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1.
J Ethnopharmacol ; 282: 114574, 2022 Jan 10.
Artigo em Inglês | MEDLINE | ID: mdl-34461187

RESUMO

ETHNOPHARMACOLOGICAL RELEVANCE: Gekko gecko is used as a traditional medicine for various diseases including respiratory disorders in northeast Asian countries, mainly Korea, Japan, and China. AIM OF THE STUDY: Allergic asthma is a chronic respiratory disease caused by an inappropriate immune response. Due to the recent spread of coronavirus disease 2019, interest in the treatment of pulmonary disorders has rapidly increased. In this study, we investigated the anti-asthmatic effects of G. gecko extract (GGE) using an established mouse model of ovalbumin-induced asthma. MATERIALS AND METHODS: To evaluate the anti-asthmatic effects of GGE, we evaluated histological changes and the responses of inflammatory mediators related to allergic airway inflammation. Furthermore, we investigated the regulatory effects of GGE on type 2 helper T (Th2) cell activation. RESULTS: Administration of GGE attenuated asthmatic phenotypes, including inflammatory cell infiltration, mucus production, and expression of Th2 cytokines. Furthermore, GGE treatment reduced Th2 cell activation and differentiation. CONCLUSIONS: These results indicate that GGE alleviates allergic airway inflammation by regulating Th2 cell activation and differentiation.


Assuntos
Antiasmáticos/uso terapêutico , Asma/tratamento farmacológico , Medicina Tradicional do Leste Asiático , Muco/metabolismo , Ovalbumina , Extratos Vegetais/uso terapêutico , Animais , Asma/induzido quimicamente , Asma/patologia , Líquido da Lavagem Broncoalveolar , COVID-19 , Citocinas/metabolismo , Feminino , Citometria de Fluxo , Imunoglobulina E/imunologia , Mediadores da Inflamação/metabolismo , Pulmão/patologia , Camundongos , Camundongos Endogâmicos BALB C , Pandemias , Células Th2/efeitos dos fármacos , Células Th2/imunologia , Triptaminas/farmacologia
2.
Anticancer Res ; 41(10): 5081-5087, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34593458

RESUMO

BACKGROUND: Pharmacological inhibition of osteoclast activity is an essential component of oncological therapy for patients with bone metastases. In rare cases, medication-related osteonecrosis of the jaws (MRONJ) is observed. MRONJ can cause bone defects not inferior to primary or metastatic jaw neoplasms. Oral examination of patients on osteoclast-inhibiting medication aims to identify risk factors at an early stage and to initiate therapy. The current focus on osteoclast-inhibiting drugs in the maxillofacial region is MRONJ. Effects of the substances other than MRONJ are rarely reported. CASE REPORT: The female patient with metastatic breast cancer had developed extensive osteolysis of the mandibular ramus at the time of initial diagnosis. The patient was treated with denosumab. Seven months later, a significant reduction in the mandibular osteolytic zone was recorded. However, known bone metastases from other sites had increased in size during multimodal therapy, and further metastases were recorded. CONCLUSION: Jaw metastasis can shrink under denosumab therapy.


Assuntos
Conservadores da Densidade Óssea/efeitos adversos , Neoplasias Ósseas/secundário , Neoplasias da Mama/tratamento farmacológico , Denosumab/efeitos adversos , Neoplasias Mandibulares/patologia , Adulto , Neoplasias Ósseas/induzido quimicamente , Neoplasias da Mama/patologia , Progressão da Doença , Feminino , Humanos , Neoplasias Mandibulares/induzido quimicamente , Prognóstico
3.
World J Gastroenterol ; 27(35): 5796-5802, 2021 Sep 21.
Artigo em Inglês | MEDLINE | ID: mdl-34629803

