipereosinofílica/fisiopatologia , Imunossupressores/uso terapêutico , Contagem de Leucócitos , Lúpus Eritematoso Sistêmico/complicações , Imagem por Ressonância Magnética , Masculino , Paresia/etiologia , Sonolência , Tomografia Computadorizada por Raios X , Troponina/sangue
3.
Obstet Gynecol ; 136(4): 844-846, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32925632

RESUMO

: With the current issue, the journal continues to bring new insights from Cochrane Systematic Reviews to the readers of Obstetrics & Gynecology. This month, we focus on potential interventions to improve pregnancy outcomes for women with recurrent pregnancy loss and antiphospholipid antibodies, the utility of pelvic floor muscle training in the perinatal period to prevent incontinence, and the use of adhesion barriers in gynecologic surgery. The summaries are published below, and the complete references with hyperlinks are listed in Box 1. BOX 1. ABSTRACTS DISCUSSED IN THIS SUMMARY.


Assuntos
Aborto Espontâneo , Incontinência Fecal , Procedimentos Cirúrgicos em Ginecologia , Assistência Perinatal , Aderências Teciduais , Incontinência Urinária , Aborto Espontâneo/etiologia , Aborto Espontâneo/prevenção & controle , Síndrome Antifosfolipídica/complicações , Síndrome Antifosfolipídica/tratamento farmacológico , Incontinência Fecal/etiologia , Incontinência Fecal/prevenção & controle , Feminino , Fibrinolíticos/farmacologia , Procedimentos Cirúrgicos em Ginecologia/métodos , Procedimentos Cirúrgicos em Ginecologia/normas , Humanos , Debilidade Muscular/etiologia , Debilidade Muscular/reabilitação , Diafragma da Pelve/fisiopatologia , Assistência Perinatal/métodos , Assistência Perinatal/normas , Gravidez , Resultado da Gravidez , Melhoria de Qualidade , Revisões Sistemáticas como Assunto , Aderências Teciduais/etiologia , Aderências Teciduais/prevenção & controle , Incontinência Urinária/etiologia , Incontinência Urinária/prevenção & controle
6.
Sci Rep ; 10(1): 12221, 2020 07 22.
Artigo em Inglês | MEDLINE | ID: mdl-32699227

RESUMO

Functional tests for lupus anticoagulants (LA) as part of a thrombophilia workup are commonly performed in patients under anticoagulant therapy that may interfere with assay results. There is no consensus on how these tests should be assessed in patients on direct oral anticoagulants (DOACs). In this retrospective cohort study, we analysed data from patients with a history of thrombosis in whom dilute Russell viper venom time (dRVVT), LA-sensitive aPTT, and solid phase assays for antiphospholipid antibodies (aPL) were performed (n = 3,147, thereof 588 on rivaroxaban, 144 on apixaban, 1,179 on other anticoagulant drugs). The dRVVT ratio was correlated with rivaroxaban (r = 0.30, P < 10-4) but not with apixaban plasma levels. The LA-sensitive aPTT/aPTT ratio showed no correlation with DOAC levels. Correspondingly, the rate of patients with abnormal dRVVT test was significantly higher (P < 10-4) under rivaroxaban (88%) than in thrombosis patients without anticoagulant medication (6%), independent from their aPL plasma levels. No isolated positive results of functional LA testing in patients on anticoagulants could be confirmed in repeated testing after discontinuation of the medication (n = 40). These data indicate that rivaroxaban should be discontinued before functional LA testing is performed. However, viable interpretation of these tests appears to be less affected in patients on apixaban.


