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[PMID]:28470719
[Au] Autor:Ballas SK
[Ad] Endereço:Cardeza Foundation for Hematologic Research, Department of Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania.
[Ti] Título:From total blood exchange to erythrocytapheresis and back to treat complications of sickle cell disease.
[So] Source:Transfusion;57(9):2277-2280, 2017 09.
[Is] ISSN:1537-2995
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Erythrocytapheresis is an important procedure in the management of certain complications of sickle cell disease, including acute stroke, stroke prevention, acute chest syndrome, and multiorgan failure. Erythrocytapheresis in sickle cell disease simply entails the removal of the patient's red blood cells containing the abnormal sickle hemoglobin and replacing them with normal red blood cells carrying normal hemoglobin. In these procedures, the patient's plasma is not exchanged but is returned to the patient. Several studies have demonstrated that the plasma of patients with sickle cell disease contains several components that increase blood viscosity and initiate or promote vaso-occlusion. These factors include increased levels of globulins, especially immunoglobulin G, acute-phase reactants, fibrinogen, coagulation factors, inflammatory mediators, and heme in the steady state and increase further during painful crises. This may explain why, in certain complications of sickle cell disease, such as acute chest syndrome, hepatic crisis, and priapism, erythrocytapheresis by itself may not be effective despite repetitive cycles of red blood cell exchange. The use of therapeutic plasma exchange in addition to erythrocytapheresis in these situations seems to be useful in resolving them more efficiently. The role of therapeutic plasma exchange in the management of certain complications of sickle cell disease needs further evaluation. This commentary addresses the role of therapeutic plasma exchange in the management of complications of sickle cell disease.
[Mh] Termos MeSH primário: Anemia Falciforme/terapia
Citaferese/métodos
Transfusão Total/métodos
[Mh] Termos MeSH secundário: Anemia Falciforme/complicações
Viscosidade Sanguínea
Gerenciamento Clínico
Eritrócitos
Seres Humanos
Troca Plasmática/métodos
[Pt] Tipo de publicação:JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T
[Em] Mês de entrada:1710
[Cu] Atualização por classe:180305
[Lr] Data última revisão:
180305
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170505
[St] Status:MEDLINE
[do] DOI:10.1111/trf.14154


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[PMID]:27774620
[Au] Autor:Vendramin C; McGuckin S; Alwan F; Westwood JP; Thomas M; Scully M
[Ad] Endereço:Department of Haematology, University College London Hospital.
[Ti] Título:A single-center prospective study on the safety of plasma exchange procedures using a double-viral-inactivated and prion-reduced solvent/detergent fresh-frozen plasma as the replacement fluid in the treatment of thrombotic microangiopathy.
[So] Source:Transfusion;57(1):131-136, 2017 01.
[Is] ISSN:1537-2995
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Patients presenting with acute episodes of thrombotic microangiopathies (TMAs) require urgent access to plasma exchange (PEX). OctaplasLG, a solvent/detergent fresh-frozen plasma product that has undergone viral inactivation and prion reduction step, has been used in our institution since 2013, replacing Octaplas. STUDY DESIGN AND METHODS: We prospectively reviewed 981 PEX procedures where OctaplasLG was the replacement fluid in 90 patients admitted acutely with a TMA presentation within our institution from January 1, 2013, to December 31, 2015. We recorded citrate toxicities, plasma reactions, viral transfer, complications related to central venous catheter, and venous thrombotic events (VTEs). RESULTS: Citrate toxicities were 5.4%, plasma reactions were 2%, and all were classified as Grade 1 or 2. VTE had an incidence of 12.2%, although 50% of the episodes occurred in early remission when patients were not receiving PEX. No line insertions complications were recorded. Line-associated infections were 2.2%. Hepatitis B and C serology and human immunodeficiency virus (HIV) were checked on admission. There were four patients who may have had passive transient transfer of hepatitis B antibodies from pooled plasma. No hepatitis C or HIV viral transfer was documented after treatment and no seroconversion was detected after treatment. CONCLUSION: Our data have demonstrated that the incidence of complications during PEX is low and using OctaplasLG is comparable to the low incidence of reactions. No cases of anaphylaxis, transfusion-related acute lung injury, or fatal plasma reactions were seen. There was no evidence of viral transmission or seroconversion after treatment.
