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Frontiers in Medicine 2023Voriconazole is mainly used to treat progressive and potentially life-threatening infections in immunocompromised patients. The adverse drug reactions related to...
BACKGROUND
Voriconazole is mainly used to treat progressive and potentially life-threatening infections in immunocompromised patients. The adverse drug reactions related to voriconazole are varied. In some rare cases, the use of voriconazole can result in myelodysplastic syndrome (MDS)-like adverse reactions.
CASE PRESENTATION
Here, we present a rare case of systemic lupus erythematosus patient with a fungal infection that developed MDS-like adverse reactions after treatment with voriconazole. The patient was admitted to the hospital because of 3 days of chest tightness and dyspnea. After the admission, the patient's sputum culture showed infection, and voriconazole was prescribed to be taken orally. After using voriconazole, drug-related adverse reactions such as visual impairment, nausea, vomiting, hiccup, middle and lower abdominal pain, disorders of consciousness, delirium, hallucination, slow response, and subcutaneous ecchymosis appeared, as well as the gradually increased serum creatinine, oliguria, and aggravated lower limb edema. In addition, there was a decrease in peripheral blood cells, and MDS-like changes in bone marrow were indicated by bone marrow biopsy. After discontinuing voriconazole, drug-related adverse symptoms disappeared, and hematocytopenia and the changes in MDS were significantly improved, which was confirmed by a subsequent bone marrow puncture at a 6 months interval.
CONCLUSION
This case reminded us that when using voriconazole for treatment, individual differences in patients should be considered, and the blood concentration of voriconazole should be closely monitored. Otherwise, potential drugs that affect voriconazole metabolism should be noted, and related adverse symptoms of patients should be closely observed during medication to reduce the occurrence of adverse drug events.
PubMed: 38131049
DOI: 10.3389/fmed.2023.1286649 -
Clinical & Translational Oncology :... Aug 2023To investigate the clinical features of thrombotic microangiopathy associated with allogeneic hematopoietic stem cell transplantation in children.
Clinical characteristics of pediatric allogeneic hematopoietic stem cell transplantation-associated thrombotic microangiopathy (TA-TMA): a retrospective single-center analysis.
OBJECTIVES
To investigate the clinical features of thrombotic microangiopathy associated with allogeneic hematopoietic stem cell transplantation in children.
METHODS
A retrospective analysis of continuous clinical data from HSCT received in the Department of Hematology and Oncology of Wuhan Children's Hospital from August 1, 2016 to December 31, 2021.
RESULTS
During this period, 209 patients received allo-HSCT in our department, 20 (9.6%) of whom developed TA-TMA. TA-TMA was diagnosed at a median of 94 (7-289) days post-HSCT. Eleven (55%) patients had early TA-TMA within 100 days post-HSCT, while the other 9 (45%) patients had TA-TMA thereafter. The most common symptom of TA-TMA was ecchymosis (55%), while the main signs were refractory hypertension (90%) and multi-cavity effusion (35%). Five (25%) patients had central nervous system symptoms (convulsions and lethargy). All 20 patients had progressive thrombocytopenia, with 16 patients receiving transfusion of platelets that was ineffective. Ruptured red blood cells were visible in only two patients with peripheral blood smears. Cyclosporine A or Tacrolimus (CNI) dose was reduced once TA-TMA was diagnosed. Nineteen cases were treated with low-molecular-weight heparin, 17 patients received plasma exchange, and 12 patients were treated with rituximab. TA-TMA-related mortality percentage in this study was 45% (9/20).
CONCLUSION
Platelet decline and/or ineffective transfusion post-HSCT should be considered an early indicator of TA-TMA in pediatric patients. TA-TMA in pediatric patients may occur without evidence of peripheral blood schistocytes. Aggressive treatment is required once diagnosis is confirmed, but the long-term prognosis is poor.
