RESUMEN
We present a case of a 30-year-old man with relapsing-remitting multiple sclerosis who developed psoriasiform dermatitis following his second course of ocrelizumab. This resolved with topical therapies and discontinuation of treatment. Cases of psoriasiform rashes have been increasingly reported in the use of ocrelizumab and are possibly due to B-cell (CD20) depletion and T-cell overregulation. Nevertheless, skin-related adverse reactions are not yet considered in the risk management plans of anti-CD20 treatments in multiple sclerosis.
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Anticuerpos Monoclonales Humanizados , Esclerosis Múltiple Recurrente-Remitente , Psoriasis , Humanos , Esclerosis Múltiple Recurrente-Remitente/tratamiento farmacológico , Anticuerpos Monoclonales Humanizados/efectos adversos , Masculino , Adulto , Psoriasis/tratamiento farmacológico , Psoriasis/inducido químicamente , Factores Inmunológicos/efectos adversos , Erupciones por Medicamentos/etiología , Erupciones por Medicamentos/patologíaRESUMEN
BACKGROUND: Hypertensive disorders of pregnancy are associated with chronic kidney disease. Early detection of renal dysfunction enables implementation of strategies to prevent progression. International guidelines recommend review at 6-8 weeks postpartum to identify persistent hypertension and abnormal renal function, but evidence for the efficacy of this review is limited. METHODS: All women attending a specialist fetal-maternal medicine clinic for hypertensive disorders of pregnancy (pre-eclampsia, chronic hypertension, gestational hypertension) were invited for a 6-8 weeks postpartum review of their blood pressure and renal function in order to establish the prevalence and independent predictors of renal dysfunction. Renal dysfunction was defined as low estimated Glomerular Filtration Rate (eGFR < 60 ml/min/1.73 m2) or proteinuria (24-h protein excretion > 150 mg or urinary albumin-to-creatinine ratio > 3 mg/mmol). All women attending a specialist clinic for hypertensive disorders were invited for a 6-8 weeks postpartum review of their blood pressure and renal function. Demographics, pregnancy and renal outcomes were prospectively collected. RESULTS: Between 2013 and 2019, 740 of 1050 (70.4%) women who had a pregnancy complicated by a hypertensive disorder attended their 6-8 weeks postpartum visit. Renal dysfunction was present in 32% of the total cohort and in 46% and 22% of women with and without pre-eclampsia, respectively. Multivariate logistic regression demonstrated that independent predictors were pre-eclampsia, chronic hypertension, highest measured antenatal serum creatinine, highest measured antenatal 24-h urinary protein, and blood pressure ≥ 140/90 mmHg at the postnatal visit. CONCLUSIONS: Renal dysfunction was present in one in three women with hypertensive disorders of pregnancy at 6-8 weeks postpartum. This includes women with gestational hypertension and chronic hypertension without superimposed pre-eclampsia, and thus these women should also be offered postnatal review.
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Hipertensión Inducida en el Embarazo , Hipertensión , Enfermedades Renales , Preeclampsia , Presión Sanguínea , Femenino , Humanos , Hipertensión/diagnóstico , Hipertensión/epidemiología , Hipertensión Inducida en el Embarazo/diagnóstico , Hipertensión Inducida en el Embarazo/epidemiología , Estudios Observacionales como Asunto , Preeclampsia/diagnóstico , Preeclampsia/epidemiología , Embarazo , Estudios ProspectivosRESUMEN
OBJECTIVES: To compare rates of severe hypertension (SH), preeclampsia (PE) birth of small for gestational age (SGA) neonates between women with chronic hypertension (CH) diagnosed during the first trimester of pregnancy and those with pre-pregnancy CH. STUDY DESIGN: Prospective cohort study of women with CH and singleton pregnancies referred to an Antenatal Hypertension Clinic at 8-14â¯weeks' gestation. At presentation the patients were subdivided into four groups based on blood pressure (BP) control. Group 1 included women without a preceding history of CH presenting with BP of ≥140/90â¯mmHg (nâ¯=â¯86). Groups 2-4 had pre-pregnancy CH; in group 2 the BP was <140/90â¯mmHg without antihypertensive medication (nâ¯=â¯200), in group 3 the BP was <140/90â¯mmHg with antihypertensive medication (nâ¯=â¯231) and in group 4 the BP was ≥140/90â¯mmHg despite antihypertensive medication (nâ¯=â¯173). MAIN OUTCOME MEASURES: PE, SH (BPâ¯≥â¯160/110â¯mmHg), SGA (birthweightâ¯<â¯10th percentile). RESULTS: In group 1, the rate of SH (15.1%), was similar to that in group 2 (10.5%) and group 3 (23.8%) but significantly lower than in group 4 (52.6%). In group 1, the rate of PE (12.8%) and SGA <10th centile (18.6%) were similar to those in group 2 (16.5% and 21.0%) and significantly lower than in group 3 (26.0 and 30.7%) and group 4 (26.6% and 31.8). CONCLUSION: In women diagnosed with CH in the first trimester of pregnancy, the rates of SH, PE and SGA are similar to those with pre-pregnancy CH who present with BP below 140/90 without the need for antihypertensive medication.
