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Sample records for angioedema adquirido autoimune

  1. Angioedema adquirido autoimune de difícil controle em paciente com lúpus eritematoso sistêmico Intractable acquired autoimmune angioedema in a patient with systemic lupus erythematosus

    Directory of Open Access Journals (Sweden)

    Vilson Furlanetto Junior

    2010-02-01

    Full Text Available O angioedema adquirido é causado por diferentes medicamentos e doenças linfoproliferativas, e tem sido raramente relacionado com a presença de doenças autoimunes. Descrevemos aqui uma paciente de 47 anos com lúpus eritematoso sistêmico (LES com envolvimento cutâneo importante que desenvolveu angioedema recorrente localizado em face incluindo lábios e pálpebras, membros superiores e tórax, não acompanhado de urticária e com dosagem do inibidor de C1 esterase reduzida. A utilização de antimaláricos, glicocorticoides e pulsoterapia com metilprednisolona associada ao uso de azatioprina não determinou melhora. A paciente utilizou também danazol sem sucesso, e apresentou resposta clínica somente após ter sido submetida a múltiplas sessões de plasmaferese, ocorrendo inclusive resolução de extenso angioedema na mucosa do trato gastrointestinal.Acquired angioedema is caused by different drugs and lymphoproliferative diseases, and rarely it has also been related to the presence of auto-immune disorders. We report the case of a 47 year old female with systemic lupus erythematosus (SLE and severe cutaneous involvement who developed recurrent localized angioedema of the face, including lips and eye lids, upper limbs, and thorax, not associated with urticaria, and with reduced levels of C1 esterase inhibitor. Treatment with antimalarials, glucocorticoids, and pulse therapy with methylprednisolone associated with azathioprine did not improve her condition. The patient was also unsuccessfully treated with danazol, and she only showed clinical response after several sessions of plasmapheresis, including resolution of the extensive edema of the gastrointestinal tract.

  2. Angioedema

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    Luisa María Holguín-Gómez

    2016-10-01

    Full Text Available Angioedema is defined as edema of the skin or mucosa, including the respiratory and the gastrointestinal mucosa, which is self-limiting, and in most cases is completely resolved in less than 72 hours. It occurs due to increased permeability of the mucosal and submucosal capillaries and postcapillary venules, with resulting plasma extravasation. There are different types of angioedema: histaminergic (which may be mediated by immunoglobulin E, hereditary, from acquired C1 inhibitor deficiency, from angiotensin converting enzyme inhibitor, bradykinin-mediated, and non-histaminergic idiopathic angioedema. Treatment depends on the cause of angioedema, age, and the frequency and severity of manifestations. The main measures are avoiding external triggers or causes, giving antihistamines, steroids, or adrenaline for histaminergic angioedema; replacing the deficient protein or blocking the action of bradykinin in C1 inhibitor deficiency and angioedema from angiotensin converting enzyme inhibitor.

  3. Hereditary angioedema

    Science.gov (United States)

    ... disease; HAE- Hereditary angioedema; Kallikrein inhibitor-HAE: bradykinin receptor antagonist-HAE; C1-inhibitors-HAE; Hives-HAE ... aunt, uncle, or grandparent. Dental procedures, sickness (including colds and the flu), and surgery may trigger HAE ...

  4. Hereditary angioedema.

    Science.gov (United States)

    Bracho, Francisco A

    2005-11-01

    Hereditary angioedema is an autosomal-dominant deficiency of C1 inhibitor--a serpin inhibitor of kallikrein, C1r, C1s, factor XII, and plasmin. Quantitative or qualitative deficiency of C1 inhibitor leads to the generation of vasoactive mediators, most likely bradykinin. The clinical syndrome is repeated bouts of nonpruritic, nonpitting edema of the face, larynx, extermities, and intestinal viscera. Recently, investigators, physicians, and industry have demonstrated a renewed interest in the biology and treatment of hereditary angioedema. Investigators have generated a C1INH-/- mouse model that has demonstrated the importance of the contact activation system for hereditary angioedema-related vascular permeability. An interactive database of mutations is available electronically. Investigators have continued exploration into mRNA/protein levels. The proceedings of a recent workshop have been impressive in the scope and depth. Clinicians have produced consensus documents and expert reviews. The pharmaceutical industry has initiated clinical trails with novel agents. Hereditary angioedema is often misdiagnosed and poorly treated. Diagnosis requires careful medical and family history and the measurement of functional C1 inhibitor and C4 levels. Attenuated androgens, anti-fibrinolytics, and C1 inhibitor concentrates are used for long-term and preprocedure prophylaxis, but have significant drawbacks. C1 inhibitor concentrates and fresh frozen plasma are available for acute intervention. The mainstays of supportive care are airway monitoring, pain relief, hydration, and control of nausea. New agents such as recombinant C1 inhibitor, kallikrein inhibitors, and bradykinin inhibitors may offer safer and more tolerable treatments.

  5. Hives and Angioedema

    Science.gov (United States)

    ... is swelling or if you're having trouble breathing. Causes Hives and angioedema can be caused by: Foods. Many foods can trigger reactions in people with sensitivities. Shellfish, fish, peanuts, tree nuts, eggs and milk are frequent ...

  6. Hereditary Angioedema in Childhood

    DEFF Research Database (Denmark)

    Kjaer, Line; Bygum, Anette

    2012-01-01

      Hereditary angioedema (HAE) is a rare inherited disease that is often difficult to diagnose. We report a case of a 9-year-old boy with a spontaneous mutation causing HAE, diagnosed after a life-threatening episode of angioedema of the head and upper respiratory tract after a 5-year history of r...... of recurrent skin swellings and abdominal pain leading to several hospital admissions. The aim of this report is to direct focus on this rare disease, which can be treated effectively, to diminish morbidity and mortality of children suffering from undiagnosed HAE....

  7. Trifluoperazine-Induced Angioedema

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    Mugtaba Osman

    2014-01-01

    Full Text Available Angioedema is a serious adverse drug reaction that can rarely be associated with trifluoperazine treatment. We present the case of a 44-year-old male with an established diagnosis of schizoaffective disorder, for which trifluoperazine therapy was considered. He presented to the emergency department with bilateral lower limb oedematous painful erythematous swelling that eased off completely when trifluoperazine was stopped. The possibility of allergic reaction, such as angioedema, should always be kept in mind by psychiatrists and mental health professionals when prescribing trifluoperazine antipsychotic.

  8. Hereditary angioedema in women

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    Bouillet Laurence

    2010-07-01

    Full Text Available Abstract Women with hereditary angioedema (HAE are more likely to be symptomatic that men. Hormonal factors (puberty, contraception, pregnancy,.... play a significant role in the precipitation or worsening of the condition in women. So, combined contraceptive pills are not indicated and progestogen pill must be preferred. During pregnancy, attack rate can increase (38-48% of women. C1Inhibitor concentrate and tranexamic acid can be used during pregnancy. Attenuated androgens for long term prophylaxis are effective but side effects appear more often in female patients. These side effects are dose dependant and can be attenuated by titrating the dose down the lowest effective level.

  9. Recent Advances in Drug-Induced Angioedema

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    Naoko Inomata

    2012-01-01

    Full Text Available Angioedema is the end result of deep dermal, subcutaneous and/or mucosal swelling, and is potentially a life- threatening condition in cases where the pharynx or larynx is involved. Drug-induced angioedema has been reported to occur in response to a wide range of drugs and vaccines. Drug-induced angioedema, like other cutaneous drug reactions, has been reported to be most frequently elicited by beta-lactam antibiotics and nonsteroidal anti-inflammatory drugs, although reliable data from epidemiologic studies are scarce. Recent reports suggested an increasing role of angiotensin-converting enzyme inhibitors (ACEIs in the causation of life- threatening angioedema. ACEI-related angioedema is never accompanied by urticaria and occurs via a kinin- dependent mechanism. ACEI-related angioedema not only can start years after beginning the treatment, but it can then recur irregularly while under that treatment. Furthermore, allergy tests are unreliable for the diagnosis of ACEI-related angioedema, and so the relationship between angioedema and ACEIs is often missed and consequently quite underestimated. Accordingly, better understanding of the kinin-dependent mechanism, which is particular to angioedema, is necessary for the appropriate management of drug-induced angioedema.

  10. Idiopathic Thrombocytopenic Purpura Misdiagnosed as Hereditary Angioedema

    DEFF Research Database (Denmark)

    Andersen, Michelle Fog; Bygum, Anette

    2015-01-01

    however not always have to be caused by angioedema but can relate to other concomitant disorders. In this report we are focusing on misdiagnosis in a patient with known hereditary angioedema, whose bleeding episode caused by idiopathic thrombocytopenic purpura was mistaken for an acute attack...

  11. Disease expression in women with hereditary angioedema

    DEFF Research Database (Denmark)

    Bouillet, Laurence; Longhurst, Hilary; Boccon-Gibod, Isabelle

    2008-01-01

    OBJECTIVE: Fluctuations in sex hormones can trigger angioedema attacks in women with hereditary angioedema. Combined oral contraceptive therapies, as well as pregnancy, can induce severe attacks. The course of angioedema may be very variable in different women. STUDY DESIGN: Within the PREHAEAT p......-sensitive phenotype for some patients. CONCLUSION: The course of angioedema in women with C1 inhibitor deficiency is affected by physiologic hormonal changes; consequently, physicians should take these into account when advising on management.......OBJECTIVE: Fluctuations in sex hormones can trigger angioedema attacks in women with hereditary angioedema. Combined oral contraceptive therapies, as well as pregnancy, can induce severe attacks. The course of angioedema may be very variable in different women. STUDY DESIGN: Within the PREHAEAT...... project launched by the European Union, data on 150 postpubertal women with hereditary angioedema were collected in 8 countries, using a patient-based questionnaire. RESULTS: Puberty worsened the disease for 62%. Combined oral contraceptives worsened the disease for 79%, whereas progestogen-only pills...

  12. Dermatoses bolhosas auto-imunes Autoimmune bullous dermatoses

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    Paulo R. Cunha

    2009-04-01

    Full Text Available Dermatoses bolhosas autoimunes são doenças cuja manifestação cutânea primária e fundamental consiste em vesículas e bolhas. Classificam-se conforme a localização da bolha, em intraepidérmica e subepidérmica. Os pacientes produzem autoanticorpos contra estruturas específicas da pele detectáveis por técnicas de imunofluorescência, immunobloting e Elisa. Os recentes avanços da biologia molecular e celular têm permitido conhecer esses autoantígenos, contra os quais os pacientes se sensibilizam e que estão localizados na epiderme ou na junção dermoepidérmica. São doenças de baixa incidência, porém de elevada morbidade e por vezes letais. O objetivo deste trabalho é revisar e descrever os progressos nos conhecimentos de quatro doenças vésico-bolhosas autoimunes: pênfigo foliáceo endêmico (fogo selvagem, pênfigo vulgar, penfigóide bolhoso e dermatite herpetiforme.Autoimmune bullous dermatoses are diseases in which blisters and vesicles are the primary and fundamental types of skin lesion. Their classification is based on the location of the blister: intraepidermal and subepidermal. Patients produce autoantibodies against self-specific structures of the skin detectable by immunofluorescence techniques, immunoblotting and ELISA. Recent advances in molecular and cellular biology have brought to knowledge these self-antigens, against which patients are sensitized, and which are found in epidermis or in the dermo-epidermal junction. These are low incidence, but high morbidity diseases that may be fatal. The aim of this article is to review and describe the progress of four autoimmune vesiculobullous disorders: endemic pemphigus foliaceous (wild fire, pemphigus vulgaris, bullous pemphigoid and dermatitis herpetiformis.

  13. Prophylactic Therapy for Hereditary Angioedema.

    Science.gov (United States)

    Longhurst, Hilary; Zinser, Emily

    2017-08-01

    Long-term prophylaxis is needed in many patients with hereditary angioedema and poses many challenges. Attenuated androgens are effective in many but are limited by side effect profiles. There is less evidence for efficacy of tranexamic acid and progestagens; however, the small side effect profile makes tranexamic acid an option for prophylaxis in children and progestagens an option for women. C1 inhibitor is beneficial, but at present requires intravenous delivery and may need dose titration for maximum efficacy. Short-term prophylaxis should be considered for all procedures. New therapies are promising in overcoming many problems encountered with current options for long-term prophylaxis. Copyright © 2017 Elsevier Inc. All rights reserved.

  14. Angioedema

    Science.gov (United States)

    ... cold or heat Foods (such as berries, shellfish, fish, nuts, eggs, and milk) Insect bites Medicines ( drug ... be painful. Other symptoms may include: Abdominal cramping Breathing difficulty Swollen eyes and mouth Swollen lining of ...

  15. Angioedema due to Systemic Isotretinoin Therapy

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    Pelin Üstüner

    2014-01-01

    Full Text Available Angioedema is the swelling of the mucosal membranes as a variant of urticaria induced by hereditary C1 esterase inhibitor enzyme deficiency, certain foods, or drugs. Herein, we report the case of a 23-year-old woman, with mild-moderate acne presenting with widespread facial angioedema on the 2nd day of systemic isotretinoin treatment. The patient had taken no drugs other than isotretinoin in the preceding days and had no known food allergy. Her angioedema was resolved after the isotretinoin was discontinued. We want to draw the attention of dermatologists to this rare adverse allergic effect of isotretinoin which is frequently used in the treatment of acne vulgaris.

