Anafilaxia / Anaphylaxis

Octubre 24, 2017. No. 2891

Mecanismos, cofactors y factores de aumento involucrados en la anafilaxia Mechanisms, Cofactors, and Augmenting Factors Involved in Anaphylaxis. Muñoz-Cano R1,2, Pascal M2,3, Araujo G1,2, Goikoetxea MJ4, Valero AL1,2, Picado C1,2, Bartra J1,2. Author information Front Immunol. 2017 Sep 26;8:1193. doi: 10.3389/fimmu.2017.01193. eCollection 2017. Abstract Anaphylaxis is an acute and life-threatening systemic reaction. Many triggers have been described, including food, drug, and hymenoptera allergens, which are the most frequently involved. The mechanisms described in anaphylactic reactions are complex and implicate a diversity of pathways. Some of these mechanisms may be key to the development of the anaphylactic reaction, while others may only modify its severity. Although specific IgE, mast cells, and basophils are considered the principal players in anaphylaxis, alternative mechanisms have been proposed in non-IgE anaphylactic reactions. Neutrophils, macrophages, as well as basophils, have been involved, as have IgG-dependent, complement and contact system activation. A range of cationic substances can induce antibody-independent mast cells activation through MRGPRX2 receptor. Cofactors and augmenting factors may explain why, in some patients, food allergen exposure can cause anaphylaxis, while in other clinical scenario it can be tolerated or elicits a mild reaction. With the influence of these factors, food allergic reactions may be induced at lower doses of allergen and/or become more severe. Exercise, alcohol, estrogens, and some drugs such as Non-steroidal anti-inflammatory drugs, angiotensin-converting enzyme inhibitors, β-blockers, and lipid-lowering drugs are the main factors described, though their mechanisms and signaling pathways are poorly understood. KEYWORDS: IgE; IgG; adenosine; anaphylaxis; cofactor; exercise; mast cell; non-steroidal anti-inflammatory drug PDF Rutas anafilácticas alternativas: el papel potencial de los macrófagos. Alternative Anaphylactic Routes: The Potential Role of Macrophages. Escribese MM1,2, Rosace D1, Chivato T2, Fernández TD3, Corbí AL4, Barber D1. Author information Front Immunol. 2017 May 8;8:515. doi: 10.3389/fimmu.2017.00515. eCollection 2017. Abstract Anaphylaxis is an acute, life-threatening, multisystem syndrome resulting from the sudden release of mediators from effector cells. There are two potential pathways for anaphylaxis. The first one, IgE-dependent anaphylaxis, is induced by antigen (Ag) cross-linking of Ag-specific IgE bound to the high-affinity IgE receptor (FcεRI) on mast cells and basophils. The second one, IgG-dependent anaphylaxis is induced by Ag cross-linking of Ag-specific IgG bound to IgG receptors (FcγRI, FcγRIIA, FcγRIIB, FcγRIIC, and FcγRIIIA) on macrophages, neutrophils, and basophils. Macrophages exhibit a huge functional plasticity and are capable of exerting their scavenging, bactericidal, and regulatory functions under a wide variety of tissue conditions. Herein, we will review their potential role in the triggering and development of anaphylaxis. Thereby, macrophages, among other immune cells, play a role in both anaphylactic pathways (1) by responding to anaphylactic mediators secreted by mast cells after specific IgE cross-linking or (2) by acting as effector cells in the anaphylactic response mediated by IgG. In this review, we will go over the cellular and molecular mechanisms that take place in the above-mentioned anaphylactic pathways and will discuss the clinical implications in human allergic reactions. KEYWORDS: IgE; IgG; anaphylaxis; macrophages; serotonin PDF ANAFILAXIA Y REACCIONES ANAFILACTOIDES El presente artículo es una actualización al mes de enero del 2006 del Capítulo del Dr. Carlos Lovesio, del Libro Medicina Intensiva, Dr. Carlos Lovesio, Editorial El Ateneo, Buenos Aires (2001) PDF XXVII Congreso Peruano de Anestesiología Lima, Noviembre 2-4, 2017 Informes / Informataion

Anestesiología y Medicina del Dolor 52 664 6848905 vwhizar@anestesia-dolor.org anestesia-dolor.org

