RESUMEN
Immunosuppressive drugs commonly used in the treatment of psoriatic arthritis make patients more susceptible to viral, bacterial, and fungal infections because of their mechanism of action. They not only increase the risk of new infections but also act altering the natural course of preexisting infections. While numerous data regarding the reactivation of tuberculosis infection are available in the literature, poor information about the risk of reactivation or exacerbation of hepatitis viruses B and C infections during treatment with biologics has been reported. Furthermore, reported series with biological therapy included short periods of followup, and therefore, they are not adequate to verify the risk of reactivation in the long-term treatment. Our study evaluated patients with a history of hepatitis B and psoriatic arthritis treated with adalimumab and monitored up to six years. During the observation period, treatment was effective and well tolerated in all patients, and liver function tests and viral load levels remained unchanged.
Asunto(s)
Anticuerpos Monoclonales Humanizados/administración & dosificación , Artritis Psoriásica/tratamiento farmacológico , Anticuerpos contra la Hepatitis B/sangre , Anticuerpos contra la Hepatitis C/sangre , Factor de Necrosis Tumoral alfa/antagonistas & inhibidores , Adalimumab , Adulto , Anciano , Anticuerpos Monoclonales Humanizados/efectos adversos , Artritis Psoriásica/inmunología , Femenino , Humanos , Inmunosupresores/administración & dosificación , Inmunosupresores/efectos adversos , Pruebas de Función Hepática , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Factores de Tiempo , Carga Viral , Activación ViralRESUMEN
Summary Background Granulocyte/macrophage colony-stimulating factor (GM-CSF), a cytokine with pleiotropic functions, has been successfully employed in the treatment of chronic skin ulcers. The biological effects underlying GM-CSF action in impaired wound healing have been only partly clarified. Objectives To investigate the effects of GM-CSF treatment of chronic venous ulcers on lesion vascularization and on the local synthesis of the angiogenic factors vascular endothelial growth factor (VEGF) and placenta growth factor (PlGF). Methods Patients with nonhealing venous leg ulcers were treated with intradermal injection of recombinant human GM-CSF, and biopsies were taken at the ulcer margin before and 5 days after administration. Wound vascularization was analysed by immunohistochemistry using antiplatelet endothelial cell adhesion molecule-1/CD31 and anti-alpha-smooth muscle actin antibodies. VEGF and PlGF transcription was assessed by in situ hybridization. To identify the cell populations transcribing VEGF within the ulcer bed, the VEGF hybridization signal was correlated with the immunostaining for different cell type markers on serial sections. Direct induction of VEGF transcription by GM-CSF was investigated in GM-CSF-treated cultured macrophages and keratinocytes. Results Blood vessel density was significantly increased in the ulcer bed following GM-CSF treatment. VEGF transcripts were localized in keratinocytes at the ulcer margin both before and after GM-CSF treatment, whereas a VEGF hybridization signal was evident within the ulcer bed only following administration. PlGF mRNA was barely detectable in keratinocytes at the ulcer margin and was not visibly increased after treatment. Unlike VEGF, a specific PlGF hybridization signal could not be detected in cells within the ulcer following GM-CSF administration. Monocytes/macrophages were the main cell population transcribing VEGF after GM-CSF treatment. In vitro analysis demonstrated that VEGF transcription can be directly stimulated by GM-CSF in a differentiated monocytic cell line, but not in keratinocytes. Conclusions Our data show that increased vascularization is associated with GM-CSF treatment of chronic venous ulcers and indicate that inflammatory cell-derived VEGF may act as an angiogenic mediator of the healing effect of GM-CSF in chronic ulcers.
Asunto(s)
Factor Estimulante de Colonias de Granulocitos y Macrófagos/uso terapéutico , Neovascularización Fisiológica/efectos de los fármacos , Piel/irrigación sanguínea , Úlcera Varicosa/tratamiento farmacológico , Factor A de Crecimiento Endotelial Vascular/biosíntesis , Adulto , Anciano , Células Cultivadas , Femenino , Humanos , Hibridación in Situ , Queratinocitos/metabolismo , Masculino , Persona de Mediana Edad , Monocitos/efectos de los fármacos , Factor de Crecimiento Placentario , Proteínas Gestacionales/biosíntesis , Proteínas Gestacionales/genética , ARN Mensajero/genética , Proteínas Recombinantes , Piel/metabolismo , Regulación hacia Arriba/efectos de los fármacos , Úlcera Varicosa/metabolismo , Factor A de Crecimiento Endotelial Vascular/genética , Cicatrización de HeridasRESUMEN
Assessing both health and human problems of immigrant children, the authors wish them to be included in the social life with no discriminatory attitude, with the rights belonging to any man, in accordance with cultural and religious habits, customs and tradition.