  16. Classification, diagnosis, and approach to treatment for angioedema

    DEFF Research Database (Denmark)

    Cicardi, M; Aberer, W; Banerji, A

    2014-01-01

    Angioedema is defined as localized and self-limiting edema of the subcutaneous and submucosal tissue, due to a temporary increase in vascular permeability caused by the release of vasoactive mediator(s). When angioedema recurs without significant wheals, the patient should be diagnosed to have...... angioedema as a distinct disease. In the absence of accepted classification, different types of angioedema are not uniquely identified. For this reason, the European Academy of Allergy and Clinical Immunology gave its patronage to a consensus conference aimed at classifying angioedema. Four types of acquired...... and three types of hereditary angioedema were identified as separate forms from the analysis of the literature and were presented in detail at the meeting. Here, we summarize the analysis of the data and the resulting classification of angioedema....

  17. Epidemiology of Non-hereditary Angioedema

    DEFF Research Database (Denmark)

    Madsen, Flemming; Attermann, Jorn; Linneberg, Allan

    2012-01-01

    The prevalence of non-hereditary angioedema was investigated in a general population sample (n = 7,931) and in a sample of Danish patients (n = 7,433) tested for deficiency of functional complement C1 esterase inhibitor protein (functional C1 INH). The general population sample (44% response rate...

  18. Epidemiology of Non-hereditary Angioedema

    DEFF Research Database (Denmark)

    Madsen, Flemming; Attermann, Jørn; Linneberg, Allan

    2012-01-01

    The prevalence of non-hereditary angioedema was investigated in a general population sample (n¿=¿7,931) and in a sample of Danish patients (n¿=¿7,433) tested for deficiency of functional complement C1 esterase inhibitor protein (functional C1 INH). The general population sample (44% response rate...

  19. Hereditary angioedema type I: a case report

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    Francisca Muñoz Peralta

    2016-03-01

    Full Text Available El angioedema hereditario es una enfermedad rara, de gran heterogeneidad en los síntomas, manifestándose con edema a nivel cutáneo, mucosa gastrointestinal y de laringe/faringe. Aunque existen tres variedades, el tipo I es el más frecuente y es provocado por una deficiencia en la síntesis del complemento C1 inhibidor. La gravedad de la clínica, junto a la baja prevalencia de la enfermedad y la necesidad de un tratamiento específico, hacen que el diagnóstico y tratamiento de dicha patología sea aún una asignatura pendiente para el médico de familia en atención primaria. Presentamos el caso de un adolescente varón con déficit de α-1 antitripsina desde los seis meses de edad, con aparición de angioedemas en piernas y brazos a los 11 años, diagnosticado de angioedema hereditario tipo I un año después. El diagnóstico definitivo de la enfermedad permitió instaurar un tratamiento adecuado a su patología, que consiste en la prevención de brotes que puedan comprometer la vida del paciente y, en el caso de que aparezcan, en la administración del complemento C1 inhibidor.

  20. An ABC of the Warning Signs of Hereditary Angioedema

    DEFF Research Database (Denmark)

    Grumach, Anete Sevciovic; Ferraroni, Natasha; Olivares, Maria Margarita

    2017-01-01

    Hereditary angioedema (HAE) with C1 inhibitor deficiency is a genetic disorder that clinically manifests with attacks of angioedema in the subcutaneous and submucosal tissues, mainly in the extremities, abdomen, and upper airway. During attacks, vascular permeability is increased due to increased...

  1. Clinical characteristics and treatment of chronic urticaria and angioedema : Dwelling on swelling, dealing with whealing

    OpenAIRE

    van den Elzen, M.T.

    2017-01-01

    The occurrence of wheals, angioedema or both for at least 6 weeks is diagnosed as chronic spontaneous urticaria in (inter) national guidelines - after excluding other illnesses. The underlying mechanism of angioedema without wheals is not entirely known. The objective of this thesis is to increase insight in the treatment of adult patients with angioedema with or without urticaria, and with urticaria with or without angioedema. We first studied patients with angioedema: we show that bradykini...

  2. Brazilian guidelines for the diagnosis and treatment of hereditary angioedema

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    Pedro Giavina-Bianchi

    2011-01-01

    Full Text Available Hereditary angioedema is an autosomal dominant disease characterized by edema attacks with multiple organ involvement. It is caused by a quantitative or functional deficiency of the C1 inhibitor, which is a member of the serine protease inhibitor family. Hereditary angioedema is unknown to many health professionals and is therefore an underdiagnosed disease. The causes of death from hereditary angioedema include laryngeal edema with asphyxia. The estimated mortality rate in patients in whom the disease goes undetected and who are therefore incorrectly treated is 25-40%. In addition to edema of the glottis, hereditary angioedema often results in edema of the gastrointestinal tract, which can be incapacitating. Patients with hereditary angioedema may undergo unnecessary surgical interventions because the digestive tract can be the primary or only organ system involved, thus mimicking acute surgical abdomen. It is estimated that patients with hereditary angioedema experience some degree of disability 20-100 days per year. The Experts in Clinical Immunology and Allergy of the "Associação Brasileira de Alergia e Imunopatologia -ASBAI" developed these guidelines for the diagnosis, therapy, and management of hereditary angioedema.

  3. Brazilian guidelines for the diagnosis and treatment of hereditary angioedema.

    Science.gov (United States)

    Giavina-Bianchi, Pedro; França, Alfeu T; Grumach, Anete S; Motta, Abílio A; Fernandes, Fátima R; Campos, Regis A; Valle, Solange O; Rosário, Nelson A; Sole, Dirceu

    2011-01-01

    Hereditary angioedema is an autosomal dominant disease characterized by edema attacks with multiple organ involvement. It is caused by a quantitative or functional deficiency of the C1 inhibitor, which is a member of the serine protease inhibitor family. Hereditary angioedema is unknown to many health professionals and is therefore an underdiagnosed disease. The causes of death from hereditary angioedema include laryngeal edema with asphyxia. The estimated mortality rate in patients in whom the disease goes undetected and who are therefore incorrectly treated is 25-40%. In addition to edema of the glottis, hereditary angioedema often results in edema of the gastrointestinal tract, which can be incapacitating. Patients with hereditary angioedema may undergo unnecessary surgical interventions because the digestive tract can be the primary or only organ system involved, thus mimicking acute surgical abdomen. It is estimated that patients with hereditary angioedema experience some degree of disability 20-100 days per year. The Experts in Clinical Immunology and Allergy of the "Associação Brasileira de Alergia e Imunopatologia -ASBAI" developed these guidelines for the diagnosis, therapy, and management of hereditary angioedema.

  4. Refractory Angioedema in a Patient with Systemic Lupus Erythematosus

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    Zahra Habibagahi

    2015-07-01

    Full Text Available Angioedema secondary to C1 inhibitor deficiency has been rarely reported to be associated with systemic lupus erythematosus. A genetic defect of C1 inhibitor produces hereditary angioedema, which is usually presented with cutaneous painless edema, but edema of the genital area, gastrointestinal and laryngeal tracts have also been reported. In lupus patients, angioedema may be the result of an acquired type of C1 inhibitor deficiency, most probably due to antibody formation directed against the C1 inhibitor molecule. Herein we report a new case of lupus nephritis that developed angioedema and a rapid course of disease progression with acute renal failure and alveolar hemorrhage without response to high dose steroid and plasmapheresis.

  5. Depleção de célula B no tratamento de citopenias auto-imunes

    OpenAIRE

    Landeiro,Luciana; Almeida,Maiana; Cal,Flávia F. P.; Cerqueira,Tais S.; Frempong,Rosana F.; Espírito Santo,Thyago M.; Santos,Deise A.; Pinto,Thiago B.; Pallotta,Ronald

    2005-01-01

    A morbidade associada ao tratamento de citopenias auto-imunes tornou necessária a busca por novas terapêuticas. Baseado no fato de que o rituximab reage especificamente contra o antígeno CD 20, induzindo depleção de células B e conseqüentemente levando à diminuição na produção de auto-anticorpos, cinco pacientes com citopenias auto-imunes foram tratados com esta droga. Os pacientes eram refratários à terapia convencional e receberam 375 mg/m² de rituximab semanalmente, por um período de quatr...

  6. Ticagrelor-Induced Angioedema: A Rare and Unexpected Phenomenon

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    Rajeev Seecheran

    2017-01-01

    Full Text Available Angioedema can cause potentially life-threatening airway obstruction. This case report describes an exceedingly rare episode of ticagrelor-induced hypersensitivity reaction, manifesting as angioedema with periorbital and likely respiratory involvement. The heart team should be vigilant for this precarious condition which may require emergent airway management. Desensitization protocols and alternative regimens (e.g., clopidogrel, prasugrel, and addition of an adjunctive anticoagulant should be considered when there is an absolute indication for antiplatelet therapy.

  7. Positive impact of omalizumab on angioedema and quality of life in patients with refractory chronic idiopathic/spontaneous urticaria: analyses according to the presence or absence of angioedema.

    Science.gov (United States)

    Maurer, M; Sofen, H; Ortiz, B; Kianifard, F; Gabriel, S; Bernstein, J A

    2017-06-01

    Approximately 50% of patients with chronic idiopathic/spontaneous urticaria (CIU/CSU) report hives and angioedema; some experience hives/angioedema only. Assess omalizumab's effect on angioedema and quality of life (QoL) in subgroups with refractory CIU/CSU: those with and without angioedema. Patients received omalizumab (75, 150 or 300 mg) or placebo every 4 weeks for 12/24 weeks. Angioedema and QoL were assessed [Urticaria Patient Daily Diary and Dermatology Quality of Life Index (DLQI)]. Subgroups were based on the presence/absence of baseline angioedema 7 days prior to randomization. Patients with baseline angioedema randomized to omalizumab 300 mg had a greater reduction in mean weekly incidence of angioedema and mean number of days/week with angioedema vs. placebo at 12 and 24 weeks. A 3.3- to 4.5-point greater mean reduction in DLQI score was achieved with omalizumab 300 mg treatment vs. placebo, above the minimal clinically important difference threshold. Results with lower doses vs. placebo were variable. Compared with placebo, omalizumab 300 mg treatment over 12-24 weeks resulted in marked reduction in incidence and number of days/week with angioedema accompanied by clinically relevant improvement in QoL. © 2016 European Academy of Dermatology and Venereology.

  8. Comparing acquired angioedema with hereditary angioedema (types I/II): findings from the Icatibant Outcome Survey.

    Science.gov (United States)

    Longhurst, H J; Zanichelli, A; Caballero, T; Bouillet, L; Aberer, W; Maurer, M; Fain, O; Fabien, V; Andresen, I

    2017-04-01

    Icatibant is used to treat acute hereditary angioedema with C1 inhibitor deficiency types I/II (C1-INH-HAE types I/II) and has shown promise in angioedema due to acquired C1 inhibitor deficiency (C1-INH-AAE). Data from the Icatibant Outcome Survey (IOS) were analysed to evaluate the effectiveness of icatibant in the treatment of patients with C1-INH-AAE and compare disease characteristics with those with C1-INH-HAE types I/II. Key medical history (including prior occurrence of attacks) was recorded upon IOS enrolment. Thereafter, data were recorded retrospectively at approximately 6-month intervals during patient follow-up visits. In the icatibant-treated population, 16 patients with C1-INH-AAE had 287 attacks and 415 patients with C1-INH-HAE types I/II had 2245 attacks. Patients with C1-INH-AAE versus C1-INH-HAE types I/II were more often male (69 versus 42%; P = 0·035) and had a significantly later mean (95% confidence interval) age of symptom onset [57·9 (51·33-64·53) versus 14·0 (12·70-15·26) years]. Time from symptom onset to diagnosis was significantly shorter in patients with C1-INH-AAE versus C1-INH-HAE types I/II (mean 12·3 months versus 118·1 months; P = 0·006). Patients with C1-INH-AAE showed a trend for higher occurrence of attacks involving the face (35 versus 21% of attacks; P = 0·064). Overall, angioedema attacks were more severe in patients with C1-INH-HAE types I/II versus C1-INH-AAE (61 versus 40% of attacks were classified as severe to very severe; P types I/II, respectively. © 2016 British Society for Immunology.

  9. Presença de auto-anticorpos não-tireóide-específicos no soro de pacientes com hipotireoidismo auto-imune

    OpenAIRE

    Soares Débora Vieira; Vanderborght Bart O. M.; Vaisman Mário

    2003-01-01

    Auto-anticorpos contra componentes não-específicos da tireóide foram encontrados no soro de pacientes com doença auto-imune da tireóide. Neste estudo avaliamos a presença de auto-anticorpos antinucleares (ANA), antimúsculo liso (anti-ML) e antimitocôndria (anti-Mc) no soro de pacientes com hipotireoidismo auto-imune (HA), comparando-os a controles saudáveis. Estudamos 70 pacientes com hipotireoidismo auto-imune (tireoidite de Hashimoto ou tireoidite atrófica ) e 70 controles saudáveis (sem di...