[Mh] Termos MeSH primário: Desinfecção/métodos
Troca Plasmática/métodos
Plasma
Príons
Microangiopatias Trombóticas/terapia
Inativação de Vírus
[Mh] Termos MeSH secundário: Adolescente
Adulto
Idoso
Idoso de 80 Anos ou mais
Detergentes/química
Feminino
HIV
Infecções por HIV/prevenção & controle
Hepacivirus
Hepatite B/prevenção & controle
Vírus da Hepatite B
Hepatite C/prevenção & controle
Seres Humanos
Masculino
Meia-Idade
Estudos Prospectivos
Solventes/química
[Pt] Tipo de publicação:CLINICAL TRIAL; JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T
[Nm] Nome de substância:
0 (Detergents); 0 (Prions); 0 (Solvents)
[Em] Mês de entrada:1706
[Cu] Atualização por classe:180302
[Lr] Data última revisão:
180302
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161025
[St] Status:MEDLINE
[do] DOI:10.1111/trf.13877


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[PMID]:29367529
[Au] Autor:Tamura M; Kitano M; Azuma K; Tsuboi K; Abe T; Ogita C; Yokoyama Y; Furukawa T; Yoshikawa T; Saito A; Nishioka A; Sekiguchi M; Azuma N; Tsunoda S; Hosono Y; Nakashima R; Ohmura K; Matsui K; Mimori T; Sano H
[Ad] Endereço:Division of Rheumatology, Department of Internal Medicine, Hyogo College of Medicine.
[Ti] Título:[A case of anti-PL-7 antibody positive polymyositis with thrombotic microangiopathy].
[So] Source:Nihon Rinsho Meneki Gakkai Kaishi;40(6):450-455, 2017.
[Is] ISSN:1349-7413
[Cp] País de publicação:Japan
[La] Idioma:jpn
[Ab] Resumo:  A 65-year-old woman with a 17-year history of polymyositis and 8-year history of rheumatoid arthritis who was treated with a low dose of prednisolone and tacrolimus (Tac) was admitted to our hospital because of general malaise and hypertension. Blood tests showed thrombocytopenia, hemolytic anemia with fragmented erythrocytes, and hypercreatinemia. Based on these clinical features, she was diagnosed with thrombotic micro-angiopathy (TMA). Thrombocytopenia and hemolytic anemia with fragmented erythrocytes improved with the discontinuation of Tac and plasma exchange; however, hypertension and renal dysfunction persisted. TMA due to calcineurin inhibitor (CNI) nephropathy was suspected based on the histopathological findings of renal biopsy. However, the condition was atypical of a CNI nephropathy because the trough level of Tac was lower than that reported previously and renal dysfunction persisted after drug discontinuation. She had mild sclerodactylia and Raynaud's symptoms, although the diagnostic criteria for systemic sclerosis (SSc) were not satisfied. Moreover, the patient tested positive for anti PL-7 antibody. The relationship between anti PL-7 antibody and pathogenesis of SSc has been reported. In this case, it was suspected that CNI nephropathy worsened because of the potential basic factors of SSc. These findings indicate that TMA may occur in patients testing positive for anti PL-7 antibody who are treated with Tac.
[Mh] Termos MeSH primário: Aminoacil-tRNA Sintetases/imunologia
Autoanticorpos/sangue
Polimiosite/complicações
Microangiopatias Trombóticas/etiologia
[Mh] Termos MeSH secundário: Idoso
Artrite Reumatoide/complicações
Artrite Reumatoide/terapia
Biomarcadores/sangue
Inibidores de Calcineurina/administração & dosagem
Inibidores de Calcineurina/efeitos adversos
Feminino
Seres Humanos
Troca Plasmática
Polimiosite/diagnóstico
Polimiosite/terapia
Tacrolimo/administração & dosagem
Tacrolimo/efeitos adversos
Microangiopatias Trombóticas/diagnóstico
Suspensão de Tratamento
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Autoantibodies); 0 (Biomarkers); 0 (Calcineurin Inhibitors); EC 6.1.1.- (Amino Acyl-tRNA Synthetases); WM0HAQ4WNM (Tacrolimus)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180227
[Lr] Data última revisão:
180227
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180126
[St] Status:MEDLINE
[do] DOI:10.2177/jsci.40.450


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[PMID]:29390523
[Au] Autor:Freist M; Garrouste C; Szlavik N; Coppo P; Lautrette A; Heng AE
[Ad] Endereço:Service de Néphrologie, Pôle REUNNIRH, CHU Clermont-Ferrand, Clermont-Ferrand.
