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Objective: To compare outcomes in patients with repeated implantation failure undergoing Intracytoplasmic Sperm Injection/In vitro fertilization (IVF/ICSI) plus immunosuppressants such as prednisolone, prednisone, or cyclosporine A versus the use of IVF/ICSI alone. Data source: Databases were systematically searched in PubMed, Cochrane, and Embase databases in September 2023. Study Selection: Randomized clinical trials and observational studies with the outcomes of interest were included. Data collect: We computed odds ratios (ORs) for binary endpoints, with 95% confidence intervals (CIs). Heterogeneity was assessed using I2 statistics. Data were analyzed using Review Manager 5.4.The main outcomes were live birth, miscarriage, implantation rate, clinical pregnancy, and biochemical pregnancy. Data synthesis: Seven studies with 2,829 patients were included. Immunosuppressive treatments were used in 1,312 (46.37%). Cyclosporine A improved implantation rate (OR 1.48; 95% CI 1.01-2.18) and clinical pregnancy (1.89, 95% CI 1.14-3.14). Compared to non-immunosuppressive treatment, prednisolone and prednisone did not improve live birth (OR 1.13, 95% CI 0.88-1.46) and miscarriage (OR 1.49, 95% CI 1.07-2.09). Prednisolone showed no significant effect in patients undergoing IVF/ICSI, clinical pregnancy (OR 1.34; 95% CI 0.76-2.36), or implantation rate (OR 1.36; 95% CI 0.76-2.42). Conclusion: Cyclosporine A may promote implantation and clinical pregnancy rates. However, given the limited sample size, it is important to approach these findings with caution. Our results indicate that prednisolone and prednisone do not have any beneficial effects on clinical outcomes of IVF/ICSI patients with repeated implantation failure. PROSPERO: CRD42023449655.
Asunto(s)
Implantación del Embrión , Inmunosupresores , Técnicas Reproductivas Asistidas , Femenino , Humanos , Embarazo , Ciclosporina/administración & dosificación , Implantación del Embrión/efectos de los fármacos , Implantación del Embrión/inmunología , Inmunosupresores/administración & dosificación , Prednisolona/administración & dosificación , Prednisona/administración & dosificación , Índice de Embarazo , Inyecciones de Esperma IntracitoplasmáticasRESUMEN
RESUMO Este artigo descreve dois casos de reação imunológica de rejeição de transplante penetrante após a aplicação de dois tipos de vacina contra a COVID-19 - CoronaVac (Sinopharm/Butantan) e MRNA BNT162&2 (Pfizer-BioNTech) - com intervalo de 1 e 10 dias, respectivamente. A rejeição se manifestou com hiperemia, edema corneano e embaçamento da visão, que responderam rapidamente ao uso de corticoide tópico e subconjuntival. Até onde sabemos, este é o primeiro relato de rejeição de transplante penetrante de córnea pós-vacina anti-COVID-19. Recomendamos, presentemente, como prevenção, colírio de prednisolona a 1% 4 dias antes e durante 2 semanas após receber qualquer tipo de vacina para a COVID-19.
ABSTRACT This paper describes two cases of allograft corneal transplant rejection after the application of two types of COVID-19 vaccines - Coronavac (Sinopharm/Butantan) and MRNA BNT162&2 (Pfizer-BioNTech) vaccines - with an interval of 1 to 10 days, respectively. The rejection manifested in the form of corneal edema, hyperemia and blurred vision, which responded rapidly to the use of topical and subconjunctival corticosteroid. As far as we know, this is the first published report of immunological rejection of penetrating corneal transplant after COVID-19 vaccination. As a preventative measure, we now recommend the use of 1% prednisolone eye drop 4 days before and during 2 weeks after having received any type of COVID-19 vaccine.
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Masculino , Femenino , Adulto , Persona de Mediana Edad , Queratoplastia Penetrante/efectos adversos , Vacunación/efectos adversos , Vacunas contra la COVID-19/efectos adversos , Rechazo de Injerto/etiología , Soluciones Oftálmicas , Prednisolona/administración & dosificación , Agudeza Visual , Trasplante de Córnea/efectos adversos , Microscopía con Lámpara de Hendidura , COVID-19 , Rechazo de Injerto/diagnóstico , Rechazo de Injerto/prevención & control , Rechazo de Injerto/tratamiento farmacológicoRESUMEN
In French Guiana, a French overseas region partly located in the Amazon, "Africanized" bees, a hybrid species of Brazilian bees known as "killer bees," have been observed since 1975. Since then, several cases requiring long hospitalization times have been described, allowing for a better understanding of the physiopathological mechanisms of this particular envenomation. Here, we report on a series of 10 cases of patients simultaneously attacked by hundreds of killer bees and immediately treated by a prehospital medical team already on site. Between 75 and 650 stingers were removed per victim. The reference treatment for anaphylaxis using intramuscular injection of epinephrine, vascular filling, and oxygen therapy was administered to all patients without delay. A clinical description was provided, and biological tests were performed immediately after the envenomation. We therefore observe the existence of a two-phase, medically well-controlled systemic toxic reaction. Thus, all our patients left the hospital after 44 hours of monitoring with no complications or sequelae, despite levels of intoxication described as potentially fatal elsewhere in the literature.