Topics: Humans; Child; Retrospective Studies; Graft vs Host Disease; Thrombotic Microangiopathies; Tacrolimus; Hematopoietic Stem Cell Transplantation
PubMed: 36973479
DOI: 10.1007/s12094-023-03129-1 -
Internal Medicine (Tokyo, Japan) Apr 2024
PubMed: 38599862
DOI: 10.2169/internalmedicine.3466-24 -
Arquivos Brasileiros de Oftalmologia 2023Peribulbar injection of triamcinolone is an alternative treatment for thyroid eye disease; however the safety profile of this therapeutic option remains controversial....
PURPOSE
Peribulbar injection of triamcinolone is an alternative treatment for thyroid eye disease; however the safety profile of this therapeutic option remains controversial. The aim of this study was to describe the occurrence of local and systemic adverse effects after peribulbar injection of triamcinolone in patients with thyroid eye disease.
METHODS
This was a retrospective case series. Medical records of patients with thyroid eye disease treated with peribulbar injections of triamcinolone at a single academic institution between 2007 and 2019 were analyzed. Local and systemic complications were documented.
RESULTS
A total of 123 patients were treated. Only 11 patients (8.9%) developed local complications. The most frequent complication was the presence of superficial eyelid ecchymosis (nine patients; 7.3%). Notably, systemic complications (hyperglycemic and suprarenal inhibition after stop treatment) occurred in two patients (1.6%). All complications were transient, and the patients did not have any long-term sequelae.
CONCLUSIONS
Peribulbar injection of triamcinolone for the treatment of thyroid eye disease is linked to a very low rate of local or systemic complications. Prospective studies are warranted to delve into this topic.
Topics: Humans; Graves Ophthalmopathy; Triamcinolone Acetonide; Retrospective Studies; Glucocorticoids; Injections
PubMed: 35544933
DOI: 10.5935/0004-2749.20230063 -
Journal of Caring Sciences Dec 2023Angiography stands as the paramount and definitive diagnostic method for coronary artery disease. However, akin to various other invasive procedures, it may carry a...
INTRODUCTION
Angiography stands as the paramount and definitive diagnostic method for coronary artery disease. However, akin to various other invasive procedures, it may carry a multitude of complications. This study sought to assess the incidence of vascular complications post-arterial sheath removal, comparing the use of a ClampEase device against manual compression.
METHODS
This quasi-experimental clinical trial involved patients undergoing angiography at the post-angiography ward in Isfahan, Iran. A total of 91 patients were selected through convenience sampling and randomly assigned to either the manual compression or ClampEase device groups. Monitoring common vascular complications like hemorrhage, hematomas, and ecchymosis occurred up to 24 hours post-arterial sheath removal. Data were collected using a digital scale model DM3, a transparent flexible ruler, and a questionnaire named 'vascular complications after angiography.' Analysis was performed using SPSS software version 13.
RESULTS
Statistical analysis revealed that, when compared to the manual method, compression with the ClampEase device led to fewer vascular complications in patients and a quicker return to homeostasis.
CONCLUSION
The findings underscore that the ClampEase method is a safer alternative with fewer vascular complications than the manual compression method. This discovery has implications for reducing hospital costs and length of stay. The ClampEase device is associated with a swifter time to hemostasis, contributing to enhanced patient comfort and acceptance.
PubMed: 38249998
DOI: 10.34172/jcs.2023.30700 -
Facial Plastic Surgery : FPS Feb 2024The purpose of this study was to evaluate the effects of wet dressing with 50% magnesium sulfate (MgSO) solution on decreasing eyelid swelling and bruising after... (Randomized Controlled Trial)
Randomized Controlled Trial
The Efficacy of Magnesium Sulfate (MgSO4) Wet Dressing in Reducing Eyelid Swelling and Bruising after Blepharoplasty: A Randomized, Controlled, and Observer-Blinded Assessment Study.