[Ti] Título:Efficacy of eculizumab in an adult patient with HIV-associated hemolytic uremic syndrome: A case report.
[So] Source:Medicine (Baltimore);96(51):e9358, 2017 Dec.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:INTRODUCTION: Hemolytic uremic syndrome (HUS) in Human Immunodeficiency Virus (HIV)-positive patients has become a rare cause of kidney injury since the era of highly active antiretroviral therapy (HAART). Plasma exchange and antiretroviral therapy were previously recommended but often failed to achieve remission. We report a case of HUS in a HIV-positive patient treated successfully with eculizumab. CASE SUMMARY: A 52-year-old woman presented to hospital with acute renal failure, thrombocytopenia, anemia, and hypoxemia. She had been diagnosed with HIV infection in 1997. Kidney biopsy showed several fibrinous microthrombi in the glomerular capillaries, formation of thrombi in arterioles, moderate parietal and mesangial deposits of C3 and Immunoglobulin M, and intense glomerular and arterial deposits of Complement component 5b9 complement component. Serum HIV viral load was 227,848 copies/mL, and CD4 lymphocyte count was 120 cells/µL. A diagnosis of HIV-associated HUS was made. The patient had no confounding cause of HUS. Initiation of eculizumab and HAART resulted in complete hematological remission on day 32 and dialysis withdrawal on day 110. The patient has not relapsed during long-term follow-up (M17). CONCLUSION: This observation suggests that eculizumab can achieve remission in HIV patients with HUS.
[Mh] Termos MeSH primário: Anticorpos Monoclonais Humanizados/uso terapêutico
Anticorpos Monoclonais/uso terapêutico
Infecções por HIV/complicações
Síndrome Hemolítico-Urêmica/complicações
Síndrome Hemolítico-Urêmica/terapia
[Mh] Termos MeSH secundário: Lesão Renal Aguda/diagnóstico
Lesão Renal Aguda/etiologia
Terapia Antirretroviral de Alta Atividade/métodos
Biópsia por Agulha
Feminino
Seguimentos
Infecções por HIV/diagnóstico
Infecções por HIV/tratamento farmacológico
Síndrome Hemolítico-Urêmica/diagnóstico
Seres Humanos
Imuno-Histoquímica
Testes de Função Renal
Meia-Idade
Troca Plasmática/métodos
Diálise Renal/métodos
Medição de Risco
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Antibodies, Monoclonal); 0 (Antibodies, Monoclonal, Humanized); A3ULP0F556 (eculizumab)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180219
[Lr] Data última revisão:
180219
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180203
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000009358


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[PMID]:29321467
[Au] Autor:Miao J; Aboagye DE; Chulpayev B; Liu L; Ishkanian G; Kolanuvada B; Alaie D; Petrillo RL
[Ad] Endereço:Department of Internal Medicine, Montefiore Mount Vernon Hospital, Mount Vernon, NY, USA.
[Ti] Título:Importance of Regular and Maintenance Therapy Adherence in Neuromyelitis Optica (NMO): Lessons from a Repeating Relapse Case.
[So] Source:Am J Case Rep;19:41-46, 2018 Jan 11.