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Abejas/clasificación , Mordeduras y Picaduras de Insectos/epidemiología , Acetaminofén/administración & dosificación , Acetaminofén/uso terapéutico , Adulto , Analgésicos no Narcóticos/administración & dosificación , Analgésicos no Narcóticos/uso terapéutico , Animales , Antiinfecciosos Locales/administración & dosificación , Antiinfecciosos Locales/uso terapéutico , Antiinflamatorios/administración & dosificación , Antiinflamatorios/uso terapéutico , Clorfeniramina/administración & dosificación , Clorfeniramina/uso terapéutico , Epinefrina/uso terapéutico , Guyana Francesa/epidemiología , Antagonistas de los Receptores Histamínicos H1/administración & dosificación , Antagonistas de los Receptores Histamínicos H1/uso terapéutico , Humanos , Mordeduras y Picaduras de Insectos/tratamiento farmacológico , Masculino , Metilprednisolona/administración & dosificación , Metilprednisolona/uso terapéutico , Persona de Mediana Edad , Oxígeno/uso terapéutico , Prednisolona/administración & dosificación , Prednisolona/uso terapéutico , Solución Salina , Simpatomiméticos/administración & dosificación , Simpatomiméticos/uso terapéutico , Adulto JovenRESUMEN
Purpose: To evaluate the effect of topical instillation of pegaptanib sodium upon inflammatory angiogenesis induced in the rabbit cornea by alkaline cauterization. Methods: Inflammatory angiogenesis was induced by alkaline (sodium hydroxide) cauterization in the corneas of 29 male New Zealand rabbits. The animals were divided into 4 groups: a control group treated with 0.5% carboxymethylcellulose sodium eye drops, a group treated with 1.0% prednisolone acetate eye drops, a group treated with 0.5% pegaptanib sodium diluted in 15 mL 0.5% carboxymethylcellulose sodium, and a group treated with 1.0% pegaptanib sodium diluted in 15 mL 0.5% carboxymethylcellulose sodium. After cauterization, eye drops were administered every 12 hours for 21 days. The animals were evaluated every 3 days after cauterization, and the newly formed vessels were quantified from photographs. The treatment effectiveness was analyzed with 3 parameters of antiangiogenic response: neovascularization area (NA), total vascular length (TVL), and number of blood vessels (BVN). Results: Average NA, TVL, and BVN values were significantly higher in both pegaptanib groups than in the prednisolone group. A nonstatistically significant reduction in parameters on days 18 and 21 was the minimum achieved in both pegaptanib groups. The efficacy of the treatments in relation to the control was significantly greater in the prednisolone group than in the 0.5% pegaptanib group or the 1.0% pegaptanib group (P < 0.001). Conclusion: Topical instillation of 0.5% and 1.0% pegaptanib sodium diluted in 15 mL 0.5% carboxymethylcellulose sodium had no inhibitory effect on corneal neovascularization in this rabbit model.
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Inhibidores de la Angiogénesis/farmacología , Aptámeros de Nucleótidos/farmacología , Inflamación/tratamiento farmacológico , Neovascularización Patológica/tratamiento farmacológico , Factor A de Crecimiento Endotelial Vascular/antagonistas & inhibidores , Administración Tópica , Inhibidores de la Angiogénesis/administración & dosificación , Inhibidores de la Angiogénesis/uso terapéutico , Animales , Antiinflamatorios/administración & dosificación , Antiinflamatorios/farmacología , Aptámeros de Nucleótidos/administración & dosificación , Aptámeros de Nucleótidos/uso terapéutico , Cáusticos/administración & dosificación , Cáusticos/efectos adversos , Córnea/patología , Lesiones de la Cornea/inducido químicamente , Neovascularización de la Córnea/inducido químicamente , Modelos Animales de Enfermedad , Inflamación/diagnóstico , Instilación de Medicamentos , Masculino , Prednisolona/administración & dosificación , Prednisolona/farmacología , Conejos , Hidróxido de Sodio/administración & dosificación , Hidróxido de Sodio/efectos adversos , Resultado del TratamientoRESUMEN
CASE DESCRIPTION: 32-month-old boy, IgG positive for SARS-CoV-2, presented to the emergency department with dermatologic lesions. CLINICAL FINDINGS: Four days before admission, he presented skin eruptions with redness and pruritus on hands and feet. Generalized papular erythema was evidenced, upper extremities with diffuse erythematosquamous plaques, palmoplantar keratoderma, so he was evaluated by a dermatologist who diagnosed pityriasis rubra pilaris. TREATMENT AND OUTCOME: rehydrating cream, cetirizine 0.5 mg/kg/day every two days, and prednisolone 2 mg/kg/day in the morning. He was discharged after 14 days, the patient presented clinical improvement, but the erythematous lesion persisted on the trunk and extremities. In the evaluation, after three months, the patient did not show the described lesions, evidencing an improvement and clinical resolution of the dermatological problems. CLINICAL RELEVANCE: We report a patient with pityriasis rubra piloris associated with a post-infection by SARS-CoV-2 that had not been described before.