RESUMO

Drug-induced pancreatitis is a gastrointestinal adverse effect concerning about 2% of drugs. The majority of cases are mild to moderate but severe episodes can also occur, leading to hospitalization or even death. Unfortunately, the mechanisms of this adverse reaction are still not clear, hindering its prevention, and the majority of data available of this potentially life-threatening adverse effect are limited to case reports leading to a probable underestimation of this event. In particular, in this editorial, special attention is given to thiopurine-induced pancreatitis (TIP), an idiosyncratic adverse reaction affecting around 5% of inflammatory bowel disease (IBD) patients taking thiopurines as immunosuppressants, with a higher incidence in the pediatric population. Validated biomarkers are not available to assist clinicians in the prevention of TIP, also because of the inaccessibility of the pancreatic tissue, which limits the possibility to perform dedicated cellular and molecular studies. In this regard, induced pluripotent stem cells (iPSCs) and the exocrine pancreatic differentiated counterpart could be a great tool to investigate the cellular and molecular mechanisms underlying the development of this undesirable event. This particular type of stem cells is obtained by reprogramming adult cells, including fibroblasts and leukocytes, with a set of transcription factors known as the Yamanaka's factors. Maintaining unaltered the donors' genetic heritage, iPSCs represent an innovative model to study the mechanisms of adverse drug reactions in individual patients' tissues not easily obtainable from human probands. Indeed, iPSCs can differentiate under adequate stimuli into almost any somatic lineage, opening a new world of opportunities for researchers. Several works are already available in the literature studying liver, central nervous system and cardiac cells derived from iPSCs and adverse drug effects. However, to our knowledge no studies have been performed on exocrine pancreas differentiated from iPSCs and drug-induced pancreatitis, so far. Hence, in this editorial we focus specifically on the description of the study of the mechanisms of TIP by using IBD patient-specific iPSCs and exocrine pancreatic differentiated cells as innovative in vitro models.


Assuntos
Células-Tronco Pluripotentes Induzidas , Pancreatite , Preparações Farmacêuticas , Diferenciação Celular , Criança , Humanos , Pâncreas , Pancreatite/induzido quimicamente
5.
BMJ Case Rep ; 14(10)2021 Oct 08.
Artigo em Inglês | MEDLINE | ID: mdl-34625443

RESUMO

A 50-year-old Indian woman presented with acute dysphasia, left upper limb numbness and thrombocytopenia 12 days after receiving the ChAdOx1 nCoV-19 vaccine (AstraZeneca/Vaxzevria). MRI of the brain was unremarkable. Microangiopathic haemolytic anaemia with thrombocytopenia was noted on her peripheral blood film. A diagnosis of thrombotic thrombocytopenic purpura (TTP) was confirmed through the findings of absent ADAMTS13 (a disintegrin and metalloproteinase with a thrombospondin type 1 motif, member 13) activity and markedly raised titre of ADAMTS13 autoantibodies. Prompt treatment with plasma exchange, adjunctive steroids and rituximab was commenced. A remission of TTP was achieved and she was discharged 3 weeks after admission. While other immune-mediated conditions have been documented after receipt of the vaccine, this report highlights the first case of immune-mediated TTP diagnosed after administration of the ChAdOx1 nCoV-19 vaccine.


Assuntos
Púrpura Trombocitopênica Trombótica , Vacinas , Vacinas contra COVID-19 , Feminino , Humanos , Pessoa de Meia-Idade , Troca Plasmática , Púrpura Trombocitopênica Trombótica/induzido quimicamente , Púrpura Trombocitopênica Trombótica/diagnóstico , Púrpura Trombocitopênica Trombótica/tratamento farmacológico , Rituximab/efeitos adversos
6.
Acta Med Indones ; 53(3): 308-314, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34611070

RESUMO

COVID-19 became a widespread infectious disease in late 2019. Indonesia currently has the highest COVID-19 mortality rate in Asia, between 4-5 percent. Interestingly, COVID-19-associated coagulopathy characterized by an increase of several procoagulant factor levels, including fibrinogen and D-dimer, that has been associated with higher mortality and unfavorable outcomes. We report a case of a 30-year-old male admitted to the hospital with a profuse vomiting and worsening fever, cough and shortness of breath, and was diagnosed with COVID-19-associated coagulopathy. Seven days after admission, he became deteriorated with significant reduction of oxygen saturation and his coagulation parameter levels were increased with highly suspicion of pulmonary embolism. He was treated with azithromycin, isoprinosine, lopinavir, and fondaparinux with thromboprophylaxis dosage since admission. The role of increased fondaparinux dosage at the time of clinical deterioration was then followed by clinical improvement and reduced D-dimer level. Anticoagulant therapy, mainly with fondaparinux, showed a better prognosis in patients with markedly elevated D-Dimer. Fondaparinux needs to be monitored appropriately to prevent bleeding and adverse. The patient was discharged from the hospital in an improved condition and normal D-Dimer levels. There was no bleeding event nor other major side effects had been found in this case. The decision for increasing dose of anticoagulant may be determined on individual basis, considering risks, benefits, and also the most important is clinical findings.