Assuntos
Anticoagulantes/uso terapêutico , Inibidor de Coagulação do Lúpus/uso terapêutico , Trombose/tratamento farmacológico , Administração Oral , Adulto , Anticorpos Antifosfolipídeos/uso terapêutico , Síndrome Antifosfolipídica/tratamento farmacológico , Coagulação Sanguínea/efeitos dos fármacos , Testes de Coagulação Sanguínea/métodos , Dabigatrana/uso terapêutico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Tempo de Tromboplastina Parcial/métodos , Tempo de Protrombina/métodos , Pirazóis/uso terapêutico , Piridonas/uso terapêutico , Estudos Retrospectivos , Rivaroxabana/uso terapêutico , Trombofilia/tratamento farmacológico
7.
Medicine (Baltimore) ; 99(26): e20811, 2020 Jun 26.
Artigo em Inglês | MEDLINE | ID: mdl-32590766

RESUMO

RATIONALE: Catastrophic antiphospholipid syndrome (CAPS) is a rare, life-threatening condition of antiphospholipid syndrome (APS). Treatment and management of CAPS remain challenging and the mortality rate is approximately 50% among cases. We describe a successfully treated case of a CAPS patient who had undergone massive bowel resection due to obstruction of superior mesenteric artery. PATIENT CONCERNS: A 40-year-old male patient was admitted to our hospital with acute abdominal pain, melena, and a history of deep vein thrombosis in both legs for over 10 years, there was no previous diagnosis of APS. DIAGNOSIS: The patient was diagnosed as CAPS with bowel necrosis due to obstruction of superior mesenteric artery based on the presence of antiphospholipid antibodies, computed tomography scan, and histopathological examination. INTERVENTIONS: Emergency surgery was performed to remove approximately 6 meters of the necrotic small intestine, of which the length of the remaining small intestine was 40 cm from the duodenum and 80 cm from the ileocaecal valve. Anticoagulants were prescribed with low molecular weight heparin. After discharging, APS was managed with direct oral anticoagulants (DOACs) for secondary thromboprophylaxis because the patient was unable to reach target International Normalized Ratio (INR) with vitamin K antagonists (VKAs). OUTCOMES: During 24 months of follow-up until now, the patient did not develop new thrombosis or relapse CAPS and his state remained stable. LESSONS: While VKAs is amongst the most important and fundamental treatment, physicians should be aware that VKAs are absorbed via the small intestine. For CAPS cases who had undergone massive bowel resection, DOACs is a reasonable alternative which has been found to be as safe and effective as VKAs in terms of thrombosis prevention.


Assuntos
Anticoagulantes/uso terapêutico , Síndrome Antifosfolipídica/tratamento farmacológico , Dor Abdominal/etiologia , Administração Oral , Adulto , Heparina de Baixo Peso Molecular/uso terapêutico , Humanos , Masculino , Melena/etiologia , Trombose/tratamento farmacológico , Trombose/prevenção & controle , Tomografia Computadorizada por Raios X/métodos
8.
Adv Rheumatol ; 60(1): 32, 2020 06 09.
Artigo em Inglês | MEDLINE | ID: mdl-32517786

RESUMO

Hydroxychloroquine and chloroquine, also known as antimalarial drugs, are widely used in the treatment of rheumatic diseases and have recently become the focus of attention because of the ongoing COVID-19 pandemic. Rheumatologists have been using antimalarials to manage patients with chronic immune-mediated inflammatory rheumatic diseases for decades. It is an appropriate time to review their immunomodulatory and anti-inflammatory mechanisms impact on disease activity and survival of systemic lupus erythematosus patient, including antiplatelet effect, metabolic and lipid benefits. We also discuss possible adverse effects, adding a practical and comprehensive approach to monitoring rheumatic patients during treatment with these drugs.