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COVID-19/complicaciones , Pitiriasis Rubra Pilaris/etiología , Cetirizina/administración & dosificación , Preescolar , Glucocorticoides/administración & dosificación , Humanos , Inmunoglobulina G , Masculino , Pitiriasis Rubra Pilaris/diagnóstico , Pitiriasis Rubra Pilaris/tratamiento farmacológico , Prednisolona/administración & dosificaciónRESUMEN
Abstract Case description: 32-month-old boy, IgG positive for SARS-CoV-2, presented to the emergency department with dermatologic lesions. Clinical findings: Four days before admission, he presented skin eruptions with redness and pruritus on hands and feet. Generalized papular erythema was evidenced, upper extremities with diffuse erythematosquamous plaques, palmoplantar keratoderma, so he was evaluated by a dermatologist who diagnosed pityriasis rubra pilaris. Treatment and outcome: rehydrating cream, cetirizine 0.5 mg/kg/day every two days, and prednisolone 2 mg/kg/day in the morning. He was discharged after 14 days, the patient presented clinical improvement, but the erythematous lesion persisted on the trunk and extremities. In the evaluation, after three months, the patient did not show the described lesions, evidencing an improvement and clinical resolution of the dermatological problems. Clinical relevance: We report a patient with pityriasis rubra piloris associated with a post-infection by SARS-CoV-2 that had not been described before.
Resumen Descripción del caso: Niño 32 meses de vida, con IgG positivo para SARS-CoV-2, acude al servicio de emergencia por presentar lesiones dermatológicas. Hallazgos clínicos: Cuatro días antes del ingreso presentó erupciones en la piel, con enrojecimiento y prurito en manos y pies. Se evidenció eritema papular generalizado, extremidades superiores con placas eritematoescamosas difusas, queratodermia palmo-plantar por lo que es evaluado por dermatólogo quien diagnostica pitiriasis rubra pilaris. Tratamiento y resultado: Crema rehidratantes, cetirizina 0.5 mg/kg/día cada 2 días y prednisolona 2 mg/kg/día por la mañana. Fue dado de alta a los 14 días, el paciente presenta mejora clínica, pero aún persiste la lesión eritematosa en tronco y extremidades. En la evaluación a los tres meses el paciente no mostró las lesiones descritas, evidenciando una mejoría y resolución clínica de los problemas dermatológicos. Relevancia clínica: Se reporta un paciente con afectación por pitiriasis rubra piloris asociado a una post-infección por SARS-CoV-2 que no se había descrito antes.
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Preescolar , Humanos , Masculino , Pitiriasis Rubra Pilaris/etiología , COVID-19/complicaciones , Pitiriasis Rubra Pilaris/diagnóstico , Pitiriasis Rubra Pilaris/tratamiento farmacológico , Inmunoglobulina G , Prednisolona/administración & dosificación , Cetirizina/administración & dosificación , Glucocorticoides/administración & dosificaciónRESUMEN
Background: Immune-mediated hemolytic anemia (IMHA) is characterized by an autoimmune response with production of auto-antibodies and destruction of erythrocytes resulting in anemia. Primary IMHA is referred to a condition when the cause is unknown (idiopathic), whereas secondary IMHA involves changes in red blood cells caused by the action of drugs, neoplasms, or infectious diseases. The diagnosis can be made through changes in the blood count, usually of a regenerative character, Coombs test, and autoagglutination test. The present study aimed to report a case of drug-induced hemolytic anemia, with emphasis on the clinical signs, diagnostic methods, and treatment, in a female dog. Case: A 9-year-old mixed-breed bitch weighing 29.6 kg was referred to the Veterinary Medical Teaching Hospital (HCVUFRGS) with a previous diagnosis of gallbladder mucocele that was unresponsive to clinical treatment. After laboratory tests, cholecystectomy was performed, and the procedure required conversion from laparoscopic to open cholecystectomy. Therapy included administration of amoxicillin, dipyrone, tramadol hydrochloride, and meloxicam. Three days after surgery, the dog presented with apathy, lethargy, hyporexia, and a pale and subicteric mucosa. The patient developed hypochromic macrocytic anemia with reticulocytosis, spherocytosis, anisocytosis, and leukocytosis with neutrophilia. The result of the autoagglutination test was positive, confirming the diagnosis. All medications were suspended, and immunosuppressive treatment with dexamethasone was included, with a subsequent switch to prednisolone. After 10 days of treatment, the patient experienced significant improvement, and therapy was discontinued. Discussion: Based on the patient's history, the cause of the IMHA was secondary to drug administration, and it is not possible to distinguish if it was due to one or a combination of drugs, as they were all started and stopped simultaneously. The patient had hypothyroidism, which may have contributed to the production of antibodies against TSH receptors, blocking the hormone's action, thereby causing tissue damage due to T cell-mediated cytotoxicity and the effect of cytokines. The pale and subicteric mucosa, apathy, weakness, lethargy, exercise intolerance, and dyspnea resulted from extravascular hemolysis and bilirubin released from erythrocyte rupture with a subsequent decrease in the number of red blood cells, leading to oxygen transport deficiency. The diagnosis is based on the blood count and results of autoagglutination supported by the response to immunosuppressive therapy. Anemia results in increased production and release of precursor cells from the bone marrow, accompanied by reticulocytosis and increased mean corpuscular volume (MCV) and mean corpuscular hemoglobin concentration (MCHC). The treatment of IMHA consists of supportive care and immunosuppressive therapy with corticosteroids to ensure suppression of the immune system, preventing response against erythrocytes. Initially, tramadol hydrochloride, dipyrone, and amoxicillin with potassium clavulanate were suspended to interrupt the cause of IMHA, and administration of dexamethasone in an immunosuppressive dose was started. Therefore, it is important to include drug-induced IMHA in the differential diagnosis of patients who present with anemia after using medications. Early diagnosis, initiation of therapy, and adequate care were important factors for the recovery of the animal.