Alergia y anestesia / Allergy and anesthesia

Octubre 25, 2017. No. 2892

Alergia a las benzodiazepinas con administración de anestesia: revisión de la literatura actual. Benzodiazepine Allergy With Anesthesia Administration: A Review of Current Literature. Haybarger E1, Young AS2, Giovannitti JA Jr3. Author information Anesth Prog. Fall 2016;63(3):160-7. doi: 10.2344/16-00019.1. Abstract The incidence of anaphylactic/anaphylactoid reactions has been reported to vary between 1:3500 and 1:20,000 cases with a mortality rate ranging from 3 to 9%. Clinical signs present as skin rash, urticaria, angioedema, bronchospasm, tachycardia, bradycardia, and hypotension. Rapid identification and treatment are crucial to overall patient prognosis, as delayed intervention is associated with increased mortality. Diagnosis may be confirmed with clinical presentation, serum tryptase levels, and skin test results. While the main causative agents in anesthetic practice are typically neuromuscular blocking agents (NMBs), latex, and antibiotics, this review aims to discuss recognition, management, and preventive measures in perioperative anaphylactic/anaphylactoid reactions from benzodiazepine administration. KEYWORDS: Anaphylactoid reactions; Anaphylaxis; Benzodiazepine allergy; Diagnosis of anaphylaxis; Management of anaphylaxis PDF Hipersensibilidad a los anestésicos locales Hypersensitivity to local anesthetics. Grzanka A, Wasilewska I, Śliwczyńska M, Misiołek H1. Author information Anaesthesiol Intensive Ther. 2016;48(2):128-34. doi: 10.5603/AIT.a2016.0017. Epub 2016 Mar 15. Abstract Using local anaesthetics in daily practice, particularly by anaesthetists and dentists, is connected with the risk of side effects. Therefore, the observation of side effects, carrying out detailed research (according to the chart proposed in this study) and conducting specialist examinations is of the highest importance. There is a variety of side effects that could occur during local anaesthesia procedures, with the intensity ranging from clinically unimportant to life threatening. Clinicians' major concerns are the appearance of various hypersensitivity reactions, including anaphylaxis. Healthcare providers responsible for the administration of local anaesthetics should be able to detect hypersensitivity reactions to implement appropriate treatment and then choose highly selected diagnostic procedures. The final diagnosis should be based on specific medical history; documentation, including a description of the case and measurement of tryptase activity; skin tests; and provocation trials. Screening tests are not recommended in populations without hypersensitivity to local anaesthestics in their medical history. KEYWORDS: hypersensitivity; local anestehtics; local anesthesia; skin tests PDF XXVII Congreso Peruano de Anestesiología Lima, Noviembre 2-4, 2017 Informes / Informataion

Anestesiología y Medicina del Dolor 52 664 6848905 vwhizar@anestesia-dolor.org anestesia-dolor.org

Señalización purinérgica / Purinergic signalling

Octubre 26, 2017. No. 2893

Señalización purinérgica: desarrollos terapéuticos. Purinergic Signalling: Therapeutic Developments. Burnstock G1,2. Author information Front Pharmacol. 2017 Sep 25;8:661. doi: 10.3389/fphar.2017.00661. eCollection 2017. Abstract Purinergic signalling, i.e., the role of nucleotides as extracellular signalling molecules, was proposed in 1972. However, this concept was not well accepted until the early 1990's when receptor subtypes for purines and pyrimidines were cloned and characterised, which includes four subtypes of the P1 (adenosine) receptor, seven subtypes of P2X ion channel receptors and 8 subtypes of the P2Y G protein-coupled receptor. Early studies were largely concerned with the physiology, pharmacology and biochemistry of purinergic signalling. More recently, the focus has been on the pathophysiology and therapeutic potential. There was early recognition of the use of P1 receptor agonists for the treatment of supraventricular tachycardia and A2A receptor antagonists are promising for the treatment of Parkinson's disease. Clopidogrel, a P2Y12 antagonist, is widely used for the treatment of thrombosis and stroke, blocking P2Y12 receptor-mediated platelet aggregation. Diquafosol, a long acting P2Y2 receptor agonist, is being used for the treatment of dry eye. P2X3 receptor antagonists have been developed that are orally bioavailable and stable in vivo and are currently in clinical trials for the treatment of chronic cough, bladder incontinence, visceral pain and hypertension. Antagonists to P2X7 receptors are being investigated for the treatment of inflammatory disorders, including neurodegenerative diseases. Other investigations are in progress for the use of purinergic agents for the treatment of osteoporosis, myocardial infarction, irritable bowel syndrome, epilepsy, atherosclerosis, depression, autism, diabetes, and cancer. KEYWORDS: ATP; CNS diseases; adenosine; infection; inflammation; peripheral diseases PDF XXVII Congreso Peruano de Anestesiología Lima, Noviembre 2-4, 2017 Informes / Informataion LI Congreso Mexicano de Anestesiología Mérida Yucatán, Noviembre 21-25, 2017 Información / Information

