RESUMEN
Importance: Describing the association with human leukocyte antigen (HLA) alleles could facilitate the understanding of increased risk factors for development of Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) in patients with severe ocular complications (SOCs). Objective: To investigate the association between HLA class I genes and cold medicine (CM)-associated SJS/TEN with SOCs. Design, Setting, and Participants: This case-control study was conducted between February 8, 2013, and August 29, 2014. Thirty-nine Brazilian patients with CM-SJS/TEN of 74 patients with SJS/TEN with SOCs and 133 healthy Brazilian volunteers were enrolled. Human leukocyte antigen class I genes (HLA-A, HLA-B, and HLA-C) were examined to determine whether there was a genetic predisposition for CM-SJS/TEN with SOC. Patients were interviewed to identify possible etiologic factors. Data analysis was performed from April 14, 2013, to August 29, 2014. Main Outcomes and Measures: Genetic predisposition for CM-SJS/TEN with SOCs by analysis of HLA class I genes. Results: Of 74 patients included in the analysis, 32 (43%) were male; mean (SD) age was 36.01 [15.42] years. HLA-A*66:01 (odds ratio [OR], 24.0; 95% CI, 2.79-206.0; P < .001), HLA-B*44:03 (OR, 2.71; 95% CI, 1.11-6.65; P = .04), and HLA-C*12:03 (OR, 5.6; 95% CI, 1.67-18.80; P = .006) were associated with Brazilian CM-SJS/TEN with SOCs, and HLA-A*11:01 (OR, 0.074; 95% CI, 0.004-1.26; P = .008), HLA-B*08:01 (OR, 0.15; 95% CI, 0.02-1.15; P = .048), and HLA-B*51:01 (OR, 0.23; 95% CI, 0.05-1.03; P = .045) were inversely associated with Brazilian CM-SJS/TEN with SOCs (39 cases: 19 Pardo and 16 European ancestry; 14 males and 25 females; age, 35.2 [14.4] years; and 133 controls: 66 Pardo and 61 European ancestry; 55 males and 78 females; age, 41.2 [12.9] years). When multiple test correction within the HLA locus, HLA-A*66:01 and HLA-C*12:03 demonstrated associations. When participants were segregated into Pardo and locus is considered, HLA-A*66:01 was associated with CM-SJS/TEN with SOC among individuals of both ethnic groups (Pardo: OR, 12.2; 95% CI, 1.19-125.0; P = .03; and European: OR, 21.2; 95% CI, 0.97-465.0; P = .04). An association was observed only in the European cohort for HLA-B*44:03 (OR, 5.50; 95% CI, 1.47-20.50; P = .01) and HLA-C*12:03 (OR, 8.79; 95% CI, 1.83-42.20; P = .008). Conclusions and Relevance: This study suggests that HLA-A*66:01 might be a marker for CM-SJS/TEN with SOCs in Brazilian individuals of Pardo and European ancestry and that HLA-B*44:03 and HLA-C*12:03 might be markers only in those of European ancestry. Moreover, HLA-A*11:01 might be a marker of resistance to CM-SJS/TEN with SOCs.
Asunto(s)
Síndromes de Ojo Seco/genética , Antígenos HLA-A/genética , Antígenos HLA-B/genética , Antígenos HLA-C/genética , Medicamentos Compuestos contra Resfriado, Gripe y Alergia/efectos adversos , Síndrome de Stevens-Johnson/genética , Adolescente , Adulto , Anciano , Alelos , Brasil , Estudios de Casos y Controles , Niño , Síndromes de Ojo Seco/inducido químicamente , Femenino , Marcadores Genéticos , Técnicas de Genotipaje , Voluntarios Sanos , Humanos , Masculino , Persona de Mediana Edad , Reacción en Cadena de la Polimerasa , Síndrome de Stevens-Johnson/etiologíaAsunto(s)
Dextrometorfano/efectos adversos , Antagonistas de Aminoácidos Excitadores/efectos adversos , Psicosis Inducidas por Sustancias/etiología , Trastornos Relacionados con Sustancias/psicología , Adulto , Trastorno Bipolar/tratamiento farmacológico , Trastorno Bipolar/psicología , Buspirona/efectos adversos , Clorfeniramina , Clorhidrato de Duloxetina/efectos adversos , Antagonistas de los Receptores Histamínicos H1 , Humanos , Masculino , Medicamentos Compuestos contra Resfriado, Gripe y Alergia , Psicosis Inducidas por Sustancias/psicología , Agonistas de Receptores de Serotonina/efectos adversos , Síndrome de la Serotonina/inducido químicamente , Inhibidores de Captación de Serotonina y Norepinefrina/efectos adversosRESUMEN
Se realizó una investigación aplicada, descriptiva, transversal y prospectiva de 1 718 niños menores de 5 años de edad egresados del Hospital Docente Infantil Sur Dr Antonio María Béguez César de Santiago de Cuba con diagnóstico de catarro común como infección portera, desde enero de 2013 hasta diciembre de 2014, a fin de caracterizarles según variables epidemiológicas de riesgo, clínicas y terapéuticas, basadas en las definiciones de infección portera y violencia terapéutica. En la serie predominaron las altas cifras de morbilidad, los factores de riesgo reconocidos y modificables (anemia carencial, ambiente polvoriento y supresión precoz de lactancia materna), la rinorrea, la fiebre, la obstrucción nasal y la tos como manifestaciones clínicas más comunes, así como la otitis media como complicación más frecuente. Por otra parte, las tasas de morbilidad por catarro común durante el bienio constituyeron datos estadísticos inéditos en la institución(AU)