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Animales , Femenino , Perros , Dexametasona/administración & dosificación , Prednisolona/administración & dosificación , Anemia Hemolítica Autoinmune/terapia , Anemia Hemolítica Autoinmune/veterinaria , Pruebas de Aglutinación/veterinariaRESUMEN
The objective of the present study was to assess the treatment of dogs with ehrlichiosis (tropical canine pancytopenia (TCP)) with doxycycline hydrochloride associated or not with prednisolone on the hematological profile and serum proteins. Ten dogs with TCP were selected in the Small Animal Medical Clinic Veterinary Hospital, Federal University of Campina Grande-UFCG-PB, Brazil. The diagnosis was obtained by clinical examination, hemogram and immunochromatographic test (with anti Ehrlichia canis antibodies). Samples were distributed randomly in two experimental groups of five animals each (n = 5), named GD and GDP. The GD group was treated with doxycycline (5 mg/kg, VO, BID for 28 days) and the GDP group was treated with doxycycline at the same dose and duration and prednisolone (2 mg/kg, VO, BID, for five days). Four blood collections were made during the treatment period: a base collection (M0), one at 10 days (M10), a second at 21 days (M21) and another at the end of the treatment (M28). These samples were used for the tests erythrogram, leucogram, plateletgram and proteinogram (dose of total proteins, pre-albumin, albumin, albumin, -1 globulin, -2 globulin, ß-globulin, -globulin and C- reactive protein) in the Clinical Pathology Laboratory, Veterinary Hospital-UFCG-PB. Results, that presented normal distribution, was submitted to the Tukey test (P 0.05). Comparison of treatments GD and GDP showed that both promoted discreet and similar response in the hematological parameters at different times. Results obtained allowed the conclusion that both therapeutic protocols resulted in clinical, hematological parameter and proteinogram improvement, but the use of prednisolone at the dose administered during the first five days of treatment did not show more beneficial effects than isolated administration of doxycycline.(AU)
Objetivou-se com este estudo avaliar os efeitos do tratamento de cães com erliquiose monocítica canina (EMC) com cloridrato de doxiciclina associada ou não à prednisolona sobre o perfil hematológico e de proteínas séricas. Foram selecionados, na Clínica Médica de Pequenos Animais do Hospital Veterinário da Universidade Federal de Campina Grande (UFCG), 10 cães com EMC. O diagnóstico foi obtido através de exame clínico, hemograma e teste de imunoensaio imunocromatográfico (com anticorpos anti Ehrlichia canis). As amostras foram distribuídas aleatoriamente em dois grupos experimentais, com cinco animais cada (n=5), denominados GD e GDP. O grupo GD foi tratado com doxiciclina (5 mg/kg, VO, BID durante 28 dias) e o grupo GDP, tratado com doxiciclina na mesma dose e duração e prednisolona (2 mg/kg, VO, BID, durante 5 dias). Durante o período de tratamento, foram realizadas quatro coletas de sangue; uma coleta basal (M0), uma com 10 dias (M10), uma aos 21 dias (M21) e outra ao final do tratamento (M28). Dessas amostras foram realizados eritrograma, leucograma, plaquetograma e proteinograma (dosagem de proteínas totais, pré-albumina, albumina, -1 globulina, -2 globulina, ß-globulina, -globulina e proteína C-reativa) no Laboratório de Patologia Clínica do Hospital Veterinário da UFCG. Os resultados que apresentaram distribuição normal foram submetidos ao teste de Tukey (P 0,05). Ao comparar os tratamentos GD e GDP, observou-se que os dois promoveram resposta discreta e semelhante dos parâmetros hematológicos nos diferentes momentos. Os resultados obtidos permitem concluir que ambos os protocolos terapêuticos resultaram em melhora clínica e dos parâmetros hematológicos e do proteinograma. Porém, o uso da prednisolona na dose empregada durante os primeiros cinco dias de tratamento não demonstrou efeitos mais benéficos do que a administração isolada da doxiciclina.(AU)
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Animales , Perros , Ehrlichiosis/tratamiento farmacológico , Ehrlichiosis/parasitología , Ehrlichiosis/veterinaria , Prednisolona/administración & dosificación , Prednisolona/uso terapéutico , Doxiciclina/administración & dosificación , Doxiciclina/uso terapéuticoRESUMEN