Assuntos
COVID-19 , Fondaparinux , Hemorragia/prevenção & controle , Embolia Pulmonar , SARS-CoV-2/isolamento & purificação , Trombofilia , Adulto , Antivirais , Azitromicina/administração & dosagem , COVID-19/sangue , COVID-19/diagnóstico , COVID-19/tratamento farmacológico , COVID-19/fisiopatologia , Deterioração Clínica , Relação Dose-Resposta a Droga , Monitoramento de Medicamentos/métodos , Inibidores do Fator Xa/administração & dosagem , Inibidores do Fator Xa/efeitos adversos , Produtos de Degradação da Fibrina e do Fibrinogênio/análise , Fondaparinux/administração & dosagem , Fondaparinux/efeitos adversos , Hemorragia/induzido quimicamente , Humanos , Inosina Pranobex/administração & dosagem , Lopinavir/administração & dosagem , Masculino , Embolia Pulmonar/diagnóstico , Embolia Pulmonar/tratamento farmacológico , Embolia Pulmonar/etiologia , Trombofilia/complicações , Trombofilia/diagnóstico , Trombofilia/tratamento farmacológico , Trombofilia/etiologia , Resultado do Tratamento
7.
Acta Med Indones ; 53(3): 326-330, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34611073

RESUMO

SARS CoV-2 virus has infected more than 200 million people worldwide and more than 4.4 million in Indonesia. The vaccination program has become one of the solutions launched by many countries globally, including Indonesia, to reduce the transmission rate of COVID-19. Various vaccination platforms are produced, such as inactivated, viral vector, mRNA, and protein subunit. The vaccination booster program with mRNA platform (Moderna) was launched by the Indonesian government to give better protection for health care workers, particularly from delta variant. In this case report, we discuss one of the typical side effects of Moderna vaccine, which is referred to as the COVID arm.


Assuntos
Acetaminofen/administração & dosagem , Vacinas contra COVID-19 , COVID-19/prevenção & controle , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos , Hipersensibilidade Tardia , Pele/patologia , Analgésicos não Narcóticos/administração & dosagem , Biópsia/métodos , COVID-19/epidemiologia , Vacinas contra COVID-19/administração & dosagem , Vacinas contra COVID-19/efeitos adversos , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/etiologia , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/fisiopatologia , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/terapia , Feminino , Febre/tratamento farmacológico , Febre/etiologia , Humanos , Hipersensibilidade Tardia/induzido quimicamente , Hipersensibilidade Tardia/fisiopatologia , Hipersensibilidade Tardia/terapia , Reação no Local da Injeção/diagnóstico , Reação no Local da Injeção/etiologia , Reação no Local da Injeção/fisiopatologia , Pessoa de Meia-Idade , Médicos , SARS-CoV-2 , Resultado do Tratamento , Vacinação/métodos
8.
Ann Saudi Med ; 41(5): 285-292, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34618606

RESUMO

BACKGROUND: Adalimumab is a fully humanized monoclonal antibody inhibitor of tumor necrosis factor-a used to treat various autoimmune disorders. Adalimumab poses a risk for tuberculosis (TB) infection, especially in countries where TB is endemic. OBJECTIVE: Determine the rate of TB infection after adalimumab therapy in Saudi Arabia. DESIGN: Medical record review. SETTINGS: Tertiary care center in Riyadh. PATIENTS AND METHODS: Demographic and clinical data were retrieved from the electronic healthcare records of all patients who received adalimumab treatment from 2015 to 2019. MAIN OUTCOME MEASURES: Occurrence of TB after adalimumab therapy. SAMPLE SIZE: 410 patients (median ([QR] age, 37 [28], range 4-81 years), 40% males RESULTS: Rheumatoid arthritis was the most frequent indication (n=153, 37%). The patients were followed for a mean of 36 (8.9) months. No case of TB infection or reactivation was observed. An inter-feron-gamma release assay (IGRA) was requested in 353/391 (90.3%) patients, prior to initiating therapy. The IGRA was positive in 26 cases (6.6%). The IGRA-positive patients received isoniazid prophylactically. Bacterial infectious complications of adalimumab therapy occurred in 12 (2.9%) patients. Urinary tract infection was the most frequent complication (culture requested in 48 patients, positive in 8). CONCLUSION: Adalimumab treatment was not associated with a risk of TB disease or TB reactivation in our cohort over the follow-up observation period. No TB reactivation occurred with adalimumab therapy when TB prophylaxis was used. The positive IGRA rate in patients on adalimumab treatment was low (7%). LIMITATIONS: Single center and one geographical area in Saudi Arabia. CONFLICT OF INTEREST: None.


