As infectious complications from blood transfusion have decreased because of improved donor questionnaires and sophisticated infectious disease blood screening, noninfectious serious hazards of ...transfusion (NISHOTs) have emerged as the most common complications of transfusion. The category of NISHOTs is very broad, including everything from well-described and categorized transfusion reactions (hemolytic, febrile, septic, and allergic/urticarial/anaphylactic) to lesser known complications. These include mistransfusion, transfusion-related acute lung injury, transfusion-associated circulatory overload, posttransfusion purpura, transfusion-associated graft versus host disease, microchimerism, transfusion-related immunomodulation, alloimmunization, metabolic derangements, coagulopathic complications of massive transfusion, complications from red cell storage lesions, complications from over or undertransfusion, and iron overload. In recent years, NISHOTs have attracted more attention than ever before, both in the lay press and in the scientific community. As the list of potential complications from blood transfusion grows, investigators have focused on the morbidity and mortality of liberal versus restrictive red blood cell transfusion, as well as the potential dangers of transfusing "older" versus "younger" blood. In this article, we review NISHOTs, focusing on the most recent concerns and literature.
Abstract Hepatitis E virus (HEV) infections are not limited to the liver but may also affect other organs. Several diseases, including Guillain-Barré syndrome, neuralgic amyotrophy, ...glomerulonephritis, cryoglobulinemia, pancreatitis, lymphoma, thrombopenia, meningitis, thyreoiditis and myocarditis have been observed in the context of hepatitis E. To date the definite pathophysiological links between HEV and extrahepatic manifestations are not yet established. However, it is suggested that HEV-infection might be causative based on serological studies, case series, in vitro data and animal models. In particular neuronal and renal diseases as well as pancreatitis seem to be caused by HEV, while a causative relationship between HEV and other diseases is more doubtful. Either direct cytopathic tissue damage by extrahepatic replication or immunological processes induced by an overwhelming host immune response are possible origins of HEV-associated extrahepatic manifestations. Hepatologists should be aware of the possibility of acute or chronically HEV-infected patients to develop extrahepatic manifestations while neurologists, nephrologists, rheumatologists and other groups of physicians should consider HEV-infection as a potential differential diagnosis when observing one of the hereby described diseases. Ribavirin and steroids have been used in small groups of patients with extrahepatic manifestations, but the efficacy of these drugs still needs to be verified by large, multicenter studies. This article comprehensively reviews the published literature regarding HEV and extrahepatic manifestations and discusses the probability of specific extrahepatic diseases to be caused by previous or ongoing HEV-infection and summarizes the published knowledge about antiviral treatment in extrahepatic disorders.
Review in peeling complications Costa, Izelda Maria Carvalho; Damasceno, Patrick Silva; Costa, Mariana Carvalho ...
Journal of cosmetic dermatology,
September 2017, 2017-Sep, 2017-09-00, 20170901, Letnik:
16, Številka:
3
Journal Article
Recenzirano
Odprti dostop
Summary
Chemical peeling, a procedure wherein a chemical agent is applied to the skin to cause controlled destruction followed by regeneration and remodeling, is a dynamic tool for the treatment of ...acne, pigmentation issues, and photoaging Journal of cutaneous and aesthetic surgery vol. 5 (2012) 254–260. The results and complications are related to the depth of the procedure, with deeper peels producing more marked results and higher rates of complications. Complications are more likely with darker skin types, certain peeling agents, and sun exposure after treatment Journal of cutaneous and aesthetic surgery vol. 5 (2012) 254–260. They can range from minor irritations and uneven pigmentation to permanent scarring. In extremely uncommon cases, the complications can be life‐threatening. This knowledge is essential to prevent, reduce, and eliminate the occurrence of complications Cirurgia dermatológica em consultório. São Paulo: Atheneu; 2009. Swelling, pain, persistent erythema, pruritus, allergic reactions, folliculitis/acne, infection, herpes recurrence, hypopigmentation and hyperpigmentation, demarcation lines, and scarring are some of the complications that will be discussed in this article. The first step in preventing complications is to identify the patients at risk. By doing so, complications can be anticipated, prevented, and, if they still occur, treated as early as possible.
Summary
Stevens–Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are severe adverse reactions to drugs that cause a life‐threatening eruption of mucocutaneous blistering and epithelial ...sloughing. While the acute complications of SJS/TEN are well described, it is increasingly recognized that survivors may develop delayed sequelae, some of which can be associated with significant morbidity. Studies of long‐term SJS/TEN outcomes mostly focus on mucocutaneous and ocular complications. However, other internal organs, such as the respiratory tract and gastrointestinal tract, can be affected. Psychological sequelae are also frequent following the trauma of widespread epidermal necrolysis. An appreciation of the ‘chronic’ phase of SJS/TEN is needed by clinicians caring for individuals who have survived the acute illness. This review aims to provide an update on the breadth and range of sequelae that can affect patients in the months and years following an acute episode of SJS/TEN.
What's already known about this topic?
Survivors of SJS/TEN suffer from cutaneous and ocular long‐term sequelae.
What does this study add?
This review highlights the spectrum and morbidity of chronic cutaneous, ocular and other systemic complications.
The review proposes a multidisciplinary framework for long‐term follow‐up.
Plain language summary available online
Many cancer centers offer acupuncture services. To date, a comprehensive systematic review of acupuncture in cancer care has not been conducted. The purpose of this review was to evaluate the ...efficacy of acupuncture for symptom management in patients with cancer.
Medline, Embase, CINAHL, Cochrane (all databases), Scopus, and PubMed were searched from inception through December 2011 for prospective randomized clinical trials (RCT) evaluating acupuncture for symptom management in cancer care. Only studies involving needle insertion into acupuncture points were included. No language limitations were applied. Studies were assessed for risk of bias (ROB) according to Cochrane criteria. Outcomes by symptom were designated as positive, negative, or unclear.
