5,306 research outputs found
Value of patch tests in clindamycin-related drug eruptions
Background. Patch tests help to confirm the aetiology of the cutaneous adverse drug reactions involving delayed hypersensitivity mechanisms, but the results vary with the pattern of skin reaction and the culprit drug. Objectives. To analyse the results of patch tests in patients with cutaneous adverse drug reactions imputable to clindamycin and assess their contribution to the diagnosis. Patients and methods. Between 2005 and 2009, we studied patients with delayed cutaneous adverse drug reactions following administration of clindamycin, usually associated with other drugs. After resolution of the cutaneous adverse drug reaction, patch tests were performed with a series of antibiotics, including pure clindamycin 10% in petrolatum. Results. We studied 30 patients (23 females and 7 males) aged 33-86 years (mean 59.97 years) with generalized maculopapular exanthema where clindamycin was among the highly suspected drugs. Two patients had a previous positive involuntary rechallenge. Patch tests with clindamycin were positive in 9 of 30 patients (30%). More than 50 control patients patch tested with clindamycin were negative. Discussion. We considered the positive patch tests results with clindamycin, in the 9 patients with maculopapular exantema, to be specific, versus the negative results observed in the control group. Although the sensitivity is low (30%), they confirmed the responsibility of this antibiotic in cutaneous adverse drug reactions in which, with only chronological criteria, it was not possible to conclude on the culprit drug
Optimising medication management for polymedicated home-dwelling older adults with multiple chronic conditions
info:eu-repo/semantics/publishedVersio
Psoriasis
Pretende-se nestas Recomendações Terapêuticas dar uma visão global dos conhecimentos actuais sobre a patogenia, clÃnica e tratamento da psorÃase. A educação dos doentes deve incidir na evicção dos factores desencadeantes (medicamentos, trauma, álcool, infecções, stress) e enfa tizar a acção benéfica da exposição solar controlada na psorÃase. A terapêutica tópica
emolientes, queratolÃticos, derivados do alcatrão, antralina, corticosteróides tópicos, calcipotriol — é essencial no controlo da psorÃase vulgar em placas e é importante como adjuvante nos casos
mais graves; chama-se a atenção para os graus de potência e para os potenciais efeitos indesejáveis da corticoterapia tópica. A radiação UV isolada (fototerapia) ou em associação a fotos sensibilizantes (fotoquimioterapia) está indicada nalgumas formas de psorÃase (gutata, em placas, palmo-plantar) refractárias aos tópicos. A terapêutica sistémica — retinóides, metotrexato, ciclosporina está reservada para as formas mais graves, extensas e refractárias de psorÃase, sendo indispensável na psorÃase eritrodérmica, pustulosa ou artropática. A estratégia actual visa obter o melhor Ãndice terapêutico e dá particular importância à s terapêuticas combinadas e/ou rotativas. Para finalizar, incluem-se alguns fluxogramas, com o objectivo de ordenar os passos a
dar na abordagem do doente com psorfase e salientar a validade cientÃfica das diferentes terapêuticas disponÃveis
Nicolau Livedoid Dermatitis following intramuscular benzathine penicillin injection
We report the case of a 64-year-old male presenting with a rapidly enlarging painful violaceous plaque in the left buttock and posterior thigh, following a gluteal intramuscular injection of benzathine penicillin. Associated urinary incontinence and lower left limb paresis were consistent with sciatic and lower sacral nerve damage, as confirmed by electromyography. Additional underlying muscular damage was observed in ultrasound and computer tomodensitometry scans and supported by high serum levels of creatine kinase and lactate dehydrogenase. Aggressive treatment was performed with fluid expansion, intravenous steroid bolus, vasodilators and anticoagulation, resulting in slow improvement of cutaneous and muscular lesions. However, no significant effect was observed on neurologic dysfunction after 6 months of regular neuromuscular rehabilitation. Nicolau Livedoid Dermatitis is a rare and potentially fatal condition showing variable levels of tissue impairment and unpredictable course and prognosis. Specific treatment is not consensual and the efficacy of any particular treatment remains to be established
A challenging coexistence of central diabetes insipidus and cerebral salt wasting syndrome: A case report
Background: Combined central diabetes insipidus and cerebral salt wasting syndrome is a rare clinical finding. However, when this happens, mortality is high due to delayed diagnosis and/or inadequate treatment. Case presentation: A 42-year-old white man was referred to neurosurgery due to a non-functional pituitary macroadenoma. He underwent a partial resection of the tumor on July 2, 2015. On the day following surgery he presented polyuria with sodium 149 mEq/L, plasma osmolality 301 mOsm/kg, and urine osmolality 293 mOsm/kg. He started nasal desmopressin 0.05 mg/day with good response. He was already on dexamethasone 4 mg and levothyroxine 75 mcg due to hypopituitarism after surgery. On July 9 he became confused. Cerebral computed tomography was performed with no significant changes. His natremia dropped to 128 mEq/L with development of polyuria despite maintenance of desmopressin dose. His hemoglobin and hematocrit rose from 9.1 g/L to 11.6 g/L and 27.5 to 32.5, respectively. His thyroid function was normal and he was on hydrocortisone 30 mg/day. At 12 p.m. 150 mg/hydrocortisone infusion was initiated, but sodium did not increase. Plasma and urine osmolality were 264 mOsm/kg and 679 mOsm/kg, respectively. At 4 p.m. hydrocortisone was increased and hypertonic saline replacement started. Two hours later he was dehydrated