[Is] ISSN:1941-5923
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND Neuromyelitis optica (NMO) is a rare demyelinating disease of the central nervous system; NMO predominantly affects the spinal cord and optic nerves. The diagnosis is based on history, clinical presentation, seropositive NMO-IgG antibody, and notably, exclusion of other diseases. Despite the absence of definitive therapeutic strategies for NMO, methylprednisolone pulse therapy and plasma exchange are used for acute phase treatment, while immunosuppressive agent(s) are recommended to prevent relapses and improve prognosis. Here, we report a repeating relapse NMO case due to lack of regular and maintenance therapy. CASE REPORT A 58-year-old female with chronic NMO presented with a three-day history of new-onset right leg weakness and pain. The patient was diagnosed with NMO three years ago and presented with her fourth attacks. During her initial diagnosis, she was initiated on steroids. One year later, she developed the first relapse and was treated with steroids and rituximab, leading to 1.5-year remission. After the second relapse, steroids and rituximab was still given as maintenance therapy, but was not followed. Thus, the third relapse occurred in five months. During this hospitalization, she received initially high-dose solumedrol (1 g daily for five days) in addition to gabapentin 100 mg (gradually increased to 300 mg) three times a day for muscle spasms. Due to worsening of paresthesia and hemiparesis, it was decided to place her on plasma exchange treatment. After two plasma exchanges, the patient's condition was improved and she regained strength in her lower extremity. She completed five more cycles of plasma exchange, and was then discharged on steroid therapy (prednisone 20 mg daily for 10 days then taper) as maintenance therapy and with follow-up in neurology clinic. CONCLUSIONS Over the span of three years, the patient has had three relapses since her NMO diagnosis where her symptoms have worsened. Steroid therapy alone seemed not insufficient in managing her more recent relapses. Nonadherence to NMO treatment likely increased her risk for recurrence, thus regular and long-term maintenance therapy is imperative to delay the progression and prevent relapse in NMO.
[Mh] Termos MeSH primário: Glucocorticoides/uso terapêutico
Imunossupressores/uso terapêutico
Neuromielite Óptica/diagnóstico
Neuromielite Óptica/terapia
Troca Plasmática
Rituximab/uso terapêutico
Cooperação e Adesão ao Tratamento
[Mh] Termos MeSH secundário: Aminas/uso terapêutico
Analgésicos/uso terapêutico
Autoanticorpos/sangue
Biomarcadores/sangue
Doença Crônica
Ácidos Cicloexanocarboxílicos/uso terapêutico
Feminino
Seres Humanos
Fatores Imunológicos/sangue
Meia-Idade
Neuromielite Óptica/sangue
Troca Plasmática/métodos
Prognóstico
Recidiva
Resultado do Tratamento
Ácido gama-Aminobutírico/uso terapêutico
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Amines); 0 (Analgesics); 0 (Autoantibodies); 0 (Biomarkers); 0 (Cyclohexanecarboxylic Acids); 0 (Glucocorticoids); 0 (Immunologic Factors); 0 (Immunosuppressive Agents); 4F4X42SYQ6 (Rituximab); 56-12-2 (gamma-Aminobutyric Acid); 6CW7F3G59X (gabapentin)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180205
[Lr] Data última revisão:
180205
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180112
[St] Status:MEDLINE


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[PMID]:29238021
[Au] Autor:Kiboshi T; Isoda K; Furukawa K; Wakahara T; Otani K; Ueda K; Konma J; Teramura K; Ueno N; Fujiwara H; Shoda T
[Ad] Endereço:Department of Rheumatology, Yodogawa Christian Hospital.
[Ti] Título:[Granulomatosis with Polyangiitis Complicated with Gastrointestinal Perforation: A Case Report and Review of Literature].
[So] Source:Nihon Rinsho Meneki Gakkai Kaishi;40(5):382-386, 2017.