A total of 2,151 publications were screened. Of those, 41 RCTs involving eight symptoms (pain, nausea, hot flashes, fatigue, radiation-induced xerostomia, prolonged postoperative ileus, anxiety/mood disorders, and sleep disturbance) met all inclusion criteria. One positive trial of acupuncture for chemotherapy-induced nausea and vomiting had low ROB. Of the remaining studies, eight had unclear ROB (four positive, three negative, and one with unclear outcomes). Thirty-three studies had high ROB (19 positive, 11 negative, and three with both positive and negative outcomes depending on the symptom).
Acupuncture is an appropriate adjunctive treatment for chemotherapy-induced nausea/vomiting, but additional studies are needed. For other symptoms, efficacy remains undetermined owing to high ROB among studies. Future research should focus on standardizing comparison groups and treatment methods, be at least single-blinded, assess biologic mechanisms, have adequate statistical power, and involve multiple acupuncturists.
Acute decompensation (AD) of cirrhosis is defined by the development of ascites, hepatic encephalopathy and/or variceal bleeding. Ascites is traditionally attributed to splanchnic arterial ...vasodilation and left ventricular dysfunction, hepatic encephalopathy to hyperammonaemia, and variceal haemorrhage to portal hypertension. Recent large-scale European observational studies have shown that systemic inflammation is a hallmark of AD. Here we present a working hypothesis, the systemic inflammation hypothesis, suggesting that systemic inflammation through an impairment of the functions of one or more of the major organ systems may be a common theme and act synergistically with the traditional mechanisms involved in the development of AD. Systemic inflammation may impair organ system function through mechanisms which are not mutually exclusive. The first mechanism is a nitric oxide-mediated accentuation of the preexisting splanchnic vasodilation, resulting in the overactivation of the endogenous vasoconstrictor systems which elicit intense vasoconstriction and hypoperfusion in certain vascular beds, in particular the renal circulation. Second, systemic inflammation may cause immune-mediated tissue damage, a process called immunopathology. Finally, systemic inflammation may induce important metabolic changes. Indeed, systemic inflammatory responses are energetically expensive processes, requiring reallocation of nutrients (glucose, amino acids and lipids) to fuel immune activation. Systemic inflammation also inhibits nutrient consumption in peripheral (non-immune) organs, an effect that may provide one mechanism of reallocation and prioritisation of metabolic fuels for inflammatory responses. However, the decrease in nutrient consumption in peripheral organs may result in decreased mitochondrial production of ATP (energy) and subsequently impaired organ function.
This report aimed to scrutinize the prevalence of Behçet's disease (BD)-related clinical manifestations based on age- and sex-specific subgroups using a Japanese nationwide registration database.
The ...database of newly registered BD was obtained from the Japanese Ministry of Health, Labour and Welfare. Patients who met the International Criteria for Behçet's Disease were selected and analysed.
Among 6627 International Criteria for Behçet's Disease cases, 2651 (40.0%) were men and 3976 (60.0%) were women with a median age of 39 years (interquartile range: 31-50 years). Ocular lesion was more common in male odds ratio (male: female) 2.64 (95% CI: 2.35, 2.95, P < 0.001) and genital ulceration was more common in female (odds ratio = 0.29, 95% CI: 0.25, 0.32, P < 0.001). Ocular lesion (P < 0.001), arthritis (P < 0.001) and vascular lesions (P < 0.001) were more frequently observed in elderly registered patients. Contrarily, genital ulceration (P < 0.001), epididymitis of males (P = 0.023) and oral ulceration (P = 0.003) were more common in younger patients. Simultaneous assessment of sex and age revealed that male predominance of ocular involvement was found in the young adult generation, but not in patients over 70 year of age. A female predominance of genital ulcer was prominently observed in patients 20-59 year of age; however, the sex difference was not found in patients over 60 years of age. Sensitivity analysis using International Study Group criteria replicated the results.
We showed that clinical phenotype in early phase of BD was different depending on onset age and sex.
Background The quality of life (QOL) of patients who survive early gastric cancer (EGC) is an area of increasing interest. Objective To compare the QOL and degree of worry of cancer recurrence in EGC ...patients who underwent endoscopic submucosal dissection (ESD) or surgery. Design Cross-sectional study. Settings A tertiary referral center. Patients A total of 565 patients with EGC who received ESD or surgery. Intervention Questionnaires. Main Outcome Measurements QOL was evaluated using the Short-form Health Survey and the European Organization for Research and Treatment of Cancer QOL questionnaires (QLQ-C30 and EORTC-QLQ-STO22). Mood disorders and the worry of cancer recurrence were estimated using the Hospital Anxiety and Depression Scale (HADS) and Worry of Cancer Scale, respectively. Results Questionnaires were completed by 55.7% of the ESD (137/246) and 58.9% of the surgery (188/319) patients. The surgery group had more QOL-related symptomatic and functional problems, including fatigue ( P = .044), nausea/vomiting ( P = .032), appetite loss ( P = .023), diarrhea ( P < .001), pain ( P = .013), reflux symptoms ( P = .005), eating restrictions ( P < .001), anxiety ( P = .015), taste impairment ( P = .011), and poor body image ( P < .001). The ESD group had significantly higher worry of cancer recurrence scores after adjusting for covariates, especially when visiting their physicians. The HADS results did not differ between the groups. Limitations Cross-sectional design. Conclusions Endoscopic treatment for EGC provides a better QOL, but stomach preservation might provoke cancer recurrence worries. Endoscopists should address this issue for relieving a patient’s concern of cancer recurrence during follow-up period after ESD. (Clinical trial registration number: WHO ICTRP KCT0000791.)
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