Assuntos
Artrite Reumatoide , Tuberculose Latente , Tuberculose , Adalimumab/efeitos adversos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Artrite Reumatoide/tratamento farmacológico , Artrite Reumatoide/epidemiologia , Criança , Pré-Escolar , Feminino , Humanos , Tuberculose Latente/induzido quimicamente , Tuberculose Latente/diagnóstico , Tuberculose Latente/epidemiologia , Masculino , Pessoa de Meia-Idade , Tuberculose/epidemiologia , Fator de Necrose Tumoral alfa , Adulto Jovem
9.
Zhonghua Yan Ke Za Zhi ; 57(10): 734-742, 2021 Oct 11.
Artigo em Chinês | MEDLINE | ID: mdl-34619943

RESUMO

Ocular local or systemic medication may cause drug-related dry eye, which has become one of the important types of dry eye. A missed diagnosis or misdiagnosis of this type of dry eye is easy to occur clinically. To arouse the attention of ophthalmologists, experts from the Chinese Branch of the Asian Dry Eye Society and other related academic organizations have combined the new research progress and clinical practice associated with this specific disease, in terms of its definition, classification, risk factors, related drug types, pathogenesis, diagnosis, differential diagnosis, treatment principles and preventive measures, to form expert consensus opinions, hoping to promote the standardized diagnosis and treatment of drug-related dry eye in China. (Chin J Ophthalmol, 2021, 57: 734-742).


Assuntos
Síndromes do Olho Seco , Preparações Farmacêuticas , China , Consenso , Síndromes do Olho Seco/induzido quimicamente , Síndromes do Olho Seco/diagnóstico , Síndromes do Olho Seco/tratamento farmacológico , Olho , Humanos
10.
J Med Case Rep ; 15(1): 493, 2021 Oct 08.
Artigo em Inglês | MEDLINE | ID: mdl-34620244

RESUMO

BACKGROUND: Minoxidil hair formulation is commonly used for the treatment of male or female androgenic alopecia. This over-the-counter product is considered safe, but should be used with caution. Ocular side effects following topical minoxidil use are rarely reported. In this paper, we report a rare case of inferior hemiretinal artery occlusion possibly caused by topical 5% minoxidil treatment. CASE DESCRIPTION: A 21-year-old Asian Indian male presented to the retina clinic with sudden onset blurring of vision and superior visual field loss in the right eye since morning. He was diagnosed with androgenic alopecia and was on treatment with topical 5% minoxidil spray twice a day for the last 3 years. On examination, his corrected distance visual acuity was 6/6, N6 in both eyes. Anterior segment examination and intraocular pressure in both eyes and left eye fundus were within normal limits. Right eye fundus examination showed features suggestive of inferior hemiretinal artery occlusion, which were confirmed on fluorescein angiography and optical coherence tomography. A detailed systemic evaluation and investigations (blood pressure, random blood sugar, hematological and coagulation profile, serum homocysteine level, Mantoux test, chest x-ray, cardiac two-dimensional echography, thyroid function test, and immunological profile) did not detect any abnormalities. The ocular condition and its visual prognosis were explained to the patient, and he was asked to review after 4 weeks. CONCLUSION: Though there is no definite cause-outcome relationship between topical minoxidil use and retinal artery occlusion development, this possibility should be kept in mind when observing retinal vascular occlusion cases with concurrent use of topical minoxidil.