Treatment of acute lymphoblastic leukemia (ALL) requires the combination of multiple drugs to integrate a complete remission. The different prognostic factors (age, leukocytes, risk, cytogenetic alterations) allow identifying those patients with a high risk of relapse, but there are few described factors that impact the induction response. The objective was to identify the utility of different risk factors (overexpression of the ABCB1 drug resistance gene, favorable response to steroids (FRS) and early response at day + 8 of treatment) on the percentage of complete remissions and overall survival. This is a prospective, observational study in adult patients with B-ALL without specific cytogenetic alterations, who started induction treatment based on a pretreatment with prednisone and subsequently vincristine (1.6 mg/m2 subcutaneous) plus daunorubicin (45 mg/m2 subcutaneously) on days + 1, + 8, + 15. The ABCB1 resistance gene was evaluated at diagnosis, the FRS at the end of the pretreatment and the early response during day + 8. A total of 53 adult patients diagnosed with ALL Philadelphia negative chromosome (Ph-), with immunophenotype B, with a normal karyotype, were studied. Cases with genetic abnormalities with a poor prognosis were excluded in order to reduce bias. The mean age was 48 years (range 17-68 years). 62.3% of patients were at high risk of relapse. When analyzing the risk factors, 30.2% showed high levels of the ABCB1 resistance gene, without showing an impact on the induction response (OR: 1.218, p = 0.743), but its overexpression was associated with a poor response to steroids as in the absence of early response. Individually, both the FRS (OR: 5.7, p = 0.004) and the absence of early response to day + 8 (OR: 6.42, p = 0.002) showed significance. By combining the different factors, having more than 2 was directly related to a failure (OR: 9.514, p = 0.000). The identification of factors such as FRS such as the persistence of blasts at the end of the first week of treatment is useful to identify patients at risk of failure in induction.
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Protocolos de Quimioterapia Combinada Antineoplásica/administración & dosificación , Regulación Leucémica de la Expresión Génica/efectos de los fármacos , Quimioterapia de Inducción , Proteínas de Neoplasias/biosíntesis , Leucemia-Linfoma Linfoblástico de Células Precursoras , Subfamilia B de Transportador de Casetes de Unión a ATP/biosíntesis , Adolescente , Adulto , Anciano , Daunorrubicina/administración & dosificación , Supervivencia sin Enfermedad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Leucemia-Linfoma Linfoblástico de Células Precursoras/tratamiento farmacológico , Leucemia-Linfoma Linfoblástico de Células Precursoras/metabolismo , Leucemia-Linfoma Linfoblástico de Células Precursoras/mortalidad , Prednisolona/administración & dosificación , Estudios Retrospectivos , Tasa de Supervivencia , Factores de Tiempo , Vincristina/administración & dosificaciónRESUMEN
Glicocorticoides são amplamente utilizados na clínica de pequenos animais, entretanto seu uso contínuo pode causar efeitos colaterais. Os gatos são considerados menos susceptíveis a esses efeitos do que outras espécies, mas existem poucos trabalhos abordando os efeitos adversos em felinos. O objetivo deste estudo foi avaliar possíveis alterações laboratoriais, histopatológicas e do grau de atenuação radiográfica do parênquima hepático de gatas submetidas à terapia com prednisolona. Um ensaio clínico foi realizado em quatro gatas hígidas, as quais receberam prednisolona, por via oral, na dose de 3mg/kg, durante 60 dias consecutivos. Nos achados histopatológicos após 60 dias de tratamento, observou-se desorganização dos cordões de hepatócitos e degeneração vacuolar, além de necrose de hepatócitos, porém não foram observados sinais de fibrose no parênquima hepático. Os dados da tomografia computadorizada demonstram aumento do grau de atenuação do parênquima hepático a partir do 30º dia da administração de prednisolona, que persistiu até o final do experimento. No presente estudo, foi possível caracterizar a existência de hepatopatia esteroidal em gatos em estágios precoces da terapia com prednisolona.(AU)
Glucocorticoids are widely used medications in small animal practice; however, its continuous use can have side effects. Cats are considered less susceptible than other species, however, the literature does not usually address adverse effects in felines. The objective of this study was to evaluate possible laboratory and histopathologic changes, as well as changes to the degree of radiographic attenuation of the hepatic parenchyma in cats treated with prednisolone. A clinical trial was done in four healthy cats, who received prednisolone orally at 3mg/kg during 60 consecutive days. In the histopathologic findings at 60 days of treatment, there were disorganized hepatocyte chords and vacuolar degeneration, as well as hepatocyte necrosis, however, there were no signs of fibrosis in the hepatic parenchyma. Data obtained via computed tomography showed increase of the degree of attenuation in the hepatic parenchyma from day 30 of prednisolone therapy, which persisted until the end of the experiment. In the present study, it was possible to characterize the existence of steroidal hepathopathy in cats in the early stages of prednisolone therapy.(AU)
Asunto(s)
Animales , Femenino , Gatos , Prednisolona/administración & dosificación , Hepatocitos/efectos de los fármacos , Glucocorticoides/efectos adversos , Fibrosis , Tomografía Computarizada por Rayos X/veterinaria , Tejido ParenquimatosoRESUMEN