Assuntos
Antimaláricos/farmacologia , Artrite Reumatoide/tratamento farmacológico , Cloroquina/farmacologia , Hidroxicloroquina/farmacologia , Lúpus Eritematoso Sistêmico/tratamento farmacológico , Síndrome Antifosfolipídica/tratamento farmacológico , Síndrome Antifosfolipídica/imunologia , Antirreumáticos/uso terapêutico , Artrite Reumatoide/imunologia , Infecções por Coronavirus/tratamento farmacológico , Erupção por Droga/etiologia , Interações Medicamentosas , Feminino , Glucose/metabolismo , Cardiopatias/induzido quimicamente , Humanos , Lipídeos/sangue , Lúpus Eritematoso Cutâneo/tratamento farmacológico , Lúpus Eritematoso Cutâneo/imunologia , Lúpus Eritematoso Sistêmico/imunologia , Lúpus Eritematoso Sistêmico/mortalidade , Masculino , Pandemias , Agregação Plaquetária/efeitos dos fármacos , Pneumonia Viral/tratamento farmacológico , Gravidez , Insuficiência Renal/prevenção & controle , Doenças Retinianas/induzido quimicamente , Síndrome de Sjogren/tratamento farmacológico , Síndrome de Sjogren/imunologia
11.
Transl Res ; 225: 70-81, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32413497

RESUMO

Antiphospholipid syndrome is one of the more common acquired causes of hypercoagulability. Its major presentations are thrombotic (arterial, venous, or microvascular) and pregnancy morbidity (miscarriages, late intrauterine fetal demise, and severe pre-eclampsia). Classification criteria include 3 different antiphospholipid antibodies: lupus anticoagulant, anticardiolipin, and anti-beta 2 glycoprotein I. Management includes both preventive strategies (low-dose aspirin, hydroxychloroquine) and long-term anticoagulation after thrombosis.


Assuntos
Síndrome Antifosfolipídica/complicações , Anticorpos Antifosfolipídeos/análise , Anticoagulantes/uso terapêutico , Síndrome Antifosfolipídica/tratamento farmacológico , Síndrome Antifosfolipídica/imunologia , Humanos
13.
Rev Med Suisse ; 16(689): 670-674, 2020 Apr 08.
Artigo em Francês | MEDLINE | ID: mdl-32270932

RESUMO

The antiphospholipid syndrome (APS) is a complex autoimmune -disease characterized by the expression of antiphospholipid -antibodies (APL) and a variety of clinical presentation. The latest classification defines APS by the occurrence of vascular thrombosis and/or typical obstetrical morbidity together with persistently -detectable APL at least 12 weeks apart. The latest recommendation proposes a risk profile based on the type and titer of APL detected, in order to guide the intensity of prophylactic measures. Based on current knowledge, novel oral anticoagulants should not be used in APS, particularly in patients with a high-risk APL profile or arterial thrombosis. Beyond the mere aspect of anticoagulant treatment, immunomodulatory approaches to the APS such as hydroxychloroquine are under investigation.


Assuntos
Anticorpos Antifosfolipídeos/sangue , Síndrome Antifosfolipídica , Trombose , Adulto , Anticoagulantes/uso terapêutico , Síndrome Antifosfolipídica/sangue , Síndrome Antifosfolipídica/complicações , Síndrome Antifosfolipídica/tratamento farmacológico , Feminino , Humanos , Hidroxicloroquina/uso terapêutico , Conhecimento , Gravidez , Complicações na Gravidez/sangue , Complicações na Gravidez/tratamento farmacológico , Fatores de Risco , Trombose/sangue , Trombose/tratamento farmacológico , Trombose/etiologia
14.
Intern Med ; 59(11): 1457-1460, 2020 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-32161219

RESUMO

We herein report a 26-year-old woman with sudden cardiac arrest who had no remarkable medical history. While resuscitation was successfully performed with adrenalin administration and extracorporeal membrane oxygenation, the cause of cardiac arrest could not be determined for over two weeks. Given the presence of autoimmune disease along with the findings of refractory renal insufficiency and thrombocytopenia, a kidney biopsy and blood examinations, including lupus anticoagulant testing, were performed, which proved the presence of antiphospholipid syndrome. The patient was successfully treated with steroid pulse therapy. This drastic case scenario highlighted the fact that autoimmune disease can be the cause of sudden cardiac arrest.