Assuntos
Minoxidil , Oclusão da Artéria Retiniana , Adulto , Feminino , Angiofluoresceinografia , Humanos , Masculino , Minoxidil/efeitos adversos , Oclusão da Artéria Retiniana/induzido quimicamente , Oclusão da Artéria Retiniana/diagnóstico , Tomografia de Coerência Óptica , Acuidade Visual , Adulto Jovem
11.
BMC Gastroenterol ; 21(1): 361, 2021 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-34600483

RESUMO

BACKGROUND: Ixekizumab is monoclonal antibody targeted against interleukin-17 (IL-17) and has been approved for use in chronic plaque psoriasis. Despite its efficacy in treating psoriasis, concerns have been raised regarding Ixekizumab's potential to induce and exacerbate inflammatory bowel disease (IBD). CASE PRESENTATION: Here we report the new onset of severe drug-associated colitis with surgical complications in a 45-year-old male patient who was receiving Ixekizumab therapy for chronic plaque psoriasis. Review of the patient's colonic pathology demonstrated acute inflammatory changes with features of Crohn's disease. The patient remained disease-free 9-months following his hospitalization and cessation of Ixekizumab. CONCLUSIONS: This case raises suspicion for an association between Ixekizumab and IBD and calls on clinicians to have heightened awareness of potential risks before prescribing anti-IL-17 agents.


Assuntos
Colite , Doença de Crohn , Fármacos Dermatológicos , Preparações Farmacêuticas , Psoríase , Anticorpos Monoclonais Humanizados , Colite/induzido quimicamente , Colite/tratamento farmacológico , Doença de Crohn/tratamento farmacológico , Fármacos Dermatológicos/uso terapêutico , Humanos , Masculino , Pessoa de Meia-Idade , Psoríase/induzido quimicamente , Psoríase/tratamento farmacológico , Índice de Gravidade de Doença , Resultado do Tratamento
12.
J Int Med Res ; 49(10): 3000605211047761, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34605302

RESUMO

Olanzapine is a widely adopted atypical antipsychotic medication used to manage schizophrenia. Reports show that the incidence rate of adverse reactions to olanzapine is significantly lower than those of other classic antipsychotic medications. However, olanzapine overdose may be associated with severe consequences. Herein, we report a 21-year-old female patient who had taken nearly 700 mg (70 tablets) of olanzapine; she was found after 30 hours. As her condition progressed, she presented with rhabdomyolysis, swelling in the thighs and hips, paralytic ileus, digestive tract hemorrhage, and elevated serum amylase and lipase levels; notably, she recovered after treatment. This intractable case is of great clinical significance and suggests that early-phase hemoperfusion plays a critical role in olanzapine poisoning-related rhabdomyolysis.


Assuntos
Antipsicóticos , Rabdomiólise , Adulto , Antipsicóticos/efeitos adversos , Benzodiazepinas , Feminino , Humanos , Músculos , Olanzapina/uso terapêutico , Rabdomiólise/induzido quimicamente , Adulto Jovem
13.
Sr Care Pharm ; 36(10): 477-488, 2021 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-34593089

RESUMO

Delirium is a syndrome that can arise from many causes or underlying conditions, and though it has been reported in younger patients, it is more prevalent in older people, though it can occur in other age groups as well. Identifying delirium is challenging in older people because of the coexistence of underlying dementia or depression, which may further complicate the presentation. Drug-induced delirium is one of the major causes of delirium, and evaluation of this potential cause or contribution is an important component of the evaluation process, since it can lead to poor patient outcomes. This article will review the epidemiology, pathophysiology, evaluation, diagnostic process, and causes of delirium in older people, with a focus on the pharmacological causes.


Assuntos
Delírio , Idoso , Delírio/induzido quimicamente , Delírio/diagnóstico , Delírio/epidemiologia , Humanos
14.
Sr Care Pharm ; 36(10): 493-500, 2021 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-34593091

RESUMO

Drug-induced dystonias are rare but can occur with second-generation antipsychotics. They are usually dose-related and occur soon after dose initiation. This case describes the development of dystonia after two years of olanzapine 5 mg daily in an older person with Alzheimer's dementia. The dystonia resolved after diphenhydramine treatment on day two of hospitalization, but then the patient became delirious, which was treated with lorazepam on day three. Six days after admission, she developed tremors and rigidity that self-resolved. Her dystonia resolved after 11 days. The recurrence of symptoms during the hospitalization may have been a result of the progression of her dementia. This is the first known case of a patient developing dystonia after chronic use of low-dose olanzapine. This was not characterized as tardive dystonia because the dystonia was resolved with anticholinergic medication. This case illustrates the difficulty of using anticholinergics to treat dystonias in older people, which can precipitate delirium. Choosing an alternative antipsychotic with less extrapyramidal symptom risk is challenging as she had previous trials with quetiapine and risperidone. Clozapine was deemed an unfavorable alternative, as laboratory monitoring would be burdensome. Olanzapine-induced dystonias can develop anytime during therapy. Families must balance the desire for mood stabilization with antipsychotics side effects.