Glicocorticoides são amplamente utilizados na clínica de pequenos animais, entretanto seu uso contínuo pode causar efeitos colaterais. Os gatos são considerados menos susceptíveis a esses efeitos do que outras espécies, mas existem poucos trabalhos abordando os efeitos adversos em felinos. O objetivo deste estudo foi avaliar possíveis alterações laboratoriais, histopatológicas e do grau de atenuação radiográfica do parênquima hepático de gatas submetidas à terapia com prednisolona. Um ensaio clínico foi realizado em quatro gatas hígidas, as quais receberam prednisolona, por via oral, na dose de 3mg/kg, durante 60 dias consecutivos. Nos achados histopatológicos após 60 dias de tratamento, observou-se desorganização dos cordões de hepatócitos e degeneração vacuolar, além de necrose de hepatócitos, porém não foram observados sinais de fibrose no parênquima hepático. Os dados da tomografia computadorizada demonstram aumento do grau de atenuação do parênquima hepático a partir do 30º dia da administração de prednisolona, que persistiu até o final do experimento. No presente estudo, foi possível caracterizar a existência de hepatopatia esteroidal em gatos em estágios precoces da terapia com prednisolona.(AU)
Glucocorticoids are widely used medications in small animal practice; however, its continuous use can have side effects. Cats are considered less susceptible than other species, however, the literature does not usually address adverse effects in felines. The objective of this study was to evaluate possible laboratory and histopathologic changes, as well as changes to the degree of radiographic attenuation of the hepatic parenchyma in cats treated with prednisolone. A clinical trial was done in four healthy cats, who received prednisolone orally at 3mg/kg during 60 consecutive days. In the histopathologic findings at 60 days of treatment, there were disorganized hepatocyte chords and vacuolar degeneration, as well as hepatocyte necrosis, however, there were no signs of fibrosis in the hepatic parenchyma. Data obtained via computed tomography showed increase of the degree of attenuation in the hepatic parenchyma from day 30 of prednisolone therapy, which persisted until the end of the experiment. In the present study, it was possible to characterize the existence of steroidal hepathopathy in cats in the early stages of prednisolone therapy.(AU)
Asunto(s)
Animales , Femenino , Gatos , Prednisolona/administración & dosificación , Hepatocitos/efectos de los fármacos , Glucocorticoides/efectos adversos , Fibrosis , Tomografía Computarizada por Rayos X/veterinaria , Tejido ParenquimatosoRESUMEN
Takayasu arteritis (TAK) is a large-vessel granulomatous vasculitis; the inflammatory infiltration in arteries comprises macrophages, multi-nucleated giant cells, CD4+ and CD8+ T cells, γδ T cells, natural killer (NK) cells and neutrophils. However, it is unknown which subtype of macrophages predominates. This study aims to evaluate macrophages subpopulations in the aorta in TAK. Immunohistochemistry was performed in the aorta from TAK patients (n = 22), patients with atherosclerotic disease (n = 9) and heart transplant donors (n = 8) using the markers CD68, CD86, CD206, CD3, CD20 and CD56. Active disease was observed in 54·5% of patients and active histological lesions were found in 40·9%. TAK patients presented atherosclerotic lesions in 27·3% of cases. The frequency of macrophages, M1 macrophages, T, B and NK cells was higher in the aorta from TAK and atherosclerotic patients compared to heart transplant donors. In TAK, macrophages and T cells were the most abundant cells in the aorta, and the expression of CD206 was higher than CD86 (P = 0·0007). No associations were found between the expression of cell markers and active disease or with atherosclerotic lesions. In TAK patients, histological disease activity led to higher T cell counts than chronic fibrotic lesions (P = 0.030), whereas prednisone use was associated with lower T cell counts (P = 0·035). In conclusion, M1 macrophages were more frequent in TAK and atherosclerotic patients compared to heart transplant donors, while M2 macrophages dominated M1 macrophages in TAK. T cells were associated with histological disease activity and with prednisone use in TAK.
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Antígenos CD/inmunología , Aorta/inmunología , Linfocitos/inmunología , Macrófagos/inmunología , Arteritis de Takayasu/inmunología , Adulto , Anciano , Aorta/patología , Estudios Transversales , Femenino , Humanos , Inflamación/tratamiento farmacológico , Inflamación/inmunología , Inflamación/patología , Linfocitos/patología , Macrófagos/patología , Masculino , Persona de Mediana Edad , Prednisolona/administración & dosificación , Arteritis de Takayasu/tratamiento farmacológico , Arteritis de Takayasu/patologíaRESUMEN
Spinal muscular atrophy is a neurodegenerative disease resulting from irreversible loss of anterior horn cells owing to biallelic deletions/mutations in the survival motor neuron (SMN) 1 gene. Gene replacement therapy using an adeno-associated virus vector containing the SMN gene was approved by the US Food and Drug Administration in May 2019. We report 2 cases of transient, drug-induced liver failure after this therapy.