with polyuria and vomiting, and natremia of 124 mEq/L. Hyponatremia was very resistant to treatment despite hypertonic saline replacement, hence desmopressin was suspended. The following day, urine spot analysis showed that natriuresis was 63 mEq/L with serum sodium 132 mEq/L. This was interpreted as a cerebral salt wasting syndrome and control was achieved with aggressive hypertonic saline replacements and fludrocortisone 0.1 mg/three times a day. Conclusions: We present a rare case of a patient with diabetes insipidus and cerebral salt wasting syndrome, who was successfully treated. Hyponatremia in a patient with diabetes insipidus may erroneously be interpreted as inadequate diabetes insipidus control or as syndrome of inappropriate antidiuretic hormone secretion, leading to therapeutic errors. Thus, all clinical and analytical data should be evaluated together for early and correct diagnosis
Guidelines for telematic second opinion consultation in headaches in Europe: on behalf of the European Headache Federation
The seeking of a second opinion is the long-established process whereby a physician or expert from the same or a similar specialty is invited to assess a clinical case in order to confirm or reject a diagnosis or treatment plan. Seeking a second opinion has become more common in recent years, and the trend is associated with significant changes in the patient-doctor relationship. Telemedicine is attractive because it is not only fast but also affordable and thus makes it possible to reach highly qualified centres and experts that would otherwise be inaccessible, being impossible, or too expensive, to reach by any surface transport. In Europe, the European Headache Federation (EHF), being able to draw on a group of headache experts covering all the European languages, is the organisation best placed to provide qualified second-opinion consultation on difficult headache cases and to develop a Headache Medical Opinion Service Centre. The provision of good quality clinical information is crucial to the formulation of a valid, expert second opinion. This preliminary step can be properly accomplished only by the primary health care provider through the furnishing of an appropriate clinical report, together with the results of all available tests, including original films of all imaging studies already performed. On receiving the EHF's proposed standardised data collection form, properly filled in, we may be sure that we have all the relevant data necessary to formulate a valid expert second opinion. This form can be accessed electronically and downloaded from the EHF website. Once finalised, the EHF second opinion project should be treated as a pilot strategy that requires careful monitoring (for the first year at least), so that appropriate changes, as suggested by the retrospective analysis and its quality control, can be implemented
The Family and Safety of the Hospitalized Patient: An Integrative Literature Review
Framework: Considering that the current data on health care
safety remain alarming, there is an overwhelming urge for the
ongoing study of this topic and for recommendations and differentiated
strategies which aim to promote health and which
prove effective. Some recommendations have been taken
into consideration, such as patient-centered care, and consequently
the need for greater involvement of patient and family
in this process. However, we have identified arguments for
and against the involvement of family in the care process, and
consequently a greater or lesser openness towards hospital
visits. Objective: What are the implications of the presence of
family for the safety of hospitalized patients? What does the
science say about these implications? Methods: We conducted
an integrative literature review by referring to the Web of
Science, CINAHL, Medline, and Scopus databases, according
to the recommendations of the Joanna Briggs Institute for
scoping review. Results: We found 115 articles. After selection,
13 articles were included in this review. There were 6
qualitative studies, 5 quantitative studies, and 2 literature reviews.
Data were grouped according to: the perspective of
patients and their families, the health professionals’ perspective,
and statistical evidence. Conclusion: Families take efforts
to protect the safety of hospitalized patients but feel unprepared;
a lack of follow-up was reported. Some health professionals
claim that the presence of the family can increase the
risks for patient safety and the fear of an increased workload.
The evidence of the presence of the family and its link to the
safety of the hospitalized patient demonstrated that this relationship
is not yet well understood. There were limited findings
about this in the current literature. Relevance to Clinical
Practice: Structured interventions about family integration in
ensuring the safety of hospitalized patients may have the potential
to contribute to the safety of health care.Enquadramento: Considerando que os dados atuais sobre
segurança em saúde ainda são alarmantes, há uma
urgência avassaladora pelo estudo contÃnuo desse tema
e por recomendações e estratégias diferenciadas que
visem a promoção da saúde. Existem algumas recomendações
que têm sido levadas em consideração a esse
respeito, como o cuidado centrado no paciente e, consequentemente,
a necessidade de maior envolvimento do
paciente e de sua famÃlia nesse processo. Porém, no contexto
de trabalho, identificamos argumentos a favor e
contra o envolvimento da famÃlia no processo de cuidado
e, consequentemente, uma maior ou menor abertura
para visitas no contexto hospitalar. Objetivo: Quais as implicações
da presença da famÃlia na segurança do doente
internado com o intuito de responder á questão de investigação:
Qual a produção cientÃfica sobre as implicações
da presença da famÃlia na segurança do doente hospitalizado?