The purpose of this study was to evaluate the effects of wet dressing with 50% magnesium sulfate (MgSO) solution on decreasing eyelid swelling and bruising after blepharoplasty. Fifty-eight patients (23 male and 35 female) who underwent bilateral blepharoplasty were enrolled in our randomized clinical trial. One side of the periorbital area (upper and lower eyelids) per patient received a wet dressing with 50% MgSO solution randomly, and the other side was cooled with an ice pack from the first postoperative day for two consecutive days (30 minutes per time and twice a day). The eyelid edema and ecchymosis were evaluated and classified using respective graded scales. Degrees of eyelid edema were similar after surgery in both groups ( > 0.05) and were significantly decreased with time. Compared with the cooled ones, less swelling was observed in the eyelids treated by MgSO wet compress on postoperative day 5 ( < 0.01). Both the incidence and area of ecchymosis were lower in the MgSO group than those in the cooling group ( < 0.01 and < 0.05, respectively). Moreover, the majority of patients (39/58, 67.2%) indicated a preference for MgSO wet dressing over ice cooling. MgSO wet dressing can be conveniently applied to alleviate eyelid swelling and reduce recovery time after blepharoplasty.
Topics: Female; Humans; Male; Bandages; Blepharoplasty; Blepharoptosis; Ecchymosis; Edema; Eyelids; Ice; Magnesium Sulfate; Postoperative Complications
PubMed: 37011896
DOI: 10.1055/s-0043-1767768 -
World Journal of Gastrointestinal... Jul 2023Hypereosinophilic syndrome (HES) is classified as primary, secondary or idiopathic. Idiopathic HES (IHES) has a variable clinical presentation and may involve multiple...
BACKGROUND
Hypereosinophilic syndrome (HES) is classified as primary, secondary or idiopathic. Idiopathic HES (IHES) has a variable clinical presentation and may involve multiple organs causing severe damage. Hepatic sinusoidal obstruction syndrome (HSOS) is characterized by damage to the endothelial cells of the hepatic sinusoids of the hepatic venules, with occlusion of the hepatic venules, and hepatocyte necrosis. We report a case of IHES with HSOS of uncertain etiology.
CASE SUMMARY
A 70-year-old male patient was admitted to our hospital with pruritus and a rash on the extremities for > 5 mo. He had previously undergone antiallergic treatment and herbal therapy in the local hospital, but the symptoms recurred. Relevant examinations were completed after admission. Bone marrow aspiration biopsy showed a significantly higher percentage of eosinophils (23%) with approximately normal morphology. Ultrasound-guided hepatic aspiration biopsy indicated HSOS. Contrast-enhanced computed tomography (CT) of the upper abdomen showed hepatic venule congestion with hydrothorax and ascites. The patient was initially diagnosed with IHES and hepatic venule occlusion. Prednisone, low molecular weight heparin and ursodeoxycholic acid were given for treatment, followed by discontinuation of low molecular weight heparin due to ecchymosis. Routine blood tests, biochemical tests, and imaging such as enhanced CT of the upper abdomen and pelvis were reviewed regularly.
CONCLUSION
Hypereosinophilia may play a facilitating role in the occurrence and development of HSOS.
PubMed: 37555104
DOI: 10.4240/wjgs.v15.i7.1532 -
Toxics Aug 2023A case of a 26-year-old male who died from consuming synthetic cannabinoid receptor agonists MDMB-4en-PINACA and 4F-ABUTINACA is reported. MDMB-4en-PINACA and...