Anestesiología y Medicina del Dolor 52 664 6848905 vwhizar@anestesia-dolor.org anestesia-dolor.org

Edad de recurrencia en el pie equinovaro idiopático tratado con el método Ponseti

http://www.ortopediainfantil.com.mx/academia/edad-de-recurrencia-en-el-pie-equinovaro-idiopatico-tratado-con-el-metodo-ponseti/

Age of Recurrence in Idiopathic Clubfoot Treated with the Ponseti Method

Fuente

Este artículo es originalmente publicado en:

https://www.ncbi.nlm.nih.gov/pubmed/28902604

https://www.readbyqxmd.com/read/28902604/age-of-recurrence-in-idiopathic-clubfoot-treated-with-the-ponseti-method

De:

Goldstein R, Chu A, Sala D, Lehman W.

Bull Hosp Jt Dis (2013). 2017 May;75(3):193-197.

Todos los derechos reservados para:

Read by QxMD is copyright © 2017 QxMD Software Inc. All rights reserved.

Abstract

OBJECTIVES:

While studies of patients undergoing the Ponseti method for idiopathic clubfoot demonstrate excellent correction after initial treatment, recurrence can occur in more than half of the cases. Few studies have demonstrated the age at which recurrence typically occurs or if age at discontinuation of the foot ankle orthosis (FAO) is associated with risk for surgical intervention.

CONCLUSIONS:

Patients with recurrence after initially successful Ponseti treatment generally do not become distinguishable by our current classification systems until 3 years of age. Patients who used the FAO for more than 2 years were 2.77 times less likely to require surgery than those who used it less than 2 years. FAO use should be continued until at least 3 years of age in patients undergoing Ponseti treatment for idiopathic clubfoot.

Resumen

OBJETIVOS:
Mientras que los estudios de pacientes que se someten al método Ponseti para pie equinovaro idiopático demuestran una corrección excelente después del tratamiento inicial, la recidiva puede ocurrir en más de la mitad de los casos. Pocos estudios han demostrado la edad a la que generalmente ocurre la recidiva o si la edad en la interrupción de la ortesis del tobillo (FAO) se asocia con riesgo de intervención quirúrgica.

CONCLUSIONES:
Los pacientes con recurrencia luego del tratamiento con Ponseti inicialmente exitoso generalmente no se vuelven distinguibles por nuestros sistemas de clasificación actuales hasta los 3 años de edad. Los pacientes que usaron la FAO por más de 2 años tenían 2.77 veces menos probabilidades de requerir cirugía que aquellos que la usaron menos de 2 años. El uso de la FAO debe continuarse hasta por lo menos 3 años de edad en pacientes sometidos a tratamiento con Ponseti para el pie equinovaro idiopático.

PMID:  28902604

http://www.columnayortopedia.com.mx/academia/sindrome-piriforme-y-pruebas/

Síndrome piriforme y Pruebas

• By admin in academia

Piriformis Syndrome and Tests

Fuente

Este artículo y/o video es originalmente publicado en:

https://youtu.be/sJ_slDEUGdQ

De y Todos los derechos reservados para:

Courtesy: Prof Nabil Ebraheim, University of Toledo, Ohio, USA

Publicado el 23 oct. 2017

Educational video describing test used to diagnose piriformis syndrome.

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El método Ponseti es superior al tratamiento quirúrgico en el pie equinovaro – Ensayo prospectivo aleatorizado a largo plazo.

http://www.ortopediainfantil.com.mx/academia/el-metodo-ponseti-es-superior-al-tratamiento-quirurgico-en-el-equinovaro-ensayo-prospectivo-aleatorizado-a-largo-plazo/

Ponseti method is superior to surgical treatment in clubfoot – Long-term, randomized, prospective trial.

Fuente

Este artículo es publicado originalmente en:

https://www.ncbi.nlm.nih.gov/pubmed/28866453

http://www.gaitposture.com/article/S0966-6362(17)30845-7/fulltext

De:

Švehlík M1, Floh U2, Steinwender G3, Sperl M4, Novak M5, Kraus T6.