Asunto(s)
Emigración e Inmigración , Estado de Salud , Problemas Sociales , Adolescente , Servicios de Salud del Adolescente/legislación & jurisprudencia , Niño , Servicios de Salud del Niño/legislación & jurisprudencia , Características Culturales , Demografía , Emigración e Inmigración/legislación & jurisprudencia , Emigración e Inmigración/estadística & datos numéricos , Femenino , Hospitalización/legislación & jurisprudencia , Humanos , Italia , Masculino , Problemas Sociales/legislación & jurisprudencia , Problemas Sociales/psicología , Problemas Sociales/estadística & datos numéricosRESUMEN
Through a careful examination of the up-to-date literature on the subject, the Authors provide a full account of the present knowledge about the physiopathology of the status asthmaticus; at the same time they draw a practical exhaustive guide to the treatment to be carried out in hospital. The work arises from the considerable increase of mortality rate, due to asthma, recorded in the last few years.
Asunto(s)
Estado Asmático , Adolescente , Corticoesteroides/uso terapéutico , Aminofilina/uso terapéutico , Broncodilatadores/uso terapéutico , Niño , Humanos , Ipratropio/uso terapéutico , Isoproterenol/uso terapéutico , Monitoreo Fisiológico , Terapia por Inhalación de Oxígeno , Estado Asmático/diagnóstico , Estado Asmático/terapia , Terbutalina/uso terapéutico , Teofilina/uso terapéuticoRESUMEN
Subcutaneous nodules of the rheumatic type can occur in patients without other evidence of rheumatic disease. Nodules are characterized by subcutaneous location with predilection for pretibial regions and scalp, occasional large size, spontaneous regression and frequent recurrence. Sometimes lesion biopsy may be usefull for confirmation of the clinical diagnosis; etiology is unknown, therapy is unnecessary. One asymptomatic child with benign rheumatoid nodules is described by the Authors.
Asunto(s)
Nódulo Reumatoide/diagnóstico , Factores de Edad , Biopsia , Preescolar , Femenino , Humanos , Pierna , Nódulo Reumatoide/diagnóstico por imagen , Nódulo Reumatoide/patología , UltrasonografíaRESUMEN
The role of etiology, pathogenesis and clinical symptoms in children with Atopic Dermatitis is evaluated. Eighteen patients with elimination diet were treated, without cow milk and egg, and with pharmacologic treatment (ketotiphene and cro molyn sodium) for two months. Dietary therapy and treatment however result in a large reduction in clinical symptoms in children affected with Atopic Dermatitis.
Asunto(s)
Dermatitis Atópica/tratamiento farmacológico , Animales , Cromolin Sódico/uso terapéutico , Dermatitis Atópica/dietoterapia , Dermatitis Atópica/etiología , Huevos/efectos adversos , Femenino , Humanos , Lactante , Cetotifen/uso terapéutico , Masculino , Leche/efectos adversosRESUMEN
Surveying and assessing chemical statistic data on the state of health of immigrant children in Rome, the authors wish a greater engagement of political administrative authorities. In this way children, whose families find integration in our society hard, could at least have an effective medical assistance.
Asunto(s)
Protección a la Infancia , Atención a la Salud/organización & administración , Emigración e Inmigración , Estado de Salud , Adolescente , Niño , Preescolar , Atención a la Salud/normas , Femenino , Servicios de Salud/estadística & datos numéricos , Humanos , Lactante , Recién Nacido , Italia , Masculino , Salud PúblicaRESUMEN
The Authors present relevant information concerning the activity carried on in 1992 in the Emergency Department of the Pediatric Hospital Bambino Gesù in Rome. Out of 34,328 cases arrived at the first aid station, only 21.17% of them needed an emergency service. This significant percentage suggests that the pediatric medical staff in service may be better employed for children who really need urgent care.
Asunto(s)
Servicios Médicos de Urgencia/estadística & datos numéricos , Hospitales Pediátricos/estadística & datos numéricos , Factores de Edad , Niño , Preescolar , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Ciudad de Roma , Estaciones del AñoRESUMEN
Our experience, as well as the latest literature in the field, stresses the importance of the clinical and neurological examinations in cases of minor head injury. This could avoid the performance of unnecessary imaging and EEG studies and the admittance of children who only need pharmacological therapy in order to relieve the neurotoxic effects of trauma at the axonal and cellular levels.