Assuntos
Síndrome Antifosfolipídica/complicações , Síndrome Antifosfolipídica/tratamento farmacológico , Síndrome Antifosfolipídica/fisiopatologia , Morte Súbita Cardíaca/etiologia , Oxigenação por Membrana Extracorpórea/métodos , Pulsoterapia/métodos , Adulto , Feminino , Humanos , Resultado do Tratamento
15.
BMJ Case Rep ; 13(3)2020 Mar 17.
Artigo em Inglês | MEDLINE | ID: mdl-32188612

RESUMO

A 64-year-old man presented to the emergency department with generalised fatigue and dizzy spells. His background history includes a previous admission with right leg deep vein thrombosis, provoked by pneumonia. Laboratory results showed evidence of hyponatremia and hyperkalaemia. A synacthen test was performed that indicated hypoadrenalism. CT of his abdomen revealed enlarged adrenal glands bilaterally. Adrenal antibodies and positron emission tomography (PET) scan were performed to assess the cause of enlarged adrenals. PET scan showed no evidence of increased uptake. Adrenal antibodies were found to be negative. Tuberculous (TB) adrenalitis was the principle differential diagnosis. TB QuantiFERON was strongly positive. Following 9 months of TB treatment, surveillance CT scan indicated a significant reduction in adrenal gland size. However, subsequent events culminated in a retrospective review of CT scans questioning the initial clinical diagnosis and suggesting that the observed adrenal gland enlargement was secondary to bilateral adrenal infarction and haemorrhage. Equally, the subsequently observed marked reduction in adrenal gland size was not secondary to an assumed response to TB therapy, but rather the sequela of infracted atrophied adrenal glands, as a manifestation of the underlying antiphospholipid syndrome (APS). The case highlights the importance of recognising adrenal insufficiency in patients with a history of APS. It also illustrates the role of multidisciplinary meetings in the management of such complex cases.


Assuntos
Síndrome Antifosfolipídica/diagnóstico , Insuficiência Adrenal/diagnóstico , Síndrome Antifosfolipídica/sangue , Síndrome Antifosfolipídica/diagnóstico por imagem , Síndrome Antifosfolipídica/tratamento farmacológico , Tontura/etiologia , Fadiga/etiologia , Humanos , Hidrocortisona/uso terapêutico , Masculino , Pessoa de Meia-Idade , Tomografia por Emissão de Pósitrons , Tomografia Computadorizada por Raios X
16.
Rev. argent. coloproctología ; 31(1): 28-30, mar. 2020. ilus
Artigo em Espanhol | LILACS | ID: biblio-1102177

RESUMO

Introducción: El término ''síndrome antifosfolipídico'' (SAF) describe la asociación de los anticuerpos antifosfolipídicos (AAF) con un cuadro clínico de hipercoagulabilidad caracterizado por trombosis a repetición y abortos recurrentes. Objetivo: Presentar un caso de celulitis severa de periné en paciente con SAF y tratamiento con hidroxicloroquina. Caso clínico: Paciente de 39 años con embarazo de término con SAF tratado con hidroxicloroquina y anticoagulación que desarrolló una infección severa de partes blandas del periné que fue tratado con interrupción del embarazo, drenaje agresivo del periné y tratamiento antibiótico extenso con buena evolución. Conclusión: La asociación del tratamiento con hidroxicloroquina, embarazo y una complicación séptica es incierta. El tratamiento con inmunosupresión no es estándar y podría haber favorecido el mal pronóstico del cuadro clínico. (AU)