Assuntos
Antipsicóticos , Distonia , Idoso , Antipsicóticos/efeitos adversos , Benzodiazepinas/efeitos adversos , Distonia/induzido quimicamente , Feminino , Humanos , Olanzapina/efeitos adversos , Risperidona
15.
J Wound Care ; 30(Sup9a): IIi-IIv, 2021 Sep 02.
Artigo em Inglês | MEDLINE | ID: mdl-34597170

RESUMO

OBJECTIVE: Local anaesthetics are often used in plastic surgery practice. Through their mechanism of action, local anaesthetics produce a sympathetic blockage with a subsequent vasodilatation and a resulting local increase of perfusion. The effect of vasodilation of the local anaesthetics causes bleeding locally resulting in haematoma, bruising and/or pain. We present an experimental study of the effects of local anaesthetics on delayed bleeding. METHOD: In this animal study, 36 adult male Wistar rats were divided into four groups of nine animals: lidocaine; lidocaine and epinephrine; bupivacaine; and control. An epigastric flap model was harvested. Local anaesthetics that are frequently used in daily practice were administered in equal amounts to the harvested flap. RESULTS: After 24 hours, the rats were euthanised to collect and measure all coagula under the epigastric flap. No statistically significant differences in relation to the amount of coagulum were found between the groups. CONCLUSION: Our results suggest that proper haemostasis is achieved, there is no difference on the effect of delayed bleeding between the local anaesthetics which are often used.


Assuntos
Anestésicos Locais , Procedimentos Cirúrgicos Reconstrutivos , Anestésicos Locais/toxicidade , Animais , Hemorragia/induzido quimicamente , Masculino , Ratos , Ratos Wistar , Retalhos Cirúrgicos
16.
Acta Gastroenterol Belg ; 84(3): 497-499, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34599575

RESUMO

Pneumatosis Intestinalis (PI) is a rare radiological finding defined as the presence of extra-luminal gas within the intestinal wall. Several anti-tumor drugs can induce a damage of the gastrointestinal walls as an adverse effect, causing loss of mucosal integrity and endoluminal gas diffusion, responsible for PI development. We retrospectively analyzed 8 cases of PI detected through radiological imaging in oncologic patients undergoing various therapeutic regimens: five patients were receiving chemotherapy, two molecular targeted therapy (MTT) and one immunotherapy. Three patients were asymptomatic and pneumatosis was incidentally detected at routinary follow-up CT and then treated conservatively. Five patients presented acute abdomen symptoms and in these cases bowel perforation was the cause of death. Our experience confirms PI and perforation as rare complications of drug toxicity, especially in oncologic patients treated with combinations of different anticancer drugs and documented the second reported case of PI associated with atezolizumab and alectinib single administration.


Assuntos
Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos , Perfuração Intestinal , Pneumatose Cistoide Intestinal , Humanos , Perfuração Intestinal/induzido quimicamente , Perfuração Intestinal/diagnóstico por imagem , Pneumatose Cistoide Intestinal/induzido quimicamente , Pneumatose Cistoide Intestinal/diagnóstico por imagem , Estudos Retrospectivos , Perfuração Espontânea
17.
Acta Gastroenterol Belg ; 84(3): 505-508, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34599577

RESUMO

Hepatocellular adenoma (HCA) is an uncommon benign liver neoplasm usually solitary and identified incidentally on imaging. We report a case of a 50-year old female who was diagnosed with multiple hepatic adenomas of the inflammatory subtype. After discontinuation of oral contraception a decrease of both the number and size of the liver lesions was seen on magnetic resonance imaging (MRI) without the need of further intervention. The major challenge in the clinical management of patients with multiple HCAs resides in the risk assessment for future complications. In the case of multiple HCAs subtype seemed to be more relevant than the actual number of lesions. Because little is known about the natural evolution in patients with multiple HCAs, we performed a review of the current literature with focus on the different subtypes and their clinical relevance.


