Desensibilización con alimentos

Hasta hace poco, el enfoque principal para tratar las alergias alimentarias implicaba evitar estrictamente el alérgeno desencadenante. Este método a menudo se consideraba insuficiente, lo que dejaba a los pacientes vulnerables a pequeñas cantidades o fuentes ocultas del alérgeno. La desensibilización, o inducción de tolerancia oral, es un método emergente que se está investigando para el tratamiento de las alergias alimentarias. El objetivo final es conseguir una tolerancia permanente, previniendo reacciones alérgicas tras una nueva exposición al alérgeno tras un periodo de abstinencia. La investigación se ha centrado en la inmunoterapia con alérgenos específicos a través de tres vías: oral, sublingual y epicutánea. La leche, el huevo y el maní son los principales alimentos estudiados debido a su prevalencia en las alergias. Se prefiere la inducción oral porque la ingestión de una persona no alérgica induce una respuesta inmune sin desencadenar una reacción alérgica. La atención de pacientes se ha desplazado de evitar el alergeno a ofrecer estrategias de consumo temprano para prevenir las alergias. En este enfoque se considera crucial el rango de edad de 4 a 6 meses. Se necesita investigación continua para evaluar los detalles de la población, los efectos a largo plazo, la viabilidad y la seguridad de estas estrategias

Latin American anaphylaxis registry

Background: Recent data about clinical features, triggers and management of anaphylaxis in Latin America is lacking. Objective: To provide updated and extended data on anaphylaxis in this region. Method: An online questionnaire was used, with 67 allergy units involved from 12 Latin-American countries and Spain. Among data recorded, demographic information, clinical features, severity, triggering agents, and treatment were received. Results: Eight hundred and seventeen anaphylactic reactions were recorded. No difference in severity, regardless of pre-existing allergy or asthma history was found. Drug induced anaphylaxis (DIA) was most frequent (40.6%), followed by food induced anaphylaxis (FIA) (32.9%) and venom induced anaphylaxis (VIA) (12%). FIA and VIA were more common in children-adolescents. Non-steroidal anti-inflammatory drugs (NSAIDs) and beta-lactam antibiotics (BLA) were the most frequent drugs involved. Milk (61.1% of FIA) and egg (15.4% of FIA) in children, and shellfish (25.5% of FIA), fresh fruits (14.2% of FIA), and fish (11.3% of FIA) in adults were the most common FIA triggers. Fire ants were the most frequent insect triggers, and they induced more severe reactions than triggers of FIA and DIA (p < 0.0001). Epinephrine was used in 43.8% of anaphylaxis episodes. After Emergency Department treatment, epinephrine was prescribed to 13% of patients. Conclusions: Drugs (NSAIDs and BLA), foods (milk and egg in children and shellfish, fruits and fish in adults) and fire ants were the most common inducers of anaphylaxis. Epinephrine was used in less than half of the episodes emphasizing the urgent need to improve dissemination and implementation of anaphylaxis guidelines.Revisión por pare

Drug-induced anaphylaxis, elicitors, risk factors, and management in Latin America

Nonsteroidal anti-inflammatory drugs were the most frequent triggers of drug-induced anaphylaxis in Latín America, whereas antibiotics elicited faster onset and more scvere reactions. An improvement was observed in epinephrinc use and adherence to guidelines in the emergency department treatment of anaphylaxis in Latín America compared with our last report.Facultad de Ciencias Médica

Effect of Drug-Coated Balloons in Native Coronary Artery Disease Left with a Dissection