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Hipertensión/epidemiología , Recién Nacido Pequeño para la Edad Gestacional , Preeclampsia/epidemiología , Complicaciones Cardiovasculares del Embarazo/epidemiología , Adulto , Antihipertensivos/administración & dosificación , Femenino , Humanos , Recién Nacido , Embarazo , Estudios Prospectivos , Factores de Riesgo , Índice de Severidad de la EnfermedadRESUMEN
OBJECTIVE: The aim of this study was to validate the Omron HBP-1300 oscillometric blood pressure (BP) device according to the British Hypertension Society validation protocol, in pregnant women of both medium-arm and large-arm circumferences. PARTICIPANTS AND METHODS: BP was measured sequentially in 72 women of any gestation requiring the use of a large-size (N=36, arm circumference ≥33 cm) or medium-size cuff (N=36, arm circumference <33 cm) alternating between a mercury sphygmomanometer and the Omron HBP-1300 device. RESULTS: The Omron HBP-1300 is accurate in pregnancy with a mean device-observer difference of 3±6 and 1±6 mmHg for systolic BP and 2±5 and 3±6 mmHg for diastolic BP in women requiring the use of the medium and large cuff, respectively. CONCLUSION: The Omron HBP-1300-automated BP device can be recommended for use in pregnant women with medium-arm or large-arm circumferences.
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Determinación de la Presión Sanguínea , Hipertensión , Complicaciones del Embarazo , Esfigmomanometros , Adulto , Presión Sanguínea , Determinación de la Presión Sanguínea/instrumentación , Etnicidad , Femenino , Humanos , Hipertensión/diagnóstico , Masculino , Embarazo , Complicaciones del Embarazo/diagnósticoRESUMEN
OBJECTIVE: The Microlife WatchBP Home automated blood pressure device was assessed for accuracy in pregnant women of medium (<32 cm) and large (≥32 cm) arm circumference. MATERIALS AND METHODS: The British Hypertension Society validation protocol was modified for the purpose of this study to include women with arm circumference of less than 32 cm (N=51) and greater than or equal to 32 cm (N=46) as two separate arms. RESULTS: The device achieved an overall A/A grade for medium arm circumference and B/A grade for large arm circumference. The mean±SD device-observer difference was 1.7±6.2 and -0.4±4.4 for systolic and diastolic blood pressure, respectively, for medium arm circumference and 3.0±8.5 and 1.5±5.1, respectively, for large arm circumference. When all women with pre-eclampsia from both groups were pooled (N=23), the device achieved an overall grade of A/A with mean differences of 2.1±7.2 for systolic blood pressure and 1.0±5.6 for diastolic blood pressure. CONCLUSION: The Microlife WatchBP Home automated blood pressure device can be recommended for use in pregnant women of all gestations, including those with pre-eclampsia. However, caution is needed for women with large arm circumferences.
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Brazo , Monitoreo Ambulatorio de la Presión Arterial , Presión Sanguínea , Pesos y Medidas Corporales , Embarazo , Adulto , Monitoreo Ambulatorio de la Presión Arterial/instrumentación , Monitoreo Ambulatorio de la Presión Arterial/métodos , Femenino , Humanos , Persona de Mediana EdadRESUMEN
OBJECTIVES: To review the development of targeted therapies and the biology of relevant therapeutic targets. To analyze the relevance of targeted agents as part of current clinical practice. DATA SOURCES: Research articles. CONCLUSION: Several targeted agents are now available for clinical use. Their mechanisms of action are more specific against tumor cells than traditional cytotoxics. Monotherapy regimens based on targeted agents tend to be better tolerated than chemotherapy, and most combination regimens with targeted agents have proven feasible. Their availability has greatly expanded cancer treatment options, especially for chemorefractory patients. IMPLICATIONS FOR NURSING PRACTICE: Nurses involved in the care of patients with cancer can benefit from an increased understanding of targeted therapies, including their mechanisms of action, their efficacy profile, as well as prophylaxis and management of adverse events and administration procedures.