  10. Epidemiology of angioedema without wheals in an allergy and immunology center.

    Science.gov (United States)

    Malbrán, Eloisa; Fernández Romero, Diego; Juri, Maria Cecilia; Larrauri, Blas J; Malbrán, Alejandro

    2015-01-01

    We describe the diagnostic epidemiology, the clinical course, the family history and the response to treatment of patients with angioedema without wheals (AWW) at an Allergy and Immunology Clinical Center. We reviewed the case records of all patients at our office from January 1997 to April 2013. We recorded sex, age, age at onset of symptoms, family history of angioedema, number of visits to the office, type of angioedema, and response to treatment from those patients with angioedema without wheals. We classified angioedema according to its pathophysiology. We also describe those patients with angioedema mimics. From a total of 17,823 new patients, 303 had a presumptive diagnosis of angioedema without wheals. Twenty-three patients had an angioedema mimic. Forty percent were male and 60% were female. Average age at first visit was 40.6. Average number of visits was 2.4. Fifty-seven patients referred a family history. We attributed idiopathic angioedema to 55.7% of patients, 24.3% were drug related, 15.7% were due to C1 inhibitor deficiency, 2.1% were drug related+idiopathic angioedema, 1.4% were type III and 0.7% had exercise-induced angioedema. Ninety six percent of 53 evaluable idiopathic angioedema patients referred a benefit with anti-histamine therapy. AWW was a rare cause of consultation. Most of our patients had anti H1 responsive idiopathic angioedema and none had allergic angioedema. Women cases prevailed over men's. Family history and average age of onset of symptoms were different among the different types of angioedema.

  11. Acute dystonic reaction leading to lingual hematoma mimicking angioedema

    Science.gov (United States)

    Sezer, Özgür; Aydin, Ali Attila; Bilge, Sedat; Arslan, Fatih; Arslan, Hasan

    2017-01-01

    Lingual hematoma is a severe situation, which is rare and endangers the airway. It can develop due to trauma, vascular abnormalities, and coagulopathy. Due to its sudden development, it can be clinically confused with angioedema. In patients who applied to the doctor with complaints of a swollen tongue, lingual hematoma can be confused with angioedema, in particular, at the beginning if the symptoms occurred after drug use. It should especially be considered that dystonia in the jaw can present as drug-induced hyperkinetic movement disorder. Early recognition of this rare clinical condition and taking precautions for providing airway patency are essential. In this case report, we will discuss mimicking angioedema and caused by a bite due to dystonia and separation of the tongue from the base of the mouth developing concurrently with lingual hematoma. PMID:29326495

  12. Inhalant abuse of computer cleaner manifested as angioedema.

    Science.gov (United States)

    Kurniali, Peter C; Henry, Letitia; Kurl, Rita; Meharg, Joseph V

    2012-01-01

    Inhalant abuse is the intentional inhalation of chemical vapors or volatile substance to achieve a euphoric effect. Although no statistical data are reported yet, inhalant abuse is potentially life-threatening and has resulted in a wide range of toxic effects such as central nervous system depression, seizures, aspiration, cardiac arrhythmia, asphyxiation, hypoxia, metabolic acidosis, and sudden death among others. We are reporting a 25-year-old white man who was brought to the emergency department after inhaling aerosolized computer-cleaning spray composed of difluoroethane. He was found to have marked upper and lower lip facial swelling consistent with angioedema. The patient also had a prolonged QT interval, mild inspiratory stridor, but no urticaria. In this case, we believe the difluoroethane-related angioedema represents either idiopathic or bradykinin-induced angioedema.

  13. Assessment of 105 Patients with Angiotensin Converting Enzyme-Inhibitor Induced Angioedema

    DEFF Research Database (Denmark)

    Rasmussen, Eva Rye; von Buchwald, Christian; Wadelius, Mia

    2017-01-01

    Objective. To asses a cohort of 105 consecutive patients with angiotensin converting enzyme-inhibitor induced angioedema with regard to demographics, risk factors, family history of angioedema, hospitalization, airway management, outcome, and use of diagnostic codes used for the condition. Study...... gender was associated with a significantly higher risk of angiotensin converting enzyme-inhibitor induced angioedema. 6.7% had a positive family history of angioedema. Diabetes seemed to be a protective factor with regard to angioedema. 95% experienced angioedema of the head and neck. 4.7% needed...... Design. Cohort study. Methods. This was a retrospective cohort study of 105 patients with angiotensin converting enzyme-inhibitor induced angioedema in the period 1995-2014. Results. The cohort consisted of 67 females and 38 males (F : M ratio 1.8), with a mean age of 63 [range 26-86] years. Female...

  14. Observação de anemia hemolítica auto-imune em artrite reumatóide

    OpenAIRE

    Souza,Ricardo A. S.; Souza,Henrique F. S.; Rangel,Leandro V.; Nogueira,Luciana V. A.; Santiago,Mittermayer B.

    2003-01-01

    Artrite reumatóide é uma doença difusa do tecido conjuntivo que se caracteriza pelo acometimento articular e sistêmico. Disfunções hematológicas como anemia ocorrem em até 65% dos pacientes, sendo a anemia das doenças crônicas a forma mais comum. A anemia hemolítica auto-imune pode estar associada à difusa do tecido conjuntivo, sendo classicamente associada ao lúpus eritematoso sistêmico e fazendo parte dos seus critérios de classificação. A presença de anemia hemolítica auto-imune em artrite...

  15. How Not to Be Misled by Disorders Mimicking Angioedema

    DEFF Research Database (Denmark)

    Andersen, Michelle Fog; Longhurst, Hilary J; Rasmussen, Eva Rye

    2016-01-01

    BACKGROUND: Angioedema is a vascular reaction involving the lower dermis, subcutis and/or submucosal tissue and causing a temporary localized swelling in any part of the body. For many health care professionals, the diagnosis presents an ongoing challenge; several disorders may manifest with subc...

  16. Urticaria and angioedema – more than just skin deep! | Holtzhausen ...

    African Journals Online (AJOL)

    Urticaria and angioedema are characterized by pruritic hives and sometimes swelling of deeper mucocutaneous layers. Urticaria is caused by release of histamine and other mediators from mast cells. A cut-off of six weeks distinguishes acute and chronic forms, as these seem to differ regarding etiological and response ...

  17. Hereditary Angioedema - Consequences of a New Treatment Paradigm in Denmark

    DEFF Research Database (Denmark)

    Bygum, Anette

    2014-01-01

    stopped long-term prophylaxis with danazol or tranexamic acid and changed treatment regimen to on-demand treatment with C1 inhibitor concentrate or icatibant. At least 10% of the attacks remained un-treated. More than half of the patients felt that hereditary angioedema had a significant psychological...

  18. Fatal angioedema induced by angiotensin conversion enzyme (ACE ...

    African Journals Online (AJOL)

    ACE inhibitors are often prescribed in the treatment of hypertension, heart failure and kidney disease. These drugs are on the Essential Drugs List, and are therefore used at primary to tertiary health care levels in South Africa. Angioedema is considered a rare, but potentially fatal side-effect of this agent, with a reported ...

  19. a case report of suspected angioedema in a child after ...

    African Journals Online (AJOL)

    consecutive days.16 Common side effects include: nausea, vomiting while rare side effects include: rash, alopecia, urticaria and angioedema. Adverse effects appear to occur more frequently when higher doses are used.17. A compiled information from Food and Drug administration (FDA) and Facts Med users submissions.

  20. Neuropatia óptica auto-imune: relato de caso Autoimmune optic neuropathy: case report

    Directory of Open Access Journals (Sweden)

    Laura Martins C. Duprat Cardoso

    2006-08-01

    Full Text Available Descrevemos uma paciente de 9 anos, sexo feminino, com perda visual bilateral grave tratada com corticóide por via oral apresentando melhora em apenas um olho. Nove anos depois apresentou recidiva que inicialmente respondeu à pulsoterapia corticóide mas foi seguida de perda progressiva e completa da visão após a redução do tratamento. Novas tentativas terapêuticas não melhoraram a visão. Avaliação clínico-laboratorial não revelou doença sistêmica, mas apresentava anticorpos antinucleares (1/640, anti-Ro e anti-La positivos. Neuropatia óptica auto-imune é uma afecção rara, que simula neurite óptica idiopática e se caracteriza por perda visual aguda, sem doença sistêmica, mas com evidências laboratoriais de doença auto-imune, em especial o FAN positivo. Biópsia de pele freqüentemente mostra evidências de vasculite. Esta condição deve ser tratada agressivamente, com corticóide e imunossupressores, uma vez que o acometimento visual geralmente é mais grave do que o da neurite óptica idiopática/desmielinizante e pode ser irreversível.We report on a 9-year-old female patient who had bilateral severe visual loss and was treated with oral corticosteroids. Visual improvement occurred in one eye. Nine years later she presented relapse of visual loss in her only seeing eye. Pulse corticosteroid therapy resulted in dramatic visual improvement followed, however, by progressive and complete visual loss as soon as the corticosteroid was tapered. Repeat treatment did not result in visual improvement. Clinical and laboratory investigation failed to find a systemic disease but the patient had positive antinuclear (1/640, anti-Ro and anti-La antibodies. Autoimmune optic neuropathy is a rare condition that may mimic an idiopathic optic neuritis and is characterized by acute visual loss, without systemic disease but with laboratory evidence of an autoimmune disorder, usually a positive ANA. A skin biopsy usually shows evidence of

  1. Icatibant, a new bradykinin-receptor antagonist, in hereditary angioedema.

    Science.gov (United States)

    Cicardi, Marco; Banerji, Aleena; Bracho, Francisco; Malbrán, Alejandro; Rosenkranz, Bernd; Riedl, Marc; Bork, Konrad; Lumry, William; Aberer, Werner; Bier, Henning; Bas, Murat; Greve, Jens; Hoffmann, Thomas K; Farkas, Henriette; Reshef, Avner; Ritchie, Bruce; Yang, William; Grabbe, Jürgen; Kivity, Shmuel; Kreuz, Wolfhart; Levy, Robyn J; Luger, Thomas; Obtulowicz, Krystyna; Schmid-Grendelmeier, Peter; Bull, Christian; Sitkauskiene, Brigita; Smith, William B; Toubi, Elias; Werner, Sonja; Anné, Suresh; Björkander, Janne; Bouillet, Laurence; Cillari, Enrico; Hurewitz, David; Jacobson, Kraig W; Katelaris, Constance H; Maurer, Marcus; Merk, Hans; Bernstein, Jonathan A; Feighery, Conleth; Floccard, Bernard; Gleich, Gerald; Hébert, Jacques; Kaatz, Martin; Keith, Paul; Kirkpatrick, Charles H; Langton, David; Martin, Ludovic; Pichler, Christiane; Resnick, David; Wombolt, Duane; Fernández Romero, Diego S; Zanichelli, Andrea; Arcoleo, Francesco; Knolle, Jochen; Kravec, Irina; Dong, Liying; Zimmermann, Jens; Rosen, Kimberly; Fan, Wing-Tze

    2010-08-05

    Hereditary angioedema is characterized by recurrent attacks of angioedema of the skin, larynx, and gastrointestinal tract. Bradykinin is the key mediator of symptoms. Icatibant is a selective bradykinin B2 receptor antagonist. In two double-blind, randomized, multicenter trials, we evaluated the effect of icatibant in patients with hereditary angioedema presenting with cutaneous or abdominal attacks. In the For Angioedema Subcutaneous Treatment (FAST) 1 trial, patients received either icatibant or placebo; in FAST-2, patients received either icatibant or oral tranexamic acid, at a dose of 3 g daily for 2 days. Icatibant was given once, subcutaneously, at a dose of 30 mg. The primary end point was the median time to clinically significant relief of symptoms. A total of 56 and 74 patients underwent randomization in the FAST-1 and FAST-2 trials, respectively. The primary end point was reached in 2.5 hours with icatibant versus 4.6 hours with placebo in the FAST-1 trial (P=0.14) and in 2.0 hours with icatibant versus 12.0 hours with tranexamic acid in the FAST-2 trial (P<0.001). In the FAST-1 study, 3 recipients of icatibant and 13 recipients of placebo needed treatment with rescue medication. The median time to first improvement of symptoms, as assessed by patients and by investigators, was significantly shorter with icatibant in both trials. No icatibant-related serious adverse events were reported. In patients with hereditary angioedema having acute attacks, we found a significant benefit of icatibant as compared with tranexamic acid in one trial and a nonsignificant benefit of icatibant as compared with placebo in the other trial with regard to the primary end point. The early use of rescue medication may have obscured the benefit of icatibant in the placebo trial. (Funded by Jerini; ClinicalTrials.gov numbers, NCT00097695 and NCT00500656.)

  2. Brazilian Guidelines for Hereditary Angioedema Management - 2017 Update Part 1: Definition, Classification and Diagnosis.

    Science.gov (United States)

    Giavina-Bianchi, Pedro; Arruda, Luisa Karla; Aun, Marcelo V; Campos, Regis A; Chong-Neto, Herberto J; Constantino-Silva, Rosemeire N; Fernandes, Fátima R; Ferraro, Maria F; Ferriani, Mariana P L; França, Alfeu T; Fusaro, Gustavo; Garcia, Juliana F B; Komninakis, Shirley; Maia, Luana S M; Mansour, Eli; Moreno, Adriana S; Motta, Antonio A; Pesquero, João B; Portilho, Nathalia; Rosário, Nelson A; Serpa, Faradiba S; Solé, Dirceu; Takejima, Priscila; Toledo, Eliana; Valle, Solange O.R; Veronez, Camila L; Grumach, Anete S

    2018-01-01

    Hereditary angioedema is an autosomal dominant disease characterized by recurrent angioedema attacks with the involvement of multiple organs. The disease is unknown to many health professionals and is therefore underdiagnosed. Patients who are not adequately diagnosed and treated have an estimated mortality rate ranging from 25% to 40% due to asphyxiation by laryngeal angioedema. Intestinal angioedema is another important and incapacitating presentation that may be the main or only manifestation during an attack. In this article, a group of experts from the "Associação Brasileira de Alergia e Imunologia (ASBAI)" and the "Grupo de Estudos Brasileiro em Angioedema Hereditário (GEBRAEH)" has updated the Brazilian guidelines for the diagnosis and treatment of hereditary angioedema.