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Enfermedad Hepática Inducida por Sustancias y Drogas/diagnóstico , Terapia Genética/efectos adversos , Oligonucleótidos/efectos adversos , Atrofias Musculares Espinales de la Infancia/tratamiento farmacológico , Enfermedad Hepática Inducida por Sustancias y Drogas/tratamiento farmacológico , Enfermedad Hepática Inducida por Sustancias y Drogas/patología , Femenino , Terapia Genética/métodos , Glucocorticoides/administración & dosificación , Humanos , Lactante , Masculino , Oligonucleótidos/administración & dosificación , Prednisolona/administración & dosificaciónAsunto(s)
Síndrome Nefrótico/tratamiento farmacológico , Síndrome Nefrótico/historia , Pediatría/historia , Esteroides/administración & dosificación , Niño , Historia del Siglo XX , Humanos , Pediatría/tendencias , Prednisolona/administración & dosificación , Recurrencia , Proyectos de Investigación , Resultado del TratamientoRESUMEN
PURPOSE: To evaluate the effects of prednisolone against sodium diclofenac both with ciprofloxacin compared to artificial tears on the symptoms and signs of acute viral conjunctivitis. METHODS: Study included 37 patients diagnosed with acute conjunctivitis and distributed by three groups: A (1% prednisolone acetate + ciprofloxacin (0.3%); B (Sodium diclofenac (0.1%) + ciprofloxacin (0.3%) and C (artificial tears + ciprofloxacin (0.3%). Patients received medication 6/6 hours daily. Signs and symptoms (e.g. lacrimation, burning, photophobia, etc.) were scored at baseline and on the first, third, fifth and seventh days and in the end of treatment using a standardized questionnaire and slit lamp anterior segment examination. RESULTS: All three groups demonstrated an improvement in the signs and symptoms of conjunctivitis in their follow-up visits. There was no significant difference in symptom and sign scores between Group A and B and B and C in the study visits ( p >0.05). However, the comparison between groups A and C showed a clinical trend (p=0.05) on third evaluation suggesting better clinical action using the corticosteroids. CONCLUSION: The prednisolone acetate was not superior to the use of sodium diclofenac or artificial tears in relieving the signs and symptoms of viral conjunctivitis.
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Corticoesteroides/administración & dosificación , Antiinflamatorios no Esteroideos/administración & dosificación , Ciprofloxacina/administración & dosificación , Conjuntivitis Viral/tratamiento farmacológico , Diclofenaco/administración & dosificación , Prednisolona/análogos & derivados , Enfermedad Aguda , Adolescente , Adulto , Anciano , Análisis de Varianza , Femenino , Humanos , Interferón gamma , Interleucinas/análisis , Gotas Lubricantes para Ojos/administración & dosificación , Masculino , Persona de Mediana Edad , Óxido Nítrico Sintasa/análisis , Soluciones Oftálmicas/administración & dosificación , Prednisolona/administración & dosificación , Resultado del Tratamiento , Factor de Necrosis Tumoral alfa/análisis , Adulto JovenRESUMEN
Strongyloides venezuelensis is a model to study human strongyloidiasis, which infects wild rodents and shares common antigenic epitopes with Strongyloides stercoralis. This study aimed to evaluate parasitological and immunological parameters of prednisolone immunosuppression protocols in rats (Rattus novergicus) infected with S. venezuelensis. Rats were divided into six groups (n = 36): untreated and uninfected (-) or infected (+); oral treatment and uninfected (o-) or infected (o+); subcutaneous treatment and uninfected (sc-) or infected (sc+). For oral immunosuppression, 5 mg/mL of water diluted prednisolone were given five days before infection, and in the days 8 and 21 (for 5 days). For subcutaneous immunosuppression, 10 mg/kg of prednisolone were given daily. The infection was established by the subcutaneous injection of approximately 3,000 S. venezuelensis filarioid larvae per animal. All animals from the (+) and (o+) groups survived, while four rats from the (sc+) died prior to necropsy date. Parasitological analysis showed higher egg elimination in (o+) in comparison to (+) and (sc+) on 7, 13 and 26 days post infection (d.p.i.).The recovery of parasitic females at day 30 was significantly higher in (o+), compared to (+). The (+) and (o+) groups showed a clear increase in anti-S. venezuelensis IgG, IgG1 and IgG2 from 13th d.p.i. Oral immunosuppression led to a higher number of adult females and increased egg output while maintaining IgG and subclasses antibody levels comparable to the positive control.
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Inmunosupresores/uso terapéutico , Prednisolona/uso terapéutico , Strongyloides/inmunología , Estrongiloidiasis/tratamiento farmacológico , Administración Oral , Animales , Modelos Animales de Enfermedad , Heces/parasitología , Inmunoglobulina G/sangre , Inmunosupresores/administración & dosificación , Inyecciones Subcutáneas , Masculino , Prednisolona/administración & dosificación , Ratas , Ratas Wistar , Estrongiloidiasis/inmunología , Estrongiloidiasis/parasitologíaRESUMEN
Abstract Introduction: Glucocorticoids are considered the first-line therapy for sudden sensorineural hearing loss. But there is currently no consensus on administering them as a single dose versus multiple divided daily doses. Objective: We aim to evaluate the treatment outcome of sudden sensorineural hearing loss between a single-dose and multiple divided daily doses of steroid treatment. Methods: A total of 94 patients who were diagnosed and treated for sudden sensorineural hearing loss and followed up for more than three months were reviewed retrospectively. Patients were divided into single-dose and multiple divided-dose groups, based on their medication regimens. Hearing thresholds were repeatedly measured: on the initial visit and 1 week, 1 month, and 3 months after the initial treatment. Treatment outcomes were analyzed by comparing hearing recovery rates and post-treatment audiometric changes. Results: The hearing threshold was significantly reduced at three months post-treatment in both groups. The hearing recovery rate of the single-dose group was significantly higher than that of the multiple divided-dose groups. Audiometric changes showed no statistical difference either in pure tone threshold or speech discrimination. Conclusion: When oral steroids are indicated for sudden sensorineural hearing loss, both a single dose and multiple divided doses can be effective for treatment and have comparable results. However, the single-dose regimen seems to be more efficacious than the divided-dose regimen.