Métodos: Revisão integrativa da literatura através
de pesquisa nas bases de dados Web of Science, CINAHL,
Medline e Scopus, de acordo com as recomendações do
Joanna Briggs Institute para scoping review. Resultados:
Da pesquisa foram encontrados 115 artigos. Após a
seleção foram incluidos neste estudo 13 artigos. Destes, 7
estudos qualitativos, 5 quantitativos e 2 revisões de literatura,
cujos dados foram agrupados de acorco com: perspetiva
da famÃlia e doente, a perspetiva dos profissionais
de saúde e a evidência estatistica. Conclusão: A familia
desenvolve esforços no sentido de proteger a segurança
do doente internado mas sente-se despreparada e desacompanhada.
Alguns profissionais de saúde alegam que
a presença da familia pode aumentar os riscos para a segurança
do doente e receiam aumento da carga de trabalho.
A evidência encontrada sobre presença da famÃlia e
a sua relação com a segurança do doente internado
demonstra que esta relação ainda não é bem compreendida,
com achados disponÃveis limitados na literatura atual.
Relevância para a Prática ClÃnica: Intervenções estruturadas
de integração da famÃlia na salvaguarda da segurança
do doente internado podem ter o potencial de
contribuir para a segurança dos cuidados de saúde.info:eu-repo/semantics/publishedVersio
Pityriasis lichenoides et varioliformis acute: case report and review of the literature
We report a case of a 63-year-old man hospitalized for a polymorphous generalized eruption consisting of maculopapules with peripheral scaling, vesicopustules, and ulceronecrotic and crusted lesions measuring 5-20 mm, localized on his trunk and extremities, particularly exuberant in the flexural area. Histopathology showed necrotic keratinocytes with exocytosis of red blood cells and lymphocytes and a dermal perivascular and periadnexal inflammatory infiltrate, composed of CD8+/CD4-/CD30- T cells, indicating the clinical diagnosis of pityriasis lichenoides et varioliformis acuta. He was treated with erythromycin and methylprednisolone reduced gradually over 5 months, with a slow but complete response; the patient was without lesions after 2 years of follow-up. The authors want to remind of this rare entity which may present difficulties in diagnosis and therap
Em torno da realidade local - Olhares dos Presidentes de Junta sobre as barreiras arquitetónicas
info:eu-repo/semantics/publishedVersio
Propolis components accountable for bactericidal accomplishment and antibiofilm activity
This study aimed at evaluating antimicrobial and antibiofilm activity of phenolic compounds present in propolis ethanol extracts (PEE).
Seventy per cent ethanol extracts from seven types of propolis, one Green, two Red and four Brown collected in four Brazilian States were prepared and total phenolics, flavonoids, tannins and anthocyanins were assessed by high-performance liquid chromatography (HPLC). Minimum bactericidal concentration (MBC) and inhibitor effect on Staphylococcus aureus biofilm formation and capacity to disrupt established biofilms were assessed towards eight S. aureus isolates from milk of small ruminants with mastitis, one methicillin-resistant S. aureus (MRSA) and S. aureus ATCC 25923. To evaluate different propolis components accountability for bactericidal accomplishment and antibiofilm activity, the results were analysed by the non-parametric Spearman coefficient.
Results of phenolic compounds were 216,21 to 312,08 gallic acid milligram equivalent per extract gram (mg EGA/g) of total phenolics, 55,08 to 140,6 quercetin milligram equivalent per extract gram (mg EQ/g) of flavonoids, 118,51 to 3766,16 catechin milligram equivalent per extract gram (mg EC/g) of tannins and 1,03 to 8,39 milligram per extract gram (mg/g) of anthocyanins. Red1 and Red2 showed higher tannin contents, while Red2 exhibited superior amount of anthocyanins and total phenolics. Brown3 presented higher flavonoid quantity. Green, Red1 and Red2 PEE showed the lowest levels of flavonoids, but the higher antimicrobial activity. Most PEE exhibit bactericidal activity at a concentration of 1.6 mg/mL. Brown4 PEE showed the worst capacity to inhibit S. aureus. Green PEE showed to be the most efficient in both preventing and disrupting biofilm. All PEE studied exhibited a better inhibitory activity prior-to than post-biofilm formation. According to non-parametric Spearman correlation analysis, there seems to be a significant negative correlation between the ability to disrupt biofilm and both tannins and anthocyanins contents
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