Objectives The authors sought to understand the clinical and angiographic outcomes of dissections left after drug-coated balloon (DCB) angioplasty. Background Second-generation DCB may be an alternative to stents in selected populations for the treatment of native coronary lesions. However, the use of these devices may be hampered by a certain risk of acute vessel recoil or residual coronary dissection. Moreover, stenting after DCB has shown limited efficacy. Little is known about when a non-flow-limiting dissection is left after DCB angioplasty. Methods This was a prospective observational study whose aim was to investigate the outcome of a consecutive series of patients with native coronary artery disease treated with second-generation DCB and residual coronary dissection at 2 Italian centers. We evaluated patient clinical conditions at 1 and 9 months, and angiographic follow up was undertaken at 6 months. Results Between July 2012 and July 2014, 156 patients were treated with DCB for native coronary artery disease. Fifty-two patients had a final dissection, 4 of which underwent prosthesis implantation and 48 were left untreated and underwent angiographic follow-up after 201 days (interquartile range: 161 to 250 days). The dissections were all type A to C, and none determined an impaired distal flow. Complete vessel healing at angiography was observed in 45 patients (93.8%), whereas 3 patients had persistent but uncomplicated dissections, and 3 had binary restenosis (6.2%). Late lumen loss was 0.14 mm (-0.14 to 0.42). Major adverse cardiovascular events occurred in 11 patients in the entire cohort and in 4 of the dissection cohort (7.2% vs. 8.1%; p = 0.48). We observed 8 and 3 target lesion revascularizations, respectively (5.3% vs. 6.2%; p = 0.37). Conclusions In this cohort of consecutive patients treated with new-generation DCB and left with a final dissection, this strategy of revascularization seemed associated with the sealing of most of dissections and without significant neointimal hyperplasia

Coronary Stent Thrombosis in 2015: A Comprehensive and Uptodated&nbsp;Review

Stent thrombosis (ST) is a life-threatening, although quite rare, complication of percutaneous coronary intervention with stenting. According to the Academic Research Consortium, it may be defined as definite, probable, or possible. Moreover, its occurrence after index procedure differentiates between early, late and very late. This complication is associated with high morbidity and mortality and has a very high impact on global health of patients with cardiovascular disorders, therefore a multifactorial approach seems a useful tool for understanding its causes and improving its outcome. In this review we analyze all the most important issues of this disorder beginning from its classification, then we overview the pathophysiological mechanisms and factors implicated and, lastly, we give a glimpse to the future perspective on prevention strategies

Effect of Drug-Coated Balloons in Native Coronary Artery Disease Left with a Dissection

Objectives The authors sought to understand the clinical and angiographic outcomes of dissections left after drug-coated balloon (DCB) angioplasty. Background Second-generation DCB may be an alternative to stents in selected populations for the treatment of native coronary lesions. However, the use of these devices may be hampered by a certain risk of acute vessel recoil or residual coronary dissection. Moreover, stenting after DCB has shown limited efficacy. Little is known about when a non-flow-limiting dissection is left after DCB angioplasty. Methods This was a prospective observational study whose aim was to investigate the outcome of a consecutive series of patients with native coronary artery disease treated with second-generation DCB and residual coronary dissection at 2 Italian centers. We evaluated patient clinical conditions at 1 and 9 months, and angiographic follow up was undertaken at 6 months. Results Between July 2012 and July 2014, 156 patients were treated with DCB for native coronary artery disease. Fifty-two patients had a final dissection, 4 of which underwent prosthesis implantation and 48 were left untreated and underwent angiographic follow-up after 201 days (interquartile range: 161 to 250 days). The dissections were all type A to C, and none determined an impaired distal flow. Complete vessel healing at angiography was observed in 45 patients (93.8%), whereas 3 patients had persistent but uncomplicated dissections, and 3 had binary restenosis (6.2%). Late lumen loss was 0.14 mm (-0.14 to 0.42). Major adverse cardiovascular events occurred in 11 patients in the entire cohort and in 4 of the dissection cohort (7.2% vs. 8.1%; p = 0.48). We observed 8 and 3 target lesion revascularizations, respectively (5.3% vs. 6.2%; p = 0.37). Conclusions In this cohort of consecutive patients treated with new-generation DCB and left with a final dissection, this strategy of revascularization seemed associated with the sealing of most of dissections and without significant neointimal hyperplasia

Manuale di zoologia

Manuale didattico descrittivo della diversità e disparità di protisti e metazoi