[Is] ISSN:1349-7413
[Cp] País de publicação:Japan
[La] Idioma:jpn
[Ab] Resumo:  A 51-year-old man was detected nasal bleeding, multiple pulmonary nodule and mass, urinalysis abnormality, renal involvement and high titer of proteinase 3-anti-neutrophil cytoplasmic antibody (PR3-ANCA), and was suspected of granulomatosis with polyangiitis and initiated with steroid pulse therapy. On the day after the start of steroid pulse therapy, generalized peritonitis due to ileal perforation occurred, and emergency ileectomy and peritonitis surgery were performed. Induction therapy with steroid pulse therapy, plasma exchange and intravenous cyclophosphamide therapy (IVCY) and maintenance therapy with glucocorticoid and azathioprine led to good therapeutic outcomes. Gastrointestinal perforation in GPA is a rare complication, and we examined the clinical features, treatment contents, and prognosis of GPA with gastrointestinal perforation from this case and previous reports. Lung involvements were complicated in all reported cases. Gastrointestinal perforations in GPA were frequent in the small intestine, occurred just before and immediately after the start of treatment, and were severe involvement with poor prognosis because of the high mortality rate (46.7%). The frequency of ear, nose and upper respiratory tract lesions in the surviving group was significantly higher than in the dead group (survival 87.5%, death 28.3%, P = 0.041). IVCY were more frequently used in the surviving group (62.5%) than the death group (16.7%), but it was not significantly. GPA complicated with gastrointestinal perforation is a severe condition with poor prognosis, but there is a possibility to improve prognosis by early diagnosis and early initiation of strong treatment.
[Mh] Termos MeSH primário: Granulomatose com Poliangiite/complicações
Granulomatose com Poliangiite/terapia
Íleo
Perfuração Intestinal/etiologia
Troca Plasmática
[Mh] Termos MeSH secundário: Anticorpos Anticitoplasma de Neutrófilos/sangue
Azatioprina/administração & dosagem
Biomarcadores/sangue
Ciclofosfamida/administração & dosagem
Diagnóstico Precoce
Granulomatose com Poliangiite/diagnóstico
Seres Humanos
Perfuração Intestinal/cirurgia
Masculino
Metilprednisolona/administração & dosagem
Meia-Idade
Mieloblastina/imunologia
Prognóstico
Pulsoterapia
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE; REVIEW
[Nm] Nome de substância:
0 (Antibodies, Antineutrophil Cytoplasmic); 0 (Biomarkers); 8N3DW7272P (Cyclophosphamide); EC 3.4.21.76 (Myeloblastin); MRK240IY2L (Azathioprine); X4W7ZR7023 (Methylprednisolone)
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180112
[Lr] Data última revisão:
180112
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171215
[St] Status:MEDLINE
[do] DOI:10.2177/jsci.40.382


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[PMID]:29173297
[Au] Autor:Ebato T; Ogata S; Ogihara Y; Fujimoto M; Kitagawa A; Takanashi M; Ishii M
[Ad] Endereço:Department of Pediatrics, Kitasato University, Kanagawa, Japan.
[Ti] Título:The Clinical Utility and Safety of a New Strategy for the Treatment of Refractory Kawasaki Disease.
[So] Source:J Pediatr;191:140-144, 2017 Dec.
[Is] ISSN:1097-6833
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: To assess the clinical utility and safety of a strategy for refractory Kawasaki disease, defined by Egami score ≥3. STUDY DESIGN: First-line treatment was with intravenous methylprednisolone (30 mg/kg, 2 hours, 1 dose) plus intravenous immunoglobulin (2 g/kg, 24 hours) treatment. Patients resistant to first-line treatment received additional intravenous immunoglobulin as a second-line treatment. Patients resistant to second-line treatment who had received Bacillus Calmette-Guérin vaccination 6 months earlier were treated with infliximab; otherwise, plasma exchange was performed. A total of 71 refractory patients with Kawasaki disease (median age: 2.4 years) of 365 patients with Kawasaki disease were treated according to our strategy from April 2007 to April 2016. Treatment resistance was defined as a persistent fever at 36 hours after treatment. We evaluated coronary artery lesions at the time of the diagnosis, at 1 month, and at 1 year after the diagnosis in accordance with the American Heart Association guidelines and the criteria of the Japanese Ministry of Health, Labour, and Welfare. RESULTS: First-line therapy was effective for 58 of 71 patients (81.6%), and second-line therapy was effective for 9 of 13 patients (69.2%). At third line, 3 patients were treated by infliximab, and 1 was treated with plasma exchange. Of the 18 patients with coronary artery abnormalities at diagnosis, 13 patients at 1 month and 6 patients at 1 year had coronary artery dilatation (median z score 3.0, 2.6, and 1.4, respectively). There were no patients with coronary artery aneurysm (CAA). CONCLUSIONS: Our strategy for refractory Kawasaki disease was safe and effective in preventing CAA.