Objetive: To present a case of severe perineal cellulitis in a pregnant patient with Antiphospholipid syndrome treated wiht hidroxicloroquine. Case report: A 39 years old female pregnant patient with AFS treated with hidroxicloroquine and heparin developed severe perineal infection with systemic impairment. Final treatment included aggressive perineal drainage in multiple sessions, pregnancy delivered and systemic treatment with wide spectrum antibiotics and general measures. Discusion and Conclusion: Treatment with hidroxicloroquine, pregnancy and septic complication is infrequent. This approach is not standard and it could favored worst prognostic of the general syndrome. (AU)


Assuntos
Humanos , Feminino , Gravidez , Adulto , Complicações Infecciosas na Gravidez , Celulite (Flegmão)/cirurgia , Celulite (Flegmão)/tratamento farmacológico , Síndrome Antifosfolipídica/tratamento farmacológico , Gangrena de Fournier/cirurgia , Gangrena de Fournier/tratamento farmacológico , Períneo/cirurgia , Períneo/lesões , Clindamicina/uso terapêutico , Vancomicina/uso terapêutico , Meropeném/uso terapêutico , Hidroxicloroquina/efeitos adversos , Hidroxicloroquina/uso terapêutico , Antibacterianos/uso terapêutico
17.
Biochem Biophys Res Commun ; 525(2): 384-391, 2020 04 30.
Artigo em Inglês | MEDLINE | ID: mdl-32093890

RESUMO

BACKGROUND: RapaLink-1 is a third generation mammalian target of rapamycin (mTOR) inhibitor and displays superior inhibitory effect on mTOR complex 1 (mTORC1). mTOR pathway is known to block autophagy and inhibition of it can protect thrombosis-related diseases including atherosclerosis, antiphospholipid syndrome (APS) and stroke. The objective of this study was to investigate whether RapaLink-1 could exert anti-thrombotic effects on APS via improving autophagy. METHODS: BALB/c mice were injected with monoclonal anti-beta-2-GPI (ß2GPI) antibodies to induce APS in vivo, and anti-ß2GPI antibodies together with anticardiolipin (aCL) antibodies in mice serum were assessed. The aortas of mice were isolated, and oil red and haematoxylin and eosin (HE) staining were used for thrombus morphology. The levels of LC3B and CD68 were quantified. Human monocyte cell line THP-1 was stimulated with oxidized low-density lipoprotein (ox-LDL) and treated with RapaLink-1 in vitro. The cell viability, LDH activity, apoptosis rate and rate of fate-positive cells were detected. LC3 expression was quantified by immunofluorescence. Western blot was utilized to assess the protein expression of LC3-І, LC3-П, Beclin-1 and p62. RESULTS: The size of arterial thrombus plaque together with the level of anti-ß2GPI antibodies and aCL was reduced by RapaLink-1. Immunostaining protocols confirmed that the application of RapaLink-1 inhibited plaque initiation and progression while decreased the extent of macrophage infiltration and enhanced the autophagy process. In vitro cultured THP-1 macrophages exposed to ox-LDL study showed that RapaLink-1 prevented cell apoptosis and enhanced autophagy of macrophages, indicated by the increasing expression of autophagy-related protein and morphological character under electron microscopy. CONCLUSION: Our results revealed that Rapalink-1 has a potential to inhibit the formation of thrombus plaque in APS and these effects were dependent on facilitating cell autophagy both in vivo and in vitro.


Assuntos
Síndrome Antifosfolipídica/complicações , Síndrome Antifosfolipídica/tratamento farmacológico , Autofagia/efeitos dos fármacos , Inibidores de Proteínas Quinases/uso terapêutico , Sirolimo/análogos & derivados , Trombose/prevenção & controle , Animais , Síndrome Antifosfolipídica/metabolismo , Linhagem Celular , Humanos , Macrófagos/efeitos dos fármacos , Macrófagos/metabolismo , Masculino , Camundongos Endogâmicos BALB C , Sirolimo/uso terapêutico , Serina-Treonina Quinases TOR/antagonistas & inibidores , Serina-Treonina Quinases TOR/metabolismo , Trombose/metabolismo
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