A case of a 26-year-old male who died from consuming synthetic cannabinoid receptor agonists MDMB-4en-PINACA and 4F-ABUTINACA is reported. MDMB-4en-PINACA and 4F-ABUTINACA are potent synthetic cannabinoid receptor agonists (SCRAs). This is the first detailed reporting of MDMB-4-en-PINACA and 4F-ABUTINACA associated fatality, which can help the routine forensic work. The scientific literature on the symptoms associated with these substances are evaluated, along with the pharmacological properties and possible mechanism of death. A forensic autopsy was performed according to Recommendation No. R (99)3 of the Council of Europe on medico-legal autopsies. Histological samples were stained with hematoxylin and eosin (HE). Complement component C9 immunohistochemistry was applied to all heart samples. Toxicological analyses were carried out by supercritical fluid chromatography coupled with tandem mass spectrometry (SFC-MS/MS) and headspace gas chromatography with a flame ionization detector (HS-GC-FID). The literature was reviewed to identify reported cases of MDMB-4en-PINACA and 4F-ABUTINACA use. Autopsy findings included brain edema, internal congestion, petechial bleeding, pleural ecchymoses, and blood fluidity. Toxicological analyses determined 7.2 ng/mL of MDMB-4en-PINACA and 9.1 ng/mL of 4F-ABUTINACA in the peripheral blood. MDMB-4en-PINACA and 4F-ABUTINACA are strong, potentially lethal SCRA, and their exact effects and outcome are unpredictable.
PubMed: 37624178
DOI: 10.3390/toxics11080673 -
World Journal of Clinical Cases May 2024Breast conservation surgery (BCS) with adjuvant radiotherapy has become a gold standard in the treatment of early-stage breast cancer, significantly reducing the risk of...
BACKGROUND
Breast conservation surgery (BCS) with adjuvant radiotherapy has become a gold standard in the treatment of early-stage breast cancer, significantly reducing the risk of tumor recurrence. However, this treatment is associated with adverse effects, including the rare but aggressive radiation-induced angiosarcoma (RIAS). Despite its rarity and nonspecific initial presentation, RIAS presents a challenging diagnosis, emphasizing the importance of imaging techniques for early detection and accurate diagnosis.
CASE SUMMARY
We present a case of a 48-year-old post-menopausal woman who developed skin ecchymosis on the right breast seven years after receiving BCS and adjuvant radiotherapy for breast cancer. Initial mammography and ultrasound were inconclusive, showing post-treatment changes but failing to identify the underlying angiosarcoma. Contrast-enhanced breast magnetic resonance imaging (MRI) revealed diffuse skin thickening and nodularity with distinctive enhancement kinetics, leading to the diagnosis of RIAS. This case highlights the crucial role of MRI in diagnosing and determining the extent of RIAS, facilitating timely and appropriate surgical intervention.
CONCLUSION
Breast MRI is crucial for detecting RIAS, especially when mammography and ultrasound are inconclusive.
PubMed: 38808350
DOI: 10.12998/wjcc.v12.i13.2237 -
International Wound Journal Apr 2024This meta-analysis investigates the effect of dexmedetomidine on postoperative wound healing in neurosurgical patients. A thorough literature search resulted in the... (Meta-Analysis)
Meta-Analysis
This meta-analysis investigates the effect of dexmedetomidine on postoperative wound healing in neurosurgical patients. A thorough literature search resulted in the selection of seven studies from an initial pool of 1546 records. The analysis focused on wound healing outcomes, evaluated by the Redness, Oedema, Ecchymosis, Discharge, Approximation (REEDA) scale and the Manchester Scar Scale (MSS). Results indicated significant improvements in the dexmedetomidine group: the REEDA scale scores at day seven post-surgery showed a Standardized Mean Difference group (SMD = -16.18, 95% CI: [-22.30, -10.06], p < 0.01), and the MSS scores at 3 months post-operation demonstrated an (SMD = -8.95, 95% CI: [-14.27, -3.62], p < 0.01). These findings suggest that dexmedetomidine may enhance wound healing and reduce scar formation in neurosurgical patients. Bias assessment indicated a low risk of bias across the studies.
Topics: Humans; Cicatrix; Dexmedetomidine; Wound Healing
PubMed: 38148721
DOI: 10.1111/iwj.14585