[Mh] Termos MeSH primário: Anti-Inflamatórios/uso terapêutico
Imunoglobulinas Intravenosas/uso terapêutico
Fatores Imunológicos/uso terapêutico
Infliximab/uso terapêutico
Metilprednisolona/uso terapêutico
Síndrome de Linfonodos Mucocutâneos/terapia
Troca Plasmática
[Mh] Termos MeSH secundário: Doença Aguda
Criança
Pré-Escolar
Protocolos Clínicos
Terapia Combinada
Aneurisma Coronário/etiologia
Aneurisma Coronário/prevenção & controle
Esquema de Medicação
Quimioterapia Combinada
Feminino
Seres Humanos
Lactente
Injeções Intravenosas
Masculino
Síndrome de Linfonodos Mucocutâneos/complicações
Resultado do Tratamento
[Pt] Tipo de publicação:CLINICAL TRIAL; JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Anti-Inflammatory Agents); 0 (Immunoglobulins, Intravenous); 0 (Immunologic Factors); B72HH48FLU (Infliximab); X4W7ZR7023 (Methylprednisolone)
[Em] Mês de entrada:1712
[Cu] Atualização por classe:171211
[Lr] Data última revisão:
171211
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:171128
[St] Status:MEDLINE


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[PMID]:29095303
[Au] Autor:Yang WY; Han YH; Cao XW; Pan JK; Zeng LF; Lin JT; Liu J
[Ad] Endereço:aDepartment of Orthopaedics, Second Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine) bSecond School of Clinical Medicine, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China.
[Ti] Título:Platelet-rich plasma as a treatment for plantar fasciitis: A meta-analysis of randomized controlled trials.
[So] Source:Medicine (Baltimore);96(44):e8475, 2017 Nov.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Recently, platelet-rich plasma (PRP) has been used as an alternative therapy for plantar fasciitis (PF) to reduce heel pain and improve functional restoration. We evaluated the current evidence concerning the efficacy and safety of PRP as a treatment for PF compared with the efficacy and safety of steroid treatments. METHODS: Databases (PubMed, EMBASE, and The Cochrane Library) were searched from their establishment to January 30, 2017, for randomized controlled trials (RCTs) comparing PRP with steroid injections as treatments for PF. The Cochrane risk of bias (ROB) tool was used to assess the methodological quality. Outcome measurements were the visual analogue scale (VAS), Foot and Ankle Disability Index (FADI), American Orthopedic Foot and Ankle Society (AOFAS) scale, and the Roles and Maudsley score (RMS). The statistical analysis was performed with RevMan 5.3.5 software. RESULTS: Nine RCTs (n = 430) were included in this meta-analysis. Significant differences in the VAS were not observed between the 2 groups after 4 [weighted mean difference (WMD) = 0.56, 95% confidence interval (95% CI): -1.10 to 2.23, P = .51, I = 89%] or 12 weeks of treatment (WMD = -0.49, 95% CI: -1.42 to 0.44, P = .30, I = 89%). However, PRP exhibited better efficacy than the steroid treatment after 24 weeks (WMD = -0.95, 95% CI: -1.80 to -0.11, P = .03, I = 85%). Moreover, no significant differences in the FADI, AOFAS, and RMS were observed between the 2 therapies (P > .05). CONCLUSION: Limited evidence supports the conclusion that PRP is superior to steroid treatments for long-term pain relief; however, significant differences were not observed between short and intermediate effects. Because of the small sample size and the limited number of high-quality RCTs, additional high-quality RCTs with larger sample sizes are required to validate this result.