  3. Socioeconomic burden of hereditary angioedema: results from the hereditary angioedema burden of illness study in Europe.

    Science.gov (United States)

    Aygören-Pürsün, Emel; Bygum, Anette; Beusterien, Kathleen; Hautamaki, Emily; Sisic, Zlatko; Wait, Suzanne; Boysen, Henrik B; Caballero, Teresa

    2014-07-04

    Hereditary angioedema (HAE) due to C1 inhibitor deficiency is a rare but serious and potentially life-threatening disease marked by spontaneous, recurrent attacks of swelling. The study objective was to characterize direct and indirect resource utilization associated with HAE from the patient perspective in Europe. The study was conducted in Spain, Germany, and Denmark to assess the real-world experience of HAE via a cross-sectional survey of HAE patients, including direct and indirect resource utilization during and between attacks for patients and their caregivers over the past 6 months. A regression model examined predictors of medical resource utilization. Overall, 164 patients had an attack in the past 6 months and were included in the analysis. The most significant predictor of medical resource utilization was the severity of the last attack (OR 2.6; p career/educational advancement. HAE poses a considerable burden on patients and their families in terms of direct medical costs and indirect costs related to lost productivity. This burden is substantial at the time of attacks and in between attacks.

  4. Angioedema hereditário: considerações sobre terapia Therapeutic approach of hereditary angioedema

    Directory of Open Access Journals (Sweden)

    Kélem de Nardi Chagas

    2004-09-01

    Full Text Available OBJETIVOS: A primeira descrição clínica completa do angioedema hereditário (HAE foi relatada por William Osler, em 1888. As formas de angioedema com deficiência de C1-INH são divididas em hereditárias e adquiridas. A terapêutica pode ser direcionada aos ataques agudos ou profilaxia de novos episódios. O tratamento de escolha é feito através de hormônios masculinizantes, podendo também ser indicado os inibidores da ativação do cininogênio e do plasminogênio como o ácido tranexâmico ou o ácido e-aminocapróico e a reposição de concentrado de C1-INH. O presente estudo relata a evolução de 10 pacientes (quatro famílias acometidos por HAE e as peculiaridades do tratamento utilizado em cada caso. MÉTODOS: Dez pacientes (1-38 anos com HAE foram diagnosticados através de história clínica e exames laboratoriais. Os testes realizados para avaliação do sistema complemento foram: dosagem sérica de C1-INH, C4 e C3 e ensaio hemolítico (CH50 e APH50 para as vias clássica e alternativa. O tratamento foi indicado de acordo com a gravidade dos sintomas, idade, sexo e resposta terapêutica. RESULTADOS: A avaliação clínica evidenciou 4/10 pacientes com edema subcutâneo recorrente; 3/10 pacientes com edema de laringe prévio e 3/10 pacientes com sintomas esporádicos. Sintomas de gravidade diferentes foram evidenciados na mesma família. A avaliação laboratorial (dosagem sérica demonstrou: níveis de C1-INH diminuídos em 10/10; níveis diminuídos de C4 8/10; níveis indetectáveis de CH50 em 3/10 e diminuídos em 6/10; níveis diminuídos de APH50 em 2/10. 6/10 pacientes não receberam tratamento específico, sendo que dois deles apresentam alto risco para asfixia; uma adolescente tem sido controlada com ácido e-aminocapróico, uma criança que fazia uso de danazol passou a receber ácido tranexâmico, uma paciente de 30 anos recebe oxandrolona e um homem de 38 anos está em tratamento com danazol. CONCLUSÃO: Apesar do

  5. Hereditary Angioedema: The Economics of Treatment of an Orphan Disease.

    Science.gov (United States)

    Lumry, William Raymond

    2018-01-01

    This review will discuss the cost burden of hereditary angioedema on patients, healthcare systems, and society. The impact of availability of and access to novel and specific therapies on morbidity, mortality, and the overall burden of disease will be explored along with potential changes in treatment paradigms to improve effectiveness and reduce cost of treatment. The prevalence of orphan diseases, legislative incentives to encourage development of orphan disease therapies and the impact of orphan disease treatment on healthcare payment systems will be discussed.

  6. Angioedema recorrente – caso clínico

    Directory of Open Access Journals (Sweden)

    Sandrina Martins

    2016-02-01

    Full Text Available Introdução: O Angioedema hereditário (AEH é uma causa rara de angioedema recorrente, resultante de um defeito a nível do gene que codifica o inibidor do C1 esterase (C1 -INH. O edema envolve predominantemente os tecidos da face, membros, trato gastrointestinal e área genital. O envolvimento da laringe, apesar de menos frequente, constitui a expressão clínica mais grave, sendo potencialmente fatal. Caso clínico: Descreve -se o caso clínico de uma criança do sexo feminino de oito anos de idade referenciada à consulta de pediatria por episódios recorrentes de angioedema. O estudo efetuado revelou tratar -se de um caso de AEH. Discussão: O diagnóstico, estabelecido com base no quadro clínico, estudo do complemento e história familiar, é de importância fundamental considerando que o AEH é potencialmente fatal e exige uma terapêutica específica.

  7. Caffeine as a cause of urticaria-angioedema

    Directory of Open Access Journals (Sweden)

    Linda Tognetti

    2014-01-01

    Full Text Available We report the case of a young woman presenting with recurrent urticaria. The episodes occurred both in and out of the workplace. On three occasions it presented as urticaria-angioedema, requiring emergency care on one occassion. A thorough clinical history along with serological and allergological tests allowed a diagnosis of caffeine-induced urticaria-angioedema. We advised the patient to follow a caffeine-free diet and to avoid all caffeine or methylxanthine-containing drugs. After two years of caffeine abstinence, she had not experienced any further episodes of urticaria-angioedema. Only a few cases of caffeine-induced urticaria and/or anaphylaxis have been reported till date, with varying outcomes in allergologic investigations. Moreover, several cases are probably undiagnosed or misdiagnosed as idiopathic urticaria or as occupational allergy. We speculate that hypersensitivity to caffeine rather than autoimmine reaction may be the probable cause of urticaria. Caffeine should considered as a potential urticaria-inducing agent and should be included in the allergological test series.

  8. Functional C1-inhibitor diagnostics in hereditary angioedema: Assay evaluation and recommendations

    NARCIS (Netherlands)

    Wagenaar-Bos, Ineke G. A.; Drouet, Christian; Aygoeren-Pursun, Emel; Bork, Konrad; Bucher, Christoph; Bygum, Anette; Farkas, Henriette; Fust, George; Gregorek, Hanna; Hack, C. Erik; Hickey, Alaco; Joller-Jemelka, Helen I.; Kapusta, Maria; Kreuz, Wolfhart; Longhurst, Hilary; Lopez-Trascasa, Margarita; Madalinski, Kazimierz; Naskalski, Jerzy; Nieuwenhuys, Ed; Ponard, Denise; Truedsson, Lennart; Varga, Lilian; Nielsen, Erik Waage; Wagner, Eric; Zingale, Lorenza; Cicardi, Marco; van Ham, S. Marieke

    2008-01-01

    Hereditary angioedema (HAE) is an autosomal dominant disease characterized by recurrent episodes of potentially life-threatening angioedema. The most widespread underlying genetic deficiency is a heterozygous deficiency of the serine protease inhibitor Cl esterase inhibitor (C1-Inh). In addition to

  9. Functional C1-inhibitor diagnostics in hereditary angioedema: assay evaluation and recommendations

    DEFF Research Database (Denmark)

    Wagenaar-Bos, Ineke G A; Drouet, Christian; Aygören-Pursun, Emel

    2008-01-01

    Hereditary angioedema (HAE) is an autosomal dominant disease characterized by recurrent episodes of potentially life-threatening angioedema. The most widespread underlying genetic deficiency is a heterozygous deficiency of the serine protease inhibitor C1 esterase inhibitor (C1-Inh). In addition ...

  10. Clinical characteristics and treatment of chronic urticaria and angioedema : Dwelling on swelling, dealing with whealing

    NARCIS (Netherlands)

    van den Elzen, M.T.

    2017-01-01

    The occurrence of wheals, angioedema or both for at least 6 weeks is diagnosed as chronic spontaneous urticaria in (inter) national guidelines - after excluding other illnesses. The underlying mechanism of angioedema without wheals is not entirely known. The objective of this thesis is to increase

  11. 2010 International consensus algorithm for the diagnosis, therapy and management of hereditary angioedema

    DEFF Research Database (Denmark)

    Bowen, Tom; Cicardi, Marco; Farkas, Henriette

    2010-01-01

    ABSTRACT: BACKGROUND: We published the Canadian 2003 International Consensus Algorithm for the Diagnosis, Therapy, and Management of Hereditary Angioedema (HAE; C1 inhibitor [C1-INH] deficiency) and updated this as Hereditary angioedema: a current state-of-the-art review: Canadian Hungarian 2007 ...

  12. Estimation of EuroQol 5-Dimensions health status utility values in hereditary angioedema

    DEFF Research Database (Denmark)

    Aygören-Pürsün, Emel; Bygum, Anette; Beusterien, Kathleen

    2016-01-01

    OBJECTIVE: To estimate health status utility (preference) weights for hereditary angioedema (HAE) during an attack and between attacks using data from the Hereditary Angioedema Burden of Illness Study in Europe (HAE-BOIS-Europe) survey. Utility measures quantitatively describe the net impact of a...

  13. Direito adquirido e emendas constitucionais sob a ótica do direito intertemporal

    OpenAIRE

    Jaques, Gustavo

    2008-01-01

    O presente estudo, dissertação de Mestrado, dedica-se a questões relevantes no mundo jurídico. Aborda, especialmente, a preocupação com o respeito ao direito adquirido dos indivíduos em face das sucessivas alterações constitucionais em nosso ordenamento, assunto conjugado à análise do direito intertemporal. Nesse contexto, elabora-se larga explanação, doutrinária e jurisprudencial, acerca dos conflitos de leis no tempo, com ênfase na análise da irretroatividade e da aplicação imediata das lei...

  14. Procesos de plasticidad cerebral en pacientes con daño adquirido

    OpenAIRE

    Márquez Noriego, Blanca Esther

    2016-01-01

    Los accidentes cerebrovasculares y los traumatismos craneoencefálicos son las dos patologías principales causantes de daño cerebral adquirido. Los avances médicos han permitido disminuir considerablemente la mortalidad derivada de dichas patologías. Consecuentemente, el número de personas que padecen déficits derivados de estas lesiones aumenta a nivel mundial. Estos déficits son consecuencia del daño cerebral, el cual puede afectar a varias áreas, según las características propias de la lesi...

  15. El conocimiento profesional adquirido por el entrenador de balonmano: experiencias y formación

    Directory of Open Access Journals (Sweden)

    Sebasti\\u00E1n Feu Molina

    2012-01-01

    Full Text Available El objetivo del estudio fue conocer la procedencia del conocimiento que utilizan los entrenadores de balonmano en su ejercicio profesional. En el estudio participaron 333 entrenadores españoles, 86.8% hombres y 13.2% mujeres. Se diseñó y validó un cuestionario que permitió conocer la influencia del conocimiento profesional en su intervención como entrenador: experiencia como jugador, formación académica o experiencia como entrenador. El análisis estadístico reflejó que los factores de la escala tenían una validez y fiabilidad adecuadas (¿ > .70, acreditando a este cuestionario como una herramienta válida y fiable. Los entrenadores utilizan las tres fuentes de conocimiento (académica, experiencia como jugador y autoformación, existiendo una mayor utilización del conocimiento académico. Los entrenadores con mayor formación utilizan menos las experiencias y conocimientos adquiridos como jugador y utilizan más los conocimientos adquiridos en su vida profesional.

  16. Angioedema Spotlight: A Closer Examination of Sacubitril/Valsartan Safety Results.

    Science.gov (United States)

    Owens, Ryan E; Oliphant, Carrie S

    2017-01-01

    Incorporation of neprilysin inhibition into heart failure pharmacotherapy regimens has recently been recommended by U.S. guidelines, based on results from the PARADIGM-HF trial comparing sacubitril/valsartan to enalapril. While most of the discussion has focused on efficacy, a closer examination of the safety results, particularly the incidence of angioedema during the run-in and double-blind periods, is also warranted. Although no major safety concerns were identified, an angioedema risk comparable to enalapril was found, primarily in the black population. Therefore, despite combination with an angiotensin receptor blocker, which historically has a lower incidence of angioedema, the addition of neprilysin inhibition yields an angioedema risk profile comparable to angiotensin converting enzyme (ACE) inhibitors. Clinicians should recognize this safety risk when prescribing sacubitril/valsartan and remain vigilant in counseling patients regarding the signs and symptoms of angioedema. As recommended by the guidelines, avoiding sacubitril/valsartan use concurrently or within 36 hours of the last dose of an ACE inhibitor or in patients with a history of angioedema is also crucial to minimize angioedema risk and prevent patient harm. © Copyright 2017 by the American Board of Family Medicine.