Assuntos
Adenoma de Células Hepáticas , Carcinoma Hepatocelular , Neoplasias Hepáticas , Adenoma de Células Hepáticas/induzido quimicamente , Anticoncepção , Anticoncepcionais Orais/efeitos adversos , Feminino , Humanos , Imageamento por Ressonância Magnética , Pessoa de Meia-Idade
18.
Medicina (B Aires) ; 81(5): 837-839, 2021.
Artigo em Espanhol | MEDLINE | ID: mdl-34633958

RESUMO

Ticagrelor is anantiplatelet agent which acts through reversible binding to the P2Y12 adenosine-diphosphate receptors. In acute coronary syndromes it has been shown to reduce the risk of major cardiovascular events such as myocardial infarction, stroke and death. Although some hemorrhagic, kidney, liver and respiratory complications have been described in detail with the use of ticagrelor, other less frequent adverse effects are not so well clarified. We report the case of a patient with a systemic inflammatory response syndrome secondary to the use of ticagrelor.


Assuntos
Síndrome Coronariana Aguda , Infarto do Miocárdio , Síndrome Coronariana Aguda/induzido quimicamente , Síndrome Coronariana Aguda/tratamento farmacológico , Adenosina/efeitos adversos , Humanos , Síndrome de Resposta Inflamatória Sistêmica/induzido quimicamente , Ticagrelor/efeitos adversos
19.
Medicina (B Aires) ; 81(5): 840-842, 2021.
Artigo em Espanhol | MEDLINE | ID: mdl-34633959

RESUMO

We describe the case of a 27-year-old female patient who presented to the emergency ward with hypoesthesia and paresthesia developing over the last two months, initially in both feet and progressing to the knees in a few days without associated gait disorders. Dystonia in the thumb and index finger of both hands was noted. Blood tests including toxic drugs were negative. The spinal magnetic resonance imaging was consistent with (C3-C5) myelopathy or myelitis without other abnormalities suggestive of systemic diseases. The biochemical and bacteriological analysis of the cerebrospinal fluid was normal. Because of these findings, the patient was re-interviewed to determine the consumption of unusual drugs, and nitrous oxide consumption was referred. The patient was admitted for further studies, which confirmed the diagnosis.


Assuntos
Óxido Nitroso , Doenças da Medula Espinal , Adulto , Feminino , Humanos , Imageamento por Ressonância Magnética , Óxido Nitroso/efeitos adversos , Doenças da Medula Espinal/induzido quimicamente , Doenças da Medula Espinal/diagnóstico por imagem
20.
Medicina (B Aires) ; 81(5): 846-849, 2021.
Artigo em Espanhol | MEDLINE | ID: mdl-34633961

RESUMO

Adrenal crisis is the most extreme presentation form of adrenal insufficiency and represents a life-threatening endocrinological emergency. This situation can be triggered by different causes including the use of CYP3A4-inducing drugs, which accelerate hydrocortisone clearance. We describe the case of an 85-year-old woman with secondary adrenal insufficiency and chronic renal disease, who presented symptoms compatible with adrenal crisis (asthenia, adynamia, severe hyponatremia associated with neurological symptoms and hypotension) nine days after the start of modafinil treatment. The clinical picture improved rapidly with the suspension of modafinil and the administration of intravenous hydrocortisone. After ruling out the possible triggering causes (infectious, ischemic, pulmonary thromboembolism and failure to take hydrocortisone), it was interpreted that modafinil precipitated the symptoms of adrenal insufficiency by increasing the steroid clearance. Modafinil has the ability to induce the activity of CYP3A4 and consequently decrease the bioavailability of hydrocortisone. We emphasize the need to adjust steroid dose replacement in subjects receiving metabolism-inducing drugs.


Assuntos
Insuficiência Adrenal , Doença Aguda , Insuficiência Adrenal/induzido quimicamente , Idoso de 80 Anos ou mais , Feminino , Glucocorticoides/efeitos adversos , Humanos , Hidrocortisona/efeitos adversos , Modafinila/efeitos adversos
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