An applied, descriptive, cross-sectional and prospective investigation of 1 718 children under 5 years discharged from Dr Antonio María Béguez Cesar Teaching Southern Children Hospital in Santiago de Cuba with diagnosis of common flu as porter infection, was carried out from January, 2013 to December, 2014, in order to characterize them according to risk, clinical and therapeutic epidemiological variables, based on the definitions of "porter infection" and "therapeutic violence". In the series the high morbidity figures, the recognized and modifiable risk factors (deficiency anemia, powdery environment and early ablactation), rhinorrea, fever, nasal obstruction and cough prevailed as the most common clinical manifestations, as well as the ear infection as the most frequent complication. On the other hand, the morbidity rates due to common flu during the biennium constituted unpublished statistical data in the institution(AU)
Asunto(s)
Humanos , Masculino , Femenino , Niño , Resfriado Común/terapia , Infecciones , Rhinovirus , Medicamentos Compuestos contra Resfriado, Gripe y Alergia , Terapéutica/ética , Epidemiología Descriptiva , Estudios Transversales , Estudios ProspectivosRESUMEN
Stevens-Johnson syndrome (SJS) and its severe variant, toxic epidermal necrolysis (TEN), are acute inflammatory vesiculobullous reactions of the skin and mucous membranes. Cold medicines including non-steroidal anti-inflammatory drugs and multi-ingredient cold medications are reported to be important inciting drugs. Recently, we reported that cold medicine related SJS/TEN (CM-SJS/TEN) with severe mucosal involvement including severe ocular surface complications (SOC) is associated with HLA-A*02:06 and HLA-B*44:03 in the Japanese. In this study, to determine whether HLA-B*44:03 is a common risk factor for CM-SJS/TEN with SOC in different ethnic groups we used samples from Indian, Brazilian, and Korean patients with CM-SJS/TEN with SOC, and investigated the association between CM-SJS/TEN with SOC and HLA-B*44:03 and/or HLA-A*02:06. We found that HLA-B*44:03 was significantly associated with CM-SJS/TEN with SOC in the Indian and Brazilian but not the Korean population, and that HLA-A*02:06 might be weakly associated in the Korean- but not the Indian and Brazilian population.
Asunto(s)
Síndromes de Ojo Seco/genética , Antígeno HLA-A2/genética , Antígeno HLA-B44/genética , Síndrome de Stevens-Johnson/genética , Triquiasis/genética , Adolescente , Adulto , Alelos , Antiinflamatorios no Esteroideos/efectos adversos , Brasil , Niño , Síndromes de Ojo Seco/etnología , Síndromes de Ojo Seco/etiología , Síndromes de Ojo Seco/inmunología , Epitelio Corneal/inmunología , Epitelio Corneal/patología , Etnicidad , Femenino , Frecuencia de los Genes , Antígeno HLA-A2/inmunología , Antígeno HLA-B44/inmunología , Humanos , India , Masculino , Persona de Mediana Edad , Medicamentos Compuestos contra Resfriado, Gripe y Alergia/efectos adversos , República de Corea , Epitelio Pigmentado de la Retina/inmunología , Epitelio Pigmentado de la Retina/patología , Factores de Riesgo , Síndrome de Stevens-Johnson/etnología , Síndrome de Stevens-Johnson/etiología , Síndrome de Stevens-Johnson/inmunología , Triquiasis/etnología , Triquiasis/etiología , Triquiasis/inmunologíaRESUMEN
Brugada syndrome (BrS) is associated with increased risk of ventricular arrhythmias and sudden death. Some drugs can trigger the electrocardiographic and arrhythmic manifestations of this syndrome. Cold medicines for symptom relief are sold without prescription in Brazil and most contain antihistamines and adrenergic agonists. We report a case of BrS probably triggered by the use of such medication.
Asunto(s)
Bromofeniramina/efectos adversos , Síndrome de Brugada/inducido químicamente , Antagonistas de los Receptores Histamínicos H1/efectos adversos , Descongestionantes Nasales/efectos adversos , Fenilefrina/efectos adversos , Adulto , Humanos , Masculino , Medicamentos Compuestos contra Resfriado, Gripe y Alergia/efectos adversosRESUMEN
We evaluated the efficacy of an antihistamine-decongestant combination as adjunctive therapy in the treatment of acute otitis media with effusion. In a randomized study, 53 children were treated for acute otitis media with antibiotics and either Naldecon or placebo. Subjects were evaluated by tympanometry and pneumotoscopy. Follow-up evaluation was performed at days seven and 14 of therapy. The antihistamine-decongestant prescription was found to influence both the duration of nasal congestion and the course of middle ear effusion: Naldecon-treated subjects were symptomatic with nasal congestion for an average of six days compared to nine days reported by those given placebo, and the risk of persisting middle ear effusion was approximately two times greater in the placebo-treated group when evaluated by tympanometry.