Gait Posture. 2017 Oct;58:346-351. doi: 10.1016/j.gaitpost.2017.08.010. Epub 2017 Aug 11.

Todos los derechos reservados para:

Copyright © 2017 Elsevier B.V. All rights reserved.

Abstract

Treatment of idiopathic clubfoot has shifted from extensive surgical release to conservative Ponseti method; however, randomized prospective trials to compare both methods are lacking. The goal of this study was to compare the long-term results of Ponseti method with those of surgery in terms of morphology, function, X-rays, overall health and gait. In 2001, a single center, prospective, randomized, and controlled trial with a parallel design was started. Twenty-four feet of 15 patients were randomly assigned to two groups: 12 feet each to a Ponseti and surgical group. Mean follow-up was 10 years. International Clubfoot Study Group score (ICFSG), the Pediatric Outcomes Data Collection Instrument (PODCI) and the Functional Rating System (FRS) were used to compare morphology, functional, radiological and subjective outcomes, and the Oxford Foot Model (OFM) was used to evaluate foot kinematics. No significant difference was seen between groups in the initial Pirani scores (p=0.618). Ponseti group had more favorable long-term outcomes according to the FRS (p=0.005), higher ICFSG, scores for morphology (p=0.021), function (p=0.005) and X-rays (p=0.02), and better parent reported functional status according to the PODCI (p=0.018). Surgically treated clubfeet were stiffer – ankle dynamic range of motion (p=0.015) and the maximal hindfoot dorsiflexion during gait were limited as measured by OFM (p=0.039). This was compensated by an increase in motion between the hindfoot and forefoot. Furthermore, these children had more difficulty playing sports and experienced more pain, which might have led to inferior results in the happiness domain of the PODCI. These results suggest that the Ponseti method provides superior long-term outcomes for idiopathic clubfoot deformity.

Copyright © 2017 Elsevier B.V. All rights reserved.

KEYWORDS: Clubfoot; Gait; Ponseti; Surgery

PMID: 28866453 DOI: 10.1016/j.gaitpost.2017.08.010

Resumen

El tratamiento del pie equinovaro idiopático se ha desplazado de la liberación quirúrgica extensa al método conservador Ponseti; sin embargo, faltan ensayos prospectivos aleatorizados para comparar ambos métodos. El objetivo de este estudio fue comparar los resultados a largo plazo del método Ponseti con los de la cirugía en términos de morfología, función, rayos X, salud general y marcha. En 2001, se inició un ensayo de un centro único, prospectivo, aleatorizado y controlado con un diseño paralelo. Veinticuatro pies de 15 pacientes fueron asignados aleatoriamente a dos grupos: 12 pies cada uno a un Ponseti y grupo quirúrgico. El seguimiento medio fue de 10 años. El puntaje International Clubfoot Study Group (ICFSG), el Instrumento Pediátrico de Recopilación de Datos (PODCI) y el Sistema Funcional de Calificación (FRS) se usaron para comparar morfología, resultados funcionales, radiológicos y subjetivos, y se utilizó el Oxford Foot Model (OFM) para evaluar la cinemática del pie. No se observaron diferencias significativas entre los grupos en las puntuaciones iniciales de Pirani (p = 0,618). El grupo de Ponseti tuvo resultados más favorables a largo plazo de acuerdo con el FRS (p = 0.005), ICFSG más alto, puntajes de morfología (p = 0.021), función (p = 0.005) y rayos X (p = 0.02), y mejor padre informó el estado funcional de acuerdo con el PODCI (p = 0.018). Los pies cuadrados tratados quirúrgicamente eran más rígidos: el rango dinámico de movimiento del tobillo (p = 0.015) y la dorsiflexión máxima del retropié durante la marcha fueron limitados según lo medido por OFM (p = 0.039). Esto fue compensado por un aumento en el movimiento entre el retropié y el antepié. Además, estos niños tenían más dificultades para practicar deportes y experimentaban más dolor, lo que podría haber conducido a resultados inferiores en el dominio de la felicidad del PODCI. Estos resultados sugieren que el método Ponseti proporciona resultados superiores a largo plazo para la deformidad idiopática del pie equinovaro.

Copyright © 2017 Elsevier B.V. Todos los derechos reservados.

PALABRAS CLAVE:

Pie equinovaro; Marcha; Ponseti; Cirugía