Resumo Introdução: Os glicocorticoides são considerados terapia de primeira linha para perda auditiva neurossensorial súbita. Contudo, atualmente não há consenso em como para administrá-los, se em dose única ou múltiplas doses diárias. Objetivo: Nosso objetivo é avaliar o resultado do tratamento da perda auditiva neurossensorial súbita com uma dose única ou várias doses diárias de tratamento com esteróides. Método: Um total de 94 pacientes que foram diagnosticados e tratados para perda auditiva neurossensorial súbita e acompanhados por mais de três meses pós-tratamento foram avalia-dos retrospectivamente. Os pacientes foram divididos em grupos de dose única diária e dose diária dividida em múltiplas tomadas, baseado em seu regime medicamentoso. Os limiares auditivos foram medidos repetidamente: na visita inicial e em 1 semana, 1 mês e 3 meses após o tratamento inicial. Os resultados do tratamento foram analisados comparando-se as taxas de recuperação da audição e as alterações audiométricas pós-tratamento. Resultados: O limiar auditivo foi significativamente reduzido aos três meses pós-tratamento em ambos os grupos. A taxa de recuperação auditiva no grupo de dose única foi significativamente maior do que no grupo de dose diária dividida em múltiplas tomadas. As alterações audiométricas não mostraram diferença estatística, tanto no limiar de tom puro quanto na discriminação da fala. Conclusão: Quando esteroides orais são indicados para perda auditiva neurossensorial súbita, tanto uma dose única quanto múltiplas doses podem ser eficazes para o tratamento e têm resultados comparáveis. No entanto, o regime de dose única diária parece ser mais eficaz do que o regime de dose diária dividida em múltiplas tomadas.
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Humanos , Masculino , Femenino , Adolescente , Adulto , Persona de Mediana Edad , Anciano , Adulto Joven , Pérdida Auditiva Súbita/tratamiento farmacológico , Glucocorticoides/administración & dosificación , Pérdida Auditiva Sensorineural/tratamiento farmacológico , Audiometría de Tonos Puros , Esteroides/administración & dosificación , Metilprednisolona/administración & dosificación , Prednisolona/administración & dosificación , Administración Oral , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
Multiple myeloma (MM) is a disease characterized by antitumoral immune dysfunction. The objective of the present study was to determine lymphocyte subsets (B, T, NK, NKT, iNKT, dendritic cells, and regulatory T cells) in 68 newly diagnosed patients and 113 healthy donors. Lymphocyte subsets were studied in the same patients 6 months after treatment. Pre-treatment values of CD4+ T cells, NK cells, type 2 dendritic cells, and B cells in MM patients were lower than in healthy donors. Forty patients (59%) received MPT treatment and 28 (41%) thal-dex. Patients with no response to treatment, exhibited a decrease in CD4+ T cells and NK cells, as well as an increase in Treg cell numbers. Median DFS and OS was lower in patients not achieving response, in patients having low numbers of NK cells, and higher values of LDH. The number of CD4 T cells, NK, DC2, and B cells at diagnosis is lower in patients with MM. Non-responder patients had lower CD4 and NK, but higher Treg cell values. Patients in which response is not achieved, and those holding lower values of NK cells and higher levels of LDH, have poor DFS and OS.
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Protocolos de Quimioterapia Combinada Antineoplásica/administración & dosificación , Células Asesinas Naturales , Mieloma Múltiple , Anciano , Dexametasona/administración & dosificación , Supervivencia sin Enfermedad , Femenino , Humanos , Recuento de Linfocitos , Masculino , Melfalán/administración & dosificación , Persona de Mediana Edad , Mieloma Múltiple/sangre , Mieloma Múltiple/tratamiento farmacológico , Mieloma Múltiple/mortalidad , Prednisolona/administración & dosificación , Tasa de Supervivencia , Talidomida/administración & dosificaciónRESUMEN
Adipsic diabetes insipidus is an infrequent disease which may be associated with craniopharyngioma. It may be secondary to the tumour's extension, as well as to resection of the mass. We present the case of a 24-year-old woman with a history of delayed puberty and hypothyroidism, but no prior study reports. She consulted due to a headache with warning signs associated with altered visual acuity. Brain MRI was performed which showed signs of a non-adenomatous lesion with suprasellar and hypothalamic extension. Following transcranial surgery, she developed diabetes insipidus criteria, with absence of thirst documented during the hospitalisation. The histopathological findings confirmed the diagnosis of craniopharyngioma. The patient was treated with desmopressin and received recommendations regarding rehydration according to the quantification of losses, with electrolyte stabilisation.