[Mh] Termos MeSH primário: Fasciíte Plantar/terapia
Manejo da Dor/métodos
Troca Plasmática/métodos
Plasma Rico em Plaquetas
Esteroides/uso terapêutico
[Mh] Termos MeSH secundário: Adulto
Fasciíte Plantar/complicações
Feminino
Calcanhar
Seres Humanos
Masculino
Meia-Idade
Dor/etiologia
Medição da Dor
Ensaios Clínicos Controlados Aleatórios como Assunto
Índice de Gravidade de Doença
Resultado do Tratamento
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE; META-ANALYSIS; REVIEW
[Nm] Nome de substância:
0 (Steroids)
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171109
[Lr] Data última revisão:
171109
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:171103
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000008475


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[PMID]:28886955
[Au] Autor:Sveinsson O; Granqvist M; Forslin Y; Blennow K; Zetterberg H; Piehl F
[Ad] Endereço:Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Department of Neurology, Karolinska University Hospital, Stockholm, Sweden. Electronic address: olafur.sveinsson@karolinska.se.
[Ti] Título:Successful combined targeting of B- and plasma cells in treatment refractory anti-NMDAR encephalitis.
[So] Source:J Neuroimmunol;312:15-18, 2017 Nov 15.
[Is] ISSN:1872-8421
[Cp] País de publicação:Netherlands
[La] Idioma:eng
[Ab] Resumo:We describe an extremely severe case of therapy refractory NMDA receptor encephalitis (NMDAe) in a 26-year-old woman. After rituximab, bilateral oophorectomy, repeated cycles of high dose methylprednisolone and plasma exchange, she received repeated cyclophosphamide, tocilizumab (interleukin-6 inhibitor) and finally bortezomib (plasma cell depleting drug) leading to remission after 204days in intensive care. Two years after disease onset her cognitive functions are still affected, but slowly improving and the cerebral atrophy has been partly reversed. The cerebrospinal fluid biomarker profile suggests an early synaptic/dendritic process, with subsequent neuroaxonal degeneration motivating aggressive treatment early on.
[Mh] Termos MeSH primário: Encefalite Antirreceptor de N-Metil-D-Aspartato/terapia
Linfócitos B/fisiologia
Plasmócitos/fisiologia
[Mh] Termos MeSH secundário: Adulto
Encefalite Antirreceptor de N-Metil-D-Aspartato/líquido cefalorraquidiano
Encefalite Antirreceptor de N-Metil-D-Aspartato/diagnóstico por imagem
Encefalite Antirreceptor de N-Metil-D-Aspartato/fisiopatologia
Linfócitos B/efeitos dos fármacos
Biomarcadores/líquido cefalorraquidiano
Feminino
Seres Humanos
Fatores Imunológicos/uso terapêutico
Estudos Longitudinais
Imagem por Ressonância Magnética
Plasmócitos/efeitos dos fármacos
Troca Plasmática
Rituximab/uso terapêutico
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Biomarkers); 0 (Immunologic Factors); 4F4X42SYQ6 (Rituximab)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171011
[Lr] Data última revisão:
171011
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170910
[St] Status:MEDLINE


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[PMID]:28821193
[Au] Autor:Cheng CW; Hendrickson JE; Tormey CA; Sidhu D
[Ad] Endereço:Departments of Laboratory Medicine.
[Ti] Título:Therapeutic Plasma Exchange and Its Impact on Drug Levels: An ACLPS Critical Review.
[So] Source:Am J Clin Pathol;148(3):190-198, 2017 Sep 01.
[Is] ISSN:1943-7722
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:Objectives: To examine and summarize the current literature on the effects of therapeutic plasma exchange on medication levels. Methods: Literature review was performed via searches of the Cochrane Database and PubMed-MEDLINE (1996 to August 2016) looking for all case reports, case series, and human randomized controlled trials involving therapeutic plasma exchange (TPE)-associated drug removal. Results: Approximately 60 peer-reviewed articles were identified with the majority being case reports; no randomized controlled trials were identified. These reports and the authors' own experiences were used to derive practical guidance regarding the effect of TPE on circulating drug levels. Conclusions: There were several limitations with existing studies, many of which relate to procedural and/or clinical properties of patients undergoing TPE. As such, additional studies are needed before definitive guidelines can be established. There is clear need for development of consensus and additional investigations in this domain.
[Mh] Termos MeSH primário: Troca Plasmática/efeitos adversos
[Mh] Termos MeSH secundário: Seres Humanos
Farmacocinética
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170906
[Lr] Data última revisão:
170906
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170820
[St] Status:MEDLINE
[do] DOI:10.1093/ajcp/aqx056



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