  17. Gastrointestinal manifestations of hereditary angioedema diagnosed by ultrasound in the emergency department.

    Science.gov (United States)

    Riguzzi, Christine; Losonczy, Lia; Teismann, Nathan; Herring, Andrew A; Nagdev, Arun

    2014-11-01

    Abdominal angioedema is a less recognized type of angioedema, which can occur in patients with hereditary angioedema (HAE). The clinical signs may range from subtle, diffuse abdominal pain and nausea, to overt peritonitis. We describe two cases of abdominal angioedema in patients with known HAE that were diagnosed in the emergency department by point-of-care (POC) ultrasound. In each case, the patient presented with isolated abdominal complaints and no signs of oropharyngeal edema. Findings on POC ultrasound included intraperitoneal free fluid and bowel wall edema. Both patients recovered uneventfully after receiving treatment. Because it can be performed rapidly, requires no ionizing radiation, and can rule out alternative diagnoses, POC ultrasound holds promise as a valuable tool in the evaluation and management of patients with HAE.

  18. Gastrointestinal Manifestations of Hereditary Angioedema Diagnosed by Ultrasound in the Emergency Department

    Directory of Open Access Journals (Sweden)

    Christine Riguzzi

    2014-11-01

    Full Text Available Abdominal angioedema is a less recognized type of angioedema, which can occur in patients with hereditary angioedema (HAE. The clinical signs may range from subtle, diffuse abdominal pain and nausea, to overt peritonitis. We describe two cases of abdominal angioedema in patients with known HAE that were diagnosed in the emergency department by point-of-care (POC ultrasound. In each case, the patient presented with isolated abdominal complaints and no signs of oropharyngeal edema. Findings on POC ultrasound included intraperitoneal free fluid and bowel wall edema. Both patients recovered uneventfully after receiving treatment. Because it can be performed rapidly, requires no ionizing radiation,and can rule out alternative diagnoses, POC ultrasound holds promise as a valuable tool in the evaluation and management of patients with HAE. [West J Emerg Med. 2014;15(7:-0.

  19. Successful treatment of hereditary angioedema with bradykinin B2-receptor antagonist icatibant.

    Science.gov (United States)

    Krause, Karoline; Metz, Martin; Zuberbier, Torsten; Maurer, Marcus; Magerl, Markus

    2010-04-01

    The bradykinin B2 receptor antagonist icatibant has recently become available for treating hereditary angioedema. Our observations demonstrate icatibant to be effective and safe for the treatment of both, abdominal and cutaneous attacks in a practice setting beyond clinical studies.

  20. Bowel Angioedema Associated With Iodinated Contrast Media: Incidence and Predisposing Factors.

    Science.gov (United States)

    Seo, Nieun; Chung, Yong Eun; Lim, Joon Seok; Song, Mi Kyung; Kim, Myeong-Jin; Kim, Ki Whang

    2017-09-01

    Bowel angioedema is an acute adverse reaction to iodinated contrast media (CM) that involves the gastrointestinal tract. We aimed to investigate the incidence and predisposing factors of iodinated CM-associated bowel angioedema during computed tomography (CT) examinations. This study was approved by our institutional review board, and informed consent was waived due to its retrospective design. From July 2013 to July 2015, adult patients with a history of adverse reactions to iodinated CM during CT (group A, n = 427) and patients without adverse reactions matched for age and sex with the propensity-score matching method (group B, n = 427) were studied. Contrast media-associated bowel angioedema was determined when bowel wall thickness increased after contrast enhancement compared with the precontrast scan. Potential predisposing factors including patient demographics, symptoms and time of adverse reactions, and CM-related factors were compared between patients with and without angioedema in group A. In addition, the incidence of bowel angioedema was compared between groups A and B. The incidence of CM-associated bowel angioedema in group A was 3.3% (14/427) in the per-patient analysis and 2.6% (15/578) in the per-examination analysis. The CM-associated bowel angioedema involved the distal duodenum and/or proximal jejunum and showed long-segmental circumferential bowel wall thickening on CT. None of the studied predisposing factors was different between patients with and without bowel angioedema (P > 0.05). The incidence of CM-associated bowel angioedema in group B was 1.9% (8/427) and 1.7% (8/458) for per-patient and per-examination analyses, respectively, and these rates were not significantly different between groups A and B (P = 0.346 and P = 0.370, respectively). The incidence of CM-associated bowel angioedema during CT was 1.7% to 3.3%, and none of the studied predisposing factors was associated with bowel angioedema.

  1. Dipeptidyl Peptidase IV in Angiotensin-Converting Enzyme Inhibitor–Associated Angioedema

    OpenAIRE

    Byrd, James Brian; Touzin, Karine; Sile, Saba; Gainer, James V.; Yu, Chang; Nadeau, John; Adam, Albert; Brown, Nancy J.

    2007-01-01

    Angioedema is a potentially life-threatening adverse effect of angiotensin-converting enzyme inhibitors. Bradykinin and substance P, substrates of angiotensin-converting enzyme, increase vascular permeability and cause tissue edema in animals. Studies indicate that amino-terminal degradation of these peptides, by aminopeptidase P and dipeptidyl peptidase IV, may be impaired in individuals with angiotensin-converting enzyme inhibitor–associated angioedema. This case-control study tested the hy...

  2. ACE-I Angioedema: Accurate Clinical Diagnosis May Prevent Epinephrine-Induced Harm

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    R. Mason Curtis

    2016-06-01

    Full Text Available Introduction: Upper airway angioedema is a life-threatening emergency department (ED presentation with increasing incidence. Angiotensin-converting enzyme inhibitor induced angioedema (AAE is a non-mast cell mediated etiology of angioedema. Accurate diagnosis by clinical examination can optimize patient management and reduce morbidity from inappropriate treatment with epinephrine. The aim of this study is to describe the incidence of angioedema subtypes and the management of AAE. We evaluate the appropriateness of treatments and highlight preventable iatrogenic morbidity. Methods: We conducted a retrospective chart review of consecutive angioedema patients presenting to two tertiary care EDs between July 2007 and March 2012. Results: Of 1,702 medical records screened, 527 were included. The cause of angioedema was identified in 48.8% (n=257 of cases. The most common identifiable etiology was AAE (33.1%, n=85, with a 60.0% male predominance. The most common AAE management strategies included diphenhydramine (63.5%, n=54, corticosteroids (50.6%, n=43 and ranitidine (31.8%, n=27. Epinephrine was administered in 21.2% (n=18 of AAE patients, five of whom received repeated doses. Four AAE patients required admission (4.7% and one required endotracheal intubation. Epinephrine induced morbidity in two patients, causing myocardial ischemia or dysrhythmia shortly after administration. Conclusion: AAE is the most common identifiable etiology of angioedema and can be accurately diagnosed by physical examination. It is easily confused with anaphylaxis and mismanaged with antihistamines, corticosteroids and epinephrine. There is little physiologic rationale for epinephrine use in AAE and much risk. Improved clinical differentiation of mast cell and non-mast cell mediated angioedema can optimize patient management.

  3. Rituximab therapy in a patient with low grade B-cell lymphoproliferative disease and concomitant acquired angioedema

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    Kaur R

    2014-12-01

    Full Text Available Ravdeep Kaur, Aerik Anthony Williams, Catherine Baker Swift, Jason W Caldwell Wake Forest University School of Medicine, Wake Forest University, Winston-Salem, NC, USA Abstract: Acquired angioedema is often associated with significant morbidity. An underlying lymphatic malignancy, autoimmune disorder, adenocarcinoma, or other malignancy may be present. Screening for these disorders should occur in all patients with acquired angioedema as treatment may result in resolution of angioedema. Keywords: complement, C1-INH deficiency, ecallantide, hemopathy

  4. 2010 International consensus algorithm for the diagnosis, therapy and management of hereditary angioedema

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    Bowen Tom

    2010-07-01

    Full Text Available Abstract Background We published the Canadian 2003 International Consensus Algorithm for the Diagnosis, Therapy, and Management of Hereditary Angioedema (HAE; C1 inhibitor [C1-INH] deficiency and updated this as Hereditary angioedema: a current state-of-the-art review: Canadian Hungarian 2007 International Consensus Algorithm for the Diagnosis, Therapy, and Management of Hereditary Angioedema. Objective To update the International Consensus Algorithm for the Diagnosis, Therapy and Management of Hereditary Angioedema (circa 2010. Methods The Canadian Hereditary Angioedema Network (CHAEN/Réseau Canadien d'angioédème héréditaire (RCAH http://www.haecanada.com and cosponsors University of Calgary and the Canadian Society of Allergy and Clinical Immunology (with an unrestricted educational grant from CSL Behring held our third Conference May 15th to 16th, 2010 in Toronto Canada to update our consensus approach. The Consensus document was reviewed at the meeting and then circulated for review. Results This manuscript is the 2010 International Consensus Algorithm for the Diagnosis, Therapy and Management of Hereditary Angioedema that resulted from that conference. Conclusions Consensus approach is only an interim guide to a complex disorder such as HAE and should be replaced as soon as possible with large phase III and IV clinical trials, meta analyses, and using data base registry validation of approaches including quality of life and cost benefit analyses, followed by large head-to-head clinical trials and then evidence-based guidelines and standards for HAE disease management.

  5. Hereditary angioedema: a bradykinin-mediated swelling disorder.

    Science.gov (United States)

    Björkqvist, Jenny; Sala-Cunill, Anna; Renné, Thomas

    2013-03-01

    Edema is tissue swelling and is a common symptom in a variety of diseases. Edema form due to accumulation of fluids, either through reduced drainage or increased vascular permeability. There are multiple vascular signalling pathways that regulate vessel permeability. An important mediator that increases vascular leak is the peptide hormone bradykinin, which is the principal agent in the swelling disorder hereditary angioedema. The disease is autosomal dominant inherited and presents clinically with recurrent episodes of acute swelling that can be life-threatening involving the skin, the oropharyngeal, laryngeal, and gastrointestinal mucosa. Three different types of hereditary angiodema exist in patients. The review summarises current knowledge on the pathophysiology of hereditary angiodema and focuses on recent experimental and pharmacological findings that have led to a better understanding and new treatments for the disease.

  6. Anemia hemolítica auto-imune e outras manifestações imunes da leucemia linfocítica crônica

    OpenAIRE

    Bordin,José O.

    2005-01-01

    A leucemia linfocítica crônica (LLC) é freqüentemente associada a manifestações auto-imunes principalmente relacionadas às células do sistema hematopoético causando anemia hemolítica auto-imune (AHAI), púrpura trombocitopênica imune (PTI), aplasia pura de série vermelha (APSV), e neutropenia imune. A LLC é diagnosticada em até 15% dos pacientes com AHAI, e em cerca de 50% dos pacientes com AHAI secundária a doença maligna. A PTI ocorre em 2%, e a APSV em 1% dos pacientes com LLC. Prednisona é...

  7. The burden of illness in patients with hereditary angioedema.

    Science.gov (United States)

    Banerji, Aleena

    2013-11-01

    Hereditary angioedema (HAE) is a rare genetic disease characterized by long-term recurrent attacks of subcutaneous or submucosal edema in different parts of the body. A comprehensive review of the literature on burden of illness for patients with HAE is presented. A Boolean search was performed using MEDLINE and EMBASE databases and the Internet. Articles discussing aspects of the burden of illness in HAE were selected. Topics focused on the course of the disease, nature of attacks, treatment, quality of life, and costs. Hereditary angioedema is associated with a significant and multifaceted disease burden. Diagnosis is often delayed for years, with patients receiving ineffective treatment and unnecessary medical procedures before diagnosis. HAE attacks are painful, unpredictable, and debilitating and often require emergency medical attention. Attacks can affect a patient's daily activities, including work or schooling. Depression and anxiety are prevalent in patients with HAE. Recent advances in treatment provide patients with effective and well-tolerated prophylactic and on-demand therapeutic options. However, end points specific to HAE that better measure the impact of treatment on disease burden are lacking. Furthermore, there is a notable paucity of literature directed toward physicians who are instrumental in diagnosing and treating patients with HAE (eg, emergency department). More publications are broadening the understanding of HAE. However, important gaps remain. Effective management of HAE requires a more comprehensive understanding of the disease burden so that disease management can be individualized to meet specific patient needs. Copyright © 2013 American College of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

  8. Hereditary angioedema: what the gastroenterologist needs to know

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    Ali MA

    2014-11-01

    Full Text Available M Aamir Ali, Marie L Borum Division of Gastroenterology and Liver Diseases, George Washington University, Washington, DC, USA Abstract: Up to 93% of patients with hereditary angioedema (HAE experience recurrent abdominal pain. Many of these patients, who often present to emergency departments, primary care physicians, general surgeons, or gastroenterologists, are misdiagnosed for years and undergo unnecessary testing and surgical procedures. Making the diagnosis of HAE can be challenging because symptoms and attack locations are often inconsistent from one episode to the next. Abdominal attacks are common and can occur without other attack locations. An early, accurate diagnosis is central to managing HAE. Unexplained abdominal pain, particularly when accompanied by swelling of the face and extremities, suggests the diagnosis of HAE. A family history and radiologic imaging demonstrating edematous bowel also support an HAE diagnosis. Once HAE is suspected, C4 and C1 esterase inhibitor (C1-INH laboratory studies are usually diagnostic. Patients with HAE may benefit from recently approved specific treatments, including plasma-derived C1-INH or recombinant C1-INH, a bradykinin B2-receptor antagonist, or a kallikrein inhibitor as first-line therapy and solvent/detergent-treated or fresh frozen plasma as second-line therapy for acute episodes. Short-term or long-term prophylaxis with nanofiltered C1-INH or attenuated androgens will prevent or reduce the frequency and severity of episodes. Gastroenterologists can play a critical role in identifying and treating patients with HAE, and should have a high index of suspicion when encountering patients with recurrent, unexplained bouts of abdominal pain. Given the high rate of abdominal attacks in HAE, it is important for gastroenterologists to appropriately diagnose and promptly recognize and treat HAE, or refer patients with HAE to an allergist. Keywords: hereditary angioedema, abdominal pain, diagnosis

