RESUMEN
Skin is usually the first and most affected organ involved in graft-versus-host disease (GvHD), and treatment is still a clinical challenge. Although the need for skin-directed treatments such as physical treatments and topical medications are generally agreed on, what the gold standard treatment strategy should be remains open to debate. The aim of this scoping review was to synthesize the current knowledge on the topical and physical treatments of cutaneous GvHD in haematopoietic stem cell transplantation patients and to highlight the best evidence available so as to reduce the gap between 'what is known' and 'what is done' in the clinical practice. Twenty-eight studies were included in this qualitative synthesis. Photo-biomodulation with psoralen was not included in this review. Phototherapy (ultraviolet A or B or narrowband B) was the physical treatment most described in the literature in both acute GvHD and chronic GvHD. Topical calcineurin inhibitors such as tacrolimus ointment and pimecrolimus cream as well as corticosteroid creams such as clobetasol and triamcinolone are mainly used in case of chronic GvHD. In all of the studies included in the review, topical treatments were always associated with systemic therapy. None of the topical interventions identified in our review provided strong evidence supporting its use, and the topical approaches seemed to have an adjuvant role in the treatment of cutaneous GvHD.
Asunto(s)
Enfermedad Injerto contra Huésped , Trasplante de Células Madre Hematopoyéticas , Enfermedades de la Piel , Inhibidores de la Calcineurina/uso terapéutico , Enfermedad Injerto contra Huésped/tratamiento farmacológico , Trasplante de Células Madre Hematopoyéticas/efectos adversos , Humanos , Fototerapia , Piel , Enfermedades de la Piel/tratamiento farmacológicoRESUMEN
Because of the methodologic differences and limited data, the sensitivity and specificity of the dexamethasone suppression test in children are in question. In our study we used 0.5 mg of dexamethasone and a 4 p.m. cortisol sample to perform the DST on 32 hospitalized prepubertal children diagnosed by a structured interview (DICA) and DSM-III criteria. Cortisols differed significantly by ANOVA among principal diagnoses, with highest values in children with major depression (MDE) or separation anxiety (SAD) and lowest in those with behavior disorders (BD). Using 5.0 micrograms/dl as a cutoff value for positive DST, MDE and SAD are positively and BD negatively associated with positive DST results. Rating scales for anxiety and depression showed no significant association with cortisol level. We conclude that the DST in this sample shows excellent sensitivity but its specificity is limited to distinguishing depressed or anxious children from those with pure behavior disorder.
Asunto(s)
Trastornos de Ansiedad/diagnóstico , Trastorno Depresivo/diagnóstico , Dexametasona , Hospitalización , Factores de Edad , Ansiedad de Separación/diagnóstico , Niño , Trastornos de la Conducta Infantil/diagnóstico , Diagnóstico Diferencial , Estudios de Evaluación como Asunto , Femenino , Humanos , Hidrocortisona/sangre , Masculino , Inventario de Personalidad , Escalas de Valoración PsiquiátricaRESUMEN
Reference is made to three cases in proposing an explanation for the shifting of endocavitary catheters, namely traction of the lead attached to the lower side of the stimulator owing to movement of the apparatus, resulting in displacement of the tip. It is pointed out that the intravasal length of the displaced catheter is markedly decreased in 3 out of 4 cases. Attention is therefore drawn to the importance of the relation between catheter and stimulator in causing a high percentage of the case of displacement observed.