  9. Autoimmune thyroiditis presenting as interstitial granulomatous dermatitis Dermatite intersticial granulomatosa como apresentação de tireoidite autoimune

    Directory of Open Access Journals (Sweden)

    Joana Antunes

    2012-10-01

    Full Text Available A 54-year-old female presented with recurrent, widespread, erythematous, painful plaques, over a 3-month period. Skin biopsy was compatible with interstitial granulomatous dermatitis. Additional investigation revealed hypothyroidism and positive anti-thyroid antibodies. Normalization of thyroid function and high-potency topical corticosteroids provided only transitory improvement of the dermatosis. Interstitial granulomatous dermatitis is a histologic inflammatory reaction, with variable cutaneous expression. It has been reported in association with several drugs, lymphoproliferative diseases and autoimmune disorders, such as rheumatoid arthritis, systemic lupus erythematosus and vasculitis, but association with autoimmune thyroiditis is rare. Optimal therapy for this condition is yet to be established, but topical corticosteroids have been a mainstay of treatment. In most cases, this disease is characterized by flares and remissions.Uma doente de 54 anos foi avaliada por placas eritematosas, dolorosas, disseminadas, recorrentes, com 3 meses de evolução. A biopsia cutânea foi compatível com dermatite intersticial granulomatosa. Os restantes exames laboratoriais revelaram hipotiroidismo e anticorpos anti-tiroideus positivos. Apesar da normalização da função tiroideia e de tratamento com corticóide tópico de alta potência, a dermatose melhorou apenas parcialmente. Dermatite intersticial inflamatória é um diagnóstico histopatológico, com expressão clínica variável. Tem sido associada a vários fármacos, doenças linfoproliferativas e autoimunes, nomeadamente artrite reumatóide, lupus eritematoso sistémico e vasculites, mas a associação com tireoidite autoimune é rara. Até ao momento, não foi definido nenhum tratamento específico, mas os corticóides tópicos são dos fármacos mais utilizados. A doença caracteriza-se por períodos de agravamento e remissão.

  10. Management of acute attacks of hereditary angioedema: potential role of icatibant

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    Hilary J Longhurst

    2010-09-01

    Full Text Available Hilary J LonghurstDepartment of Immunology, Barts and The London NHS Trust, London, UKAbstract: Icatibant (Firazyr® is a novel subcutaneous treatment recently licensed in the European Union for acute hereditary angioedema. Hereditary angioedema, resulting from inherited partial C1 inhibitor deficiency, is a disabling condition characterized by intermittent episodes of bradykinin-mediated angioedema. Icatibant blocks bradykinin B2 receptors, attenutating the episode. Randomized double-blind, placebo-controlled trials of icatibant, showed significant superiority over oral tranexamic acid in 74 European patients and a trend to improvement in a similar US trial comparing icatibant with placebo in 55 patients. Outcomes for several endpoints did not reach significance in the US trial, perhaps because of low participant numbers and confounding factors: a further trial is planned. Open label studies have shown benefit in multiple treatments for attacks at all sites. Approximately 10% of patients require a second dose for re-emergent symptoms, usually 10 to 27 hours after the initial treatment. Its subcutaneous route of administration, good tolerability and novel mode of action make icatibant a promising addition to the limited repertoire of treatments for hereditary angioedema.Keywords: hereditary angioedema, bradykinin, icatibant, C1 inhibitor deficiency

  11. Enzymatic assays for the diagnosis of bradykinin-dependent angioedema.

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    Federica Defendi

    Full Text Available BACKGROUND: The kinins (primarily bradykinin, BK represent the mediators responsible for local increase of vascular permeability in hereditary angioedema (HAE, HAE I-II associated with alterations of the SERPING1 gene and HAE with normal C1-Inhibitor function (HAE-nC1INH. Besides C1-Inhibitor function and concentration, no biological assay of kinin metabolism is actually available to help physicians for the diagnosis of angioedema (AE. We describe enzymatic tests on the plasma for diagnosis of BK-dependent AE. METHODS: The plasma amidase assays are performed using the Pro-Phe-Arg-p-nitroanilide peptide substrate to evaluate the spontaneous amidase activity and the proenzyme activation. We analyzed data of 872 patients presenting with BK-dependent AE or BK-unrelated diseases, compared to 303 controls. Anti-high MW kininogen (HK immunoblot was achieved to confirm HK cleavage in exemplary samples. Reproducibility, repeatability, limit of blank, limit of detection, precision, linearity and receiver operating characteristics (ROC were used to calculate the diagnostic performance of the assays. RESULTS: Spontaneous amidase activity was significantly increased in all BK-dependent AE, associated with the acute phase of disease in HAE-nC1INH, but preserved in BK-unrelated disorders. The increase of the amidase activity was associated to HK proteolysis, indicating its relevance to identify kininogenase activity. The oestrogens, known for precipitating AE episodes, were found as triggers of enzymatic activity. Calculations from ROC curves gave the optimum diagnostic cut-off for women (9.3 nmol⋅min(-1⋅mL(-1, area under curve [AUC] 92.1%, sensitivity 80.0%, and specificity 90.1% and for men (6.6 nmol·min(-1⋅mL(-1, AUC 91.0%, sensitivity 87.0% and specificity 81.2%. CONCLUSION: The amidase assay represents a diagnostic tool to help physicians in the decision to distinguish between BK-related and -unrelated AE.

  12. Angiodema due to oral acitretin and isotretinoin Angioedema por acitretina e isotretinoína oral

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    Roberto Rheingantz da Cunha Filho

    2011-08-01

    Full Text Available Angioedema may be caused by nonsteroidal antiinflammatory drugs, angiotensin- converting enzyme inhibitors, radiocontrast media, antibiotics, sea food etc. It can involve an allergic (IgE-mediated or non-allergic hypersensitivity reaction, both with a similar clinical presentation. While angioedema due to isotretionin has been described previously, this is the first description of angiodema due to acitretin. We report two uncommon cases of palpebral and labial angiodema due to retinoids, by acitretin and oral isotretinoin respectively: a 48-year-old man with psoriasis and a 24-year-old woman with severe acne resistant to antibiotics and topical drugs. In both cases the reaction persisted through-out treatment with these drugs, but resolved quickly after discontinuation. Reintroduction of the drugs brought on angioedema againAngioedema pode ser causado por diversos fármacos como : antiinflamatórios não-esteroidais, inibidores da ECA, contrastes, antibióticos e frutos do mar, entre outras causas. Pode ser uma reação alérgica, mediada por IgE, ou não-alérgica, com apresentações clínicas semelhantes. Angioedema por isotretinoína já foi relatado, mas não por acitretina. Relatamos dois casos, uma com angioedema palpebral e um labial, por acitretina e isotretinoína, respectivamente: um paciente de 48 anos com psoríase e uma paciente de 24 anos com acne resistente à terapia convencional. Em ambos casos a afecção persistiu durante o tratamento, resolveu com a interrupção e recidivou com reexposição

  13. Management of upper airway edema caused by hereditary angioedema

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    Farkas Henriette

    2010-07-01

    Full Text Available Abstract Hereditary angioedema is a rare disorder with a genetic background involving mutations in the genes encoding C1-INH and of factor XII. Its etiology is unknown in a proportion of cases. Recurrent edema formation may involve the subcutis and the submucosa - the latter can produce obstruction in the upper airways and thereby lead to life-threatening asphyxia. This is the reason for the high, 30-to 50-per-cent mortality of undiagnosed or improperly managed cases. Airway obstruction can be prevented through early diagnosis, meaningful patient information, timely recognition of initial symptoms, state-of-the-art emergency therapy, and close monitoring of the patient. Prophylaxis can substantially mitigate the risk of upper airway edema and also improve the patients' quality of life. Notwithstanding the foregoing, any form of upper airway edema should be regarded as a potentially life-threatening condition. None of the currently available prophylactic modalities is capable of preventing UAE with absolute certainty.

  14. Recent advances in management and treatment of hereditary angioedema.

    Science.gov (United States)

    Sardana, Niti; Craig, Timothy J

    2011-12-01

    Hereditary angioedema (HAE) is a rare autosomal-dominant disease characterized by recurrent self-limiting episodes of skin and mucosal edema. Morbidity and mortality are significant, and new and pending therapies are now available to reduce the risk associated with the disease. To update the reader on new advances in HAE to improve patient care. We performed a literature search of Ovid, PubMed, and Google to develop this review. Articles that are necessary for the understanding and use of the new therapeutic options for HAE were chosen, and studies of high quality were used to support the use of therapies, and in most cases, results from phase III studies were used. Until recently, therapy for HAE attacks in the United States consisted of symptom relief with narcotics, hydration, and fresh-frozen plasma, which contains active C1 inhibitor. Therapy to prevent HAE attacks has been confined to androgens and, occasionally, antifibrinolytic agents; however, both drug groups have significant adverse effects. The approval of C1-inhibitor concentrate for prevention and acute therapy has improved efficacy and safety. Ecallantide has also been approved for therapy of attacks, and icatibant is expected to be approved in the next few months for attacks. Recombinant C1 inhibitor is presently in phase III studies and should be available for attacks in the near future. In this article we review the changing therapeutic options available for patients in 2011 and beyond.

  15. Angioedema hereditario: Guía de tratamiento

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    Alejandro Malbrán

    2012-04-01

    Full Text Available El angioedema hereditario (HAE es una enfermedad rara, autosómica dominante, caracterizada por episodios que comprometen la piel, el tracto gastrointestinal y la laringe. Tiene una mortalidad histórica por asfixia del 15 al 50%. Es producida por la deficiencia funcional del C1 inhibidor. La identificación de la bradiquinina como mediador principal ha estimulado el desarrollo de nuevos medicamentos para tratar la enfermedad. El tratamiento del HAE se establece en consensos internacionales. El desarrollo de guías para el tratamiento de la enfermedad permite ordenar el uso de procedimientos diagnósticos y drogas. Describimos aquí algunas características farmacológicas de los medicamentos utilizados en el tratamiento del HAE en la Argentina: el concentrado plasmático de C1 inhibidor, el antagonista de la bradiquinina, icatibant, el andrógeno atenuado danazol y los agentes anti-fibrinolíticos ácidos épsilon aminocaproico (EACA y tranexámico. Asimismo, se describe su forma de uso y del control de los eventos adversos más frecuentes, así como las recomendaciones del último consenso internacional, aplicables para conformar una primera guía de tratamiento del HAE en la Argentina.

  16. Dipeptidyl peptidase-4 inhibitor induced angioedema - an overlooked and potentially lethal adverse drug reaction?

    DEFF Research Database (Denmark)

    Scott, Susanne Irene; Andersen, Michelle Fog; Aagaard, Lise

    2018-01-01

    to vasodilatation and increase in vascular permeability in the capillaries. Objective To assess the risk and pathomechanism of angioedema due to inhibition of dipeptidyl peptidase-4 inhibitors when used as monotherapy and in combination with angiotensin converting enzyme-inhibitors. Method PubMed, Embase......, the Cochrane Library, PubMed Central, Web of Science, Google Scholar and clinicaltrials.gov were searched using different combinations of keywords "angioedema", "dipeptidyl peptidase 4", "dipeptidyl peptidase 4 inhibitors", "gliptins", "bradykinin", "substance P" and "angiotensin converting enzyme...

  17. Observação de anemia hemolítica auto-imune em artrite reumatóide Observation of autoimmune hemolytic anemia in rheumatoid arthritis

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    Ricardo A. S. Souza

    2003-01-01

    Full Text Available Artrite reumatóide é uma doença difusa do tecido conjuntivo que se caracteriza pelo acometimento articular e sistêmico. Disfunções hematológicas como anemia ocorrem em até 65% dos pacientes, sendo a anemia das doenças crônicas a forma mais comum. A anemia hemolítica auto-imune pode estar associada à difusa do tecido conjuntivo, sendo classicamente associada ao lúpus eritematoso sistêmico e fazendo parte dos seus critérios de classificação. A presença de anemia hemolítica auto-imune em artrite reumatóide é relatada raramente na literatura e os mecanismos etiopatogênicos para o seu desenvolvimento ainda não estão esclarecidos. Descrevemos um caso de artrite reumatóide no adulto e outro de artrite reumatóide juvenil que desenvolveram anemia hemolítica auto-imune e discutimos os prováveis mecanismos etiopatogênicos envolvidos.Rheumatoid arthritis is a connective tissue disease characterized by articular and systemic involvement. Hematological abnormalities such as anemia may occur in up to 65% of the patients, with chronic disease anemia being the commonest form. Autoimmune hemolytic anemia can be associated with different connective tissue diseases, particularly systemic lupus erythematosus and it is part of its classification criteria. On the other hand, the presence of autoimmune hemolytic anemia in rheumatoid arthritis has rarely been described in the literature and the pathogenic mechanisms for its development remain unclear. We describe here a case of rheumatoid arthritis and another of juvenile rheumatoid arthritis that developed to autoimmune hemolytic anemia and present the probable etiopathogenic mechanisms.

  18. Incidência de neoplasias nas doenças reumatológicas autoimunes mais prevalentes: uma revisão sistemática

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    Roberta Ismael Lacerda Machado

    2014-04-01

    Full Text Available O presente artigo é uma revisão sistemática da literatura que aborda a coexistência de neoplasias e doenças reumatológicas autoimunes, suas principais associações, tipos de cânceres e os possíveis fatores de riscos associados, com ênfase nos estudos de base populacional existentes, além de verificar a relação dessa ocorrência com o uso dos fármacos utilizados no tratamento de doenças autoimunes. Foi realizada uma busca de artigos científicos indexados na Cochrane/BVS, Pubmed/Medline e Scielo/Lilacs no período de 2002 a 2012. Também foi consultada a IBICT (biblioteca digital brasileira de teses e mestrados, com os descritores em português e inglês para as palavras: "Esclerose sistêmica", "Artrite reumatoide", "Lúpus Eritematoso Sistêmico" e "Síndrome de Sjögren", correlacionando cada um com o descritor AND "neoplasias". Os resultados mostraram que, na base de dados IBICT, preencheram os critérios de inclusão uma tese e uma dissertação para o descritor LES, nenhuma para AR e uma tese para SS. Na base de dados Lilacs/Scielo foram encontrados dois artigos sobre "Artrite Reumatoide" AND "neoplasias". No Pubmed/Medline, a busca inicial resultou em 118 artigos; destes, preencheram os critérios e foram secionados 41 artigos. Esta revisão observou relação entre neoplasias e as doenças reumatológicas autoimunes, tanto como fator de risco quanto de proteção, embora os mecanismos fisiopatológicos não estejam totalmente elucidados.

  19. Transplante de células tronco hematopoéticas para doenças auto-imunes no Brasil

    OpenAIRE

    Voltarelli,Júlio C.

    2002-01-01

    O transplante de células progenitoras hematopoéticas apresenta bases sólidas para ser indicado no tratamento das doenças autoimunes. No relato são apresentados estes dados e a seqüência de eventos que tem contribuído para a implantação de um protocolo brasileiro do procedimento na modalidade autogênica utilizando regimes de mobilização uniforme com Ciclofosfamida 2g/m2 mais fator estimulador de colônias granulocitárias e condicionamentos particulares para o lúpus eritematoso sistêmico, escler...

  20. Angioedema in heart failure patients treated with sacubitril/valsartan (LCZ696) or enalapril in the PARADIGM-HF study.

    Science.gov (United States)

    Shi, Victor; Senni, Michele; Streefkerk, Hendrik; Modgill, Vikas; Zhou, Wenchun; Kaplan, Allen

    2018-08-01

    PARADIGM-HF demonstrated significant clinical benefits for sacubitril/valsartan (LCZ696, an angiotensin receptor neprilysin inhibitor) versus the angiotensin-converting enzyme inhibitor (ACEI) enalapril in patients with heart failure with reduced ejection fraction. As inhibition of ACE, and co-inhibition of ACE and neprilysin, may increase the risk of angioedema, this was an adverse event of special interest. Following sequential enalapril and sacubitril/valsartan run-ins, patients were randomized to twice-daily sacubitril/valsartan 200 mg or enalapril 10 mg. The study design incorporated two wash-out periods (~36 h each) to minimize any potential risk of angioedema due to overlapping ACE and neprilysin inhibition. Suspected cases of angioedema were reported to, and blindly adjudicated by, an independent angioedema adjudication committee (AAC). Of the 10,513 patients entering the enalapril run-in, 9419 entered the sacubitril/valsartan run-in and 8432 received double-blind treatment. Overall, 148 suspected angioedema events occurring in 144 patients were reported to AAC, with one event reported during screening period. Of the remaining 147 events, 54 were confirmed as angioedema by AAC. A confirmed event was experienced by 15 (0.14%) and 10 (0.11%) patients, during the enalapril and sacubitril/valsartan run-ins, respectively, and by 10 (0.24%) and 19 (0.45%) patients in the corresponding randomized arms during the double-blind phase. The frequency of confirmed angioedema was higher in black patients. Most events were mild. Only five patients required hospitalization and none required mechanical airway support. The number of confirmed angioedema events in PARADIGM-HF was low and there was no-marked excess risk of angioedema with sacubitril/valsartan versus enalapril. Copyright © 2018 The Authors. Published by Elsevier B.V. All rights reserved.

  1. Depression and anxiety in patients with hereditary angioedema.

    Science.gov (United States)

    Fouche, Andrew S; Saunders, Erika F H; Craig, Timothy

    2014-04-01

    Hereditary angioedema (HAE) is characterized by edematous swelling attacks of the face, extremities, abdomen, genitalia, and upper airway. The potential for laryngeal swelling makes the disease life-threatening, and the swelling elsewhere contributes to the significant burden of illness. The increased risk for mental health disorders in HAE is due to the burden of disease and possibly associated activation of the immune system. To determine the prevalence of depression and anxiety in HAE patients and the most high-yield features of depression to target in a clinical encounter. Depression and anxiety symptoms were evaluated using the 29 items of the Hamilton Depression Rating Scale along with the 14-item Hamilton Anxiety Rating Scale. The sample size was 26 participants with a diagnosis of type 1 or 2 HAE drawn from a cohort of 60 adult patients. In addition, a literature search was performed regarding how immune modulation affects depression and anxiety. A total of 39% of participants were identified as experiencing depression of mild (50%), moderate (40%), or severe (10%) levels. Fifteen percent of participants displayed prominent anxiety, half of whom had mild anxiety, 25% moderate anxiety, and 25% severe anxiety. The literature on inflammation and depression suggests a possible link between HAE and depression. Our data and the literature support that depression and anxiety symptoms are common in patients with HAE and may be secondary to chronic disease burden, associated pathophysiologic features, or both. Treatment that addresses the psychosocial and mental health of HAE patients is critical for best practice. Copyright © 2014 American College of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

  2. Evidence of impaired sense of smell in hereditary angioedema.

    Science.gov (United States)

    Perricone, C; Agmon-Levin, N; Shoenfeld, N; de Carolis, C; Guarino, M D; Gigliucci, G; Milana, I; Novelli, L; Valesini, G; Perricone, R; Shoenfeld, Y

    2011-01-01

    Hereditary angioedema (HAE) is an autosomal-dominant disorder resulting from C1-inhibitor (C1INH) deficiency. Smell impairments were found in patients affected with systemic lupus erythematosus, that, similarly to HAE, is characterized by the activation of the classical complement pathway with C4 consumption. In this study, we aimed at evaluating the sense of smell in patients with HAE. Thirty patients with HAE and 30 healthy age- and sex-matched controls were evaluated for olfactory functions using the 3-stages Sniffin'-Sticks kit (threshold, discrimination, and identification [TDI]). TDI scores were analyzed according to complement levels (C1INH, C3, C4 and CH50), Beck depression inventory (BDI-II) and danazol treatment. A significant decrease in olfactory function was observed in patients affected with HAE compared with controls in total TDI score (P < 0.001), and in the discrimination (P < 0.001) and identification scores (P = 0.012). Anosmia was present only in patients with HAE (3.3%) who also exhibited more frequently hyposmia (53.3%vs 3.3%, P < 0.0001). Complement levels were reduced in patients with HAE. C4 serum levels showed positive correlation with total TDI score (P < 0.001), and with discrimination (P = 0.002) and identification (P = 0.011) scores. CH50 complement levels showed positive correlation with total TDI score (P < 0.001), and with threshold (P = 0.002) and discrimination (P = 0.011) scores. Sex, age, danazol treatment, BDI-II scores were not different between the patients and controls and did not influence TDI scores significantly. Evidence for an impaired sense of smell was found in patients with HAE. The reduction in olfactory function in these cases seems to correlate with complement C4 and CH50 levels. Immune and genetic mechanisms might play a role in this defect. © 2010 John Wiley & Sons A/S.

  3. Effectiveness of icatibant for treatment of hereditary angioedema attacks is not affected by body weight

    DEFF Research Database (Denmark)

    Caballero, Teresa; Zanichelli, Andrea; Aberer, Werner

    2018-01-01

    Background: Icatibant is a bradykinin B2-receptor antagonist used for the treatment of hereditary angioedema attacks resulting from C1-inhibitor deficiency. Treatment is not adjusted by body weight however the impact of body mass index (BMI) on the effectiveness of icatibant is not documented in ...

  4. Management of acute attacks of hereditary angioedema: potential role of icatibant.

    Science.gov (United States)

    Longhurst, Hilary J

    2010-09-07

    Icatibant (Firazyr(®)) is a novel subcutaneous treatment recently licensed in the European Union for acute hereditary angioedema. Hereditary angioedema, resulting from inherited partial C1 inhibitor deficiency, is a disabling condition characterized by intermittent episodes of bradykinin-mediated angioedema. Icatibant blocks bradykinin B2 receptors, attenutating the episode. Randomized double-blind, placebo-controlled trials of icatibant, showed significant superiority over oral tranexamic acid in 74 European patients and a trend to improvement in a similar US trial comparing icatibant with placebo in 55 patients. Outcomes for several endpoints did not reach significance in the US trial, perhaps because of low participant numbers and confounding factors: a further trial is planned. Open label studies have shown benefit in multiple treatments for attacks at all sites. Approximately 10% of patients require a second dose for re-emergent symptoms, usually 10 to 27 hours after the initial treatment. Its subcutaneous route of administration, good tolerability and novel mode of action make icatibant a promising addition to the limited repertoire of treatments for hereditary angioedema.

  5. Open-label, multicenter study of self-administered icatibant for attacks of hereditary angioedema

    DEFF Research Database (Denmark)

    Aberer, W; Maurer, M; Reshef, A

    2014-01-01

    Historically, treatment for hereditary angioedema (HAE) attacks has been administered by healthcare professionals (HCPs). Patient self-administration could reduce delays between symptom onset and treatment, and attack burden. The primary objective was to assess the safety of self-administered ica...

  6. Breakthrough attacks in patients with hereditary angioedema receiving long-term prophylaxis are responsive to icatibant

    DEFF Research Database (Denmark)

    Aberer, Werner; Maurer, Marcus; Bouillet, Laurence

    2017-01-01

    BACKGROUND: Patients with hereditary angioedema (HAE) due to C1-inhibitor deficiency (C1-INH-HAE) experience recurrent attacks of cutaneous or submucosal edema that may be frequent and severe; prophylactic treatments can be prescribed to prevent attacks. However, despite the use of long-term prop...

  7. Management of acute attacks of hereditary angioedema: potential role of icatibant

    Science.gov (United States)

    Longhurst, Hilary J

    2010-01-01

    Icatibant (Firazyr®) is a novel subcutaneous treatment recently licensed in the European Union for acute hereditary angioedema. Hereditary angioedema, resulting from inherited partial C1 inhibitor deficiency, is a disabling condition characterized by intermittent episodes of bradykinin-mediated angioedema. Icatibant blocks bradykinin B2 receptors, attenutating the episode. Randomized double-blind, placebo-controlled trials of icatibant, showed significant superiority over oral tranexamic acid in 74 European patients and a trend to improvement in a similar US trial comparing icatibant with placebo in 55 patients. Outcomes for several endpoints did not reach significance in the US trial, perhaps because of low participant numbers and confounding factors: a further trial is planned. Open label studies have shown benefit in multiple treatments for attacks at all sites. Approximately 10% of patients require a second dose for re-emergent symptoms, usually 10 to 27 hours after the initial treatment. Its subcutaneous route of administration, good tolerability and novel mode of action make icatibant a promising addition to the limited repertoire of treatments for hereditary angioedema. PMID:20859548

  8. Helicobacter pylori infection as a triggering factor of attacks in patients with hereditary angioedema

    DEFF Research Database (Denmark)

    Visy, Beáta; Füst, George; Bygum, Anette

    2007-01-01

    BACKGROUND: Helicobacter pylori infection is considered among the causative factors of urticaria and angioedema. Having conducted a study on 65 patients, Hungarian authors reported in 2001 that successful eradication of H. pylori is followed by a significant reduction in the number of attacks in ...

  9. Medición del conocimiento adquirido en tecnología de la madera por industriales forestales en Costa Rica

    OpenAIRE

    Camacho-Cornejo, Luis Diego; Salas-Garita, Cynthia; Vargas-Fonseca, Lupita; Valverde-Otárola, Juan Carlos

    2017-01-01

    La cuantificación del conocimiento adquirido en individuos de edad adulta, permite no solo definir la efectividad de un sistema de aprendizaje, sino que también abre la posibilidad de definir las fortalezas y debilidades del sistema y analizar mejoras para el aumento de la retención de conocimiento; por lo cual el objetivo de este estudio consistió en cuantificar el conocimiento adquirido en tres temáticas de tecnología de la madera dirigidas a industriales forestales de Costa Rica. Se trabaj...

  10. Microquimerismo fetal-materno nas doenças reumáticas auto-imunes Maternal-fetal microchimerism in autoimmune rheumatic diseases

    Directory of Open Access Journals (Sweden)

    Karin Spat Albino Barcellos

    2004-02-01

    Full Text Available Estudos recentes indicam a existência de um tráfego bidirecional de células durante a gestação humana normal. Células fetais persistem no sangue periférico materno por muitos anos após a gestação. Muitas doenças auto-imunes são mais prevalentes em mulheres, algumas das quais apresentam pico de incidência em fases tardias dos anos férteis femininos. A doença enxerto-versushospedeiro é uma condição conhecida de quimerismo e possui similaridades clínicas com algumas doenças auto-imunes reumáticas, notavelmente com esclerose sistêmica e síndrome de Sjögren e, algumas vezes, com lúpus eritematoso sistêmico. Este artigo explora a hipótese de que o microquimerismo fetal contribua para a patogênese de algumas doenças auto-imunes, baseado em revisões de estudos anteriores que trabalharam com esta hipótese. São apresentadas ressalvas de ordem conceitual e técnica a serem consideradas na interpretação dos dados da literatura.Recent studies indicate that there is bi-directional traffic of cells during normal human pregnancy. Fetal cells have been found to persist in the maternal peripheral blood for many years after pregnancy. Many autoimmune diseases are more prevalent in women, and some of them have peak incidence at late stages of childbearing years. Chronic graft versus host disease (cGVHD is a known condition of chimerism and has clinical similarities to some rheumatic autoimmune diseases, notably systemic sclerosis, Sjögren's syndrome and systemic lupus erythematosus. This article explores the hypothesis that fetal microchimerism contributes to the pathogenesis of some autoimmune diseases, based on reviews of previous studies that have worked with this hypothesis. Technical and conceptual considerations are presented for a critical appraisal of the available literature.

  11. Optimum Use of Acute Treatments for Hereditary Angioedema: Evidence-Based Expert Consensus

    OpenAIRE

    Hilary Longhurst

    2018-01-01

    Acute treatment of hereditary angioedema due to C1 inhibitor deficiency has become available in the last 10 years and has greatly improved patients’ quality of life. Two plasma-derived C1 inhibitors (Berinert and Cinryze), a recombinant C1 inhibitor (Ruconest/Conestat alpha), a kallikrein inhibitor (Ecallantide), and a bradykinin B2 receptor inhibitor (Icatibant) are all effective. Durably good response is maintained over repeated treatments and several years. All currently available prophyla...

  12. Acetyl salicylic acid induced-urticaria and/or angioedema in atopic children.

    Science.gov (United States)

    Botey, J; Navarro, C; Aulesa, C; Marín, A; Eseverri, J L

    1988-01-01

    From the report of Hirschberg, only 3 years after aspirin synthesis, there have been numerous works dedicated to showing the different types of adverse reactions found following aspirin administration. However, there are few publications on the process of urticaria and/or acute angioedema induced by ASA and few reported cases were found in children. Thus, we present 6 atopic children with urticaria and/or angioedema related with ASA. A carefully detailed history, oral provocation with ASA, oral provocation with other NSAI and HBDT with ASA were done to all of them. The oral provocation with ASA was positive in 5 of the 6 cases. The provocations with the rest of the NSAI and tartrazine and sodium benzoate were negative in all of the patients. The HBDT was positive in 5 of the cases. In conclusion, we insist that aspirin intolerance is not infrequent in infancy and it is not rare to see urticaria and or angioedema, in spite of the fact that asthmatics, atopics or non atopics, usually present as bronchospasm. We also believe that the HBDT can be a method of diagnosis used in these cases.

  13. ACE Inhibitor-Induced Angioedema of the Intestine: Case Report, Incidence, Pathophysiology, Diagnosis and Management

    Directory of Open Access Journals (Sweden)

    Gavin Oudit

    2001-01-01

    Full Text Available A case report of fosinopril-induced angioedema of the intestine with a chronic course accompanied by multiple acute exacerbations is described. Angiotensin-converting enzyme (ACE inhibitor-induced angioedema of the intestine (AIAI occurs in a minority of patients taking an ACE inhibitor. The clinical presentation encompasses acute abdominal symptoms, pronounced bowel edema and ascites with occasional facial and/or oropharyngeal swelling. AIAI is diagnosed based on the temporal relationship between the symptomatic presentation and drug use, absence of alternative diagnoses including other causes of angioedema, and the prompt resolution of symptoms upon discontinuation of the ACE inhibitor. Prompt radiological investigation (abdominal computerized tomography and/or ultrasound is critical in making an early diagnosis and in preventing unnecessary surgical intervention. There is a female predominance of AIAI, which may reflect the interaction of estradiol with the various pathways involved in the pathophysiology of AIAI. Management of AIAI consists mainly of conservative measures and discontinuation of the ACE inhibitor. Angiotensin II receptor antagonists should not be considered as appropriate alternatives. Awareness and knowledge of AIAI are important because of the increasing use of ACE inhibitors, current delays in making the diagnosis, obvious management strategies once the diagnosis is made and the dysutility of alternative diagnoses, which may lead to considerable morbidity. AIAI must be considered in patients taking ACE inhibitors who develop gastrointestinal complaints irrespective of the duration of the therapy.

  14. Overview of hereditary angioedema caused by C1-inhibitor deficiency: assessment and clinical management.

    Science.gov (United States)

    Bork, K; Davis-Lorton, M

    2013-02-01

    Hereditary angioedema due to C1-inhibitor deficiency (HAE-C1-INH) is a rare, autosomal-dominant disease. HAE-C1-INH is characterized by recurrent attacks of marked, diffuse, nonpitting and nonpruritic skin swellings, painful abdominal attacks, and laryngeal edema. The extremities and the gastrointestinal tract are most commonly affected. Swelling of the upper respiratory mucosa poses the greatest risk because death from asphyxiation can result from laryngealedema. HAE-C1-INH attacks are variable, unpredictable, and may be induced by a variety of stimuli, including stress or physical trauma. Because the clinical presentation of HAE-C1-INH is similar to other types of angioedema, the condition may be a challenge to diagnose. Accurate identification of HAE-C1-INH is critical in order to avoid asphyxiation by laryngeal edema and to improve the burden of disease. Based on an understanding of the underlying pathophysiology of IHAE-C1-INH, drugs targeted specifically to the disease, such as C1-inhibitor therapy, bradykinin B2-receptor antagonists, and kallikrein-inhibitors, have become available for both treatment and prevention of angioedema attacks. This article reviews the clinical features, differential diagnosis, and current approaches to management of HAE-C1-INH.

  15. Suspected tartrazine-induced acute urticaria/angioedema is only rarely reproducible by oral rechallenge.

    Science.gov (United States)

    Nettis, E; Colanardi, M C; Ferrannini, A; Tursi, A

    2003-12-01

    Tartrazine has been frequently linked to several diseases. However, a cause-and-effect role for tartrazine in these illnesses, especially in urticaria, has not always been established. The aim of this study is to determine the incidence of intolerance to tartrazine among subjects who experienced an acute episode of urticaria/angioedema following the ingestion of a meal or a product containing this substance. This was a retrospective study based on analysis of data of patients reported to have experienced episodes of urticaria and/or angioedema after ingesting meals or products containing tartrazine. At the first visit to the outpatients clinic, a careful anamnesis had been taken. Patients had then been submitted to the following diagnostic tests: IgE tests to common inhalant allergens and food allergens and a double-blind placebo-controlled challenge with tartrazine. A total of 102 subjects were enrolled in the study: 19 (18.6%) showed at least one relevant positive reaction to an IgE test for food allergy. Only one subject (1%) had reactions after ingestion of 5 mg of tartrazine, given on day 5. She did not have adverse reactions to placebo. This study shows that the percentage of acute urticaria and/or angioedema induced by tartrazine is very low (1%). In view of our results, we suggest that all physicians with patients who have suffered adverse reactions that could be attributed to tartrazine should also carefully evaluate other possible causes.

  16. Hereditary angioedema with C1 inhibitor deficiency: delay in diagnosis in Europe.

    Science.gov (United States)

    Zanichelli, Andrea; Magerl, Markus; Longhurst, Hilary; Fabien, Vincent; Maurer, Marcus

    2013-08-12

    Hereditary angioedema (HAE) is a rare, debilitating, and potentially life-threatening disease characterized by recurrent edema attacks. Important advances in HAE treatment have been made, including the development of new therapies for treating or preventing attacks. Nevertheless, the disease is still frequently misdiagnosed and inappropriately treated, potentially exposing patients with laryngeal attacks to the risk of asphyxiation. The Icatibant Outcome Survey (IOS) is an international, observational study that documents the clinical outcome of HAE patients eligible for treatment with icatibant. Patient ages at first symptoms and at diagnosis were recorded at enrolment, and the delay between first symptoms and diagnosis was calculated. The median [range] diagnostic delay in HAE type I and II patients across eight countries was 8.5 years [0-62.0]. The median delay in diagnosis was longer for HAE type II versus type I (21 versus 8 years, respectively), although this did not quite reach statistical significance. Although it can be difficult to differentiate HAE symptoms from those of more common angioedema sub-types (e.g. idiopathic or acquired angioedema), our results show that HAE type I and II patients have an unacceptable delay in diagnosis, even those with a family history of the disease. Raising physician awareness of this disabling and potentially fatal disease may lead to a more accurate diagnosis and timely treatment.

  17. [Acquired angioedema – clinical characteristic of the patients diagnosed in 2012-2016 with acquired C1 inhibitor deficiency].

    Science.gov (United States)

    Stobiecki, Marcin; Czarnobilska, Ewa; Obtułowicz, Krystyna

    Acquired angioedema is a rare disease caused by a deficiency of C1 esterase inhibitor with recurrent swelling symptoms. It may occur in the course of lymphoproliferative disorders or autoimmune diseases. Symptoms resemble hereditary angioedema, and the only differentiating features is negative family history, late onset of symptoms and accompanying lymphoproliferative disorder. The aim of the study was to analyze the cases of acquired angioedema. The retrospective analysis of 341 patients from the registry of patients with C1 inhibitor deficiency. Results: We identified 4 patients among 119 with HAE (3.57%) diagnosed in this same period of time 2012-2016 who fulfilled the criteria of acquired edema. In two cases the primary reason of angioedema was lymphoproliferive disease, in two monoclonal gammapathy of unknown reason. We analyzed also the results of laboratory tests C4, C1 inhibitor, C1q. In all cases the face was dominated localization. After the treatment of primary lymphoproliferive disease, in two cases, we observed total remission of angioedema. Only one patient with gammapathy require treatment with C1 inhibitor during the attacks. In these case we observed both plasma deriver, and recombinant C1 inhibitor were effective.

  18. Autoimmune thyroid disease as a risk factor for angioedema in patients with chronic idiopathic urticaria: a case-control study

    Directory of Open Access Journals (Sweden)

    Ruy Felippe Brito Gonçalves Missaka

    Full Text Available CONTEXT AND OBJECTIVE: An association between chronic idiopathic urticaria (CIU and autoimmune thyroid disease (ATD has been reported. However, there have not been any reports on whether ATD raises the risk of angioedema, which is a more severe clinical presentation of CIU. Thus, the aim of the present study was to evaluate whether the risk of angioedema is increased in patients with CIU and ATD. DESIGN AND SETTING: Case-control study including 115 patients with CIU at a tertiary public institution. METHODS: The patients were evaluated with regard to occurrence of angioedema and presence of ATD, hypothyroidism or hyperthyroidism. RESULTS: Angioedema was detected in 70 patients (60.9%. There were 22 cases (19.1% of ATD, 19 (16.5% of hypothyroidism and nine (7.8% of hyperthyroidism. The risk among patients with ATD was 16.2 times greater than among those without this thyroid abnormality (confidence interval, CI = 2.07-126.86. The odds ratio for hypothyroidism was 4.6 (CI = 1.00-21.54 and, for hyperthyroidism, 3.3 (CI = 0.38-28.36. CONCLUSIONS: Patients with CIU and ATD presented greater risk of angioedema, which reinforces the idea that a relationship exists between this allergic condition and thyroid autoimmunity. This finding could imply that such patients require specifically directed therapy.

  19. Staphylococcus aureus resistente a meticilina adquirido en la comunidad aislados en tres hospitales de Lima-Perú

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    Jesús Tamariz

    2010-01-01

    Full Text Available Staphylococcus aureus es un importante patógeno involucrado en una serie de infecciones e intoxicaciones, presenta múltiples factores de virulencia y su impacto se incrementa por su notable resistencia a los antimicrobianos. Objetivo: Determinar la frecuencia de Staphylococcus aureus meticilino resistente adquiridos en la comunidad, en hospitales de Lima- Perú. Material y métodos: Se realizó un estudio descriptivo multicéntrico. La resistencia a meticilina se determinó por el método Oxacillin Agar Screen. El origen de la cepa fue determinado mediante los criterios de los CDC; la Leucocidina de Panton Valentine fue identificada por métodos moleculares. Resultados: Se aislaron 276 cepas de Staphylococcus aureus, 160 fueron resistentes a meticilina (58%, 9 de ellas fueron identificadas como adquiridas en la comunidad (5,6%. La PVL fue identificada en 25 cepas (9,1%, 14 fueron MSSA y 11 MRSA, de éstas últimas solo 4 fueron MRSAcom, 7 fueron MRSAhosp (p<0,001. Conclusiones: El estudio revela niveles elevados de resistencia a meticilina, pero niveles bajos de MRSAcom. En nuestro medio la presencia de PVL no constituiría un marcador para la identificación de los MRSAcom. (Rev Med Hered 2010;21:4-10.

  20. Isolated angioedema of the bowel due to C1 esterase inhibitor deficiency: a case report and review of literature

    Directory of Open Access Journals (Sweden)

    Kothari Shivangi T

    2011-02-01

    Full Text Available Abstract Introduction We report a rare, classic case of isolated angioedema of the bowel due to C1-esterase inhibitor deficiency. It is a rare presentation and very few cases have been reported worldwide. Angioedema has been classified into three categories. Case presentation A 66-year-old Caucasian man presented with a ten-month history of episodic severe cramping abdominal pain, associated with loose stools. A colonoscopy performed during an acute attack revealed nonspecific colitis. Computed tomography of the abdomen performed at the same time showed a thickened small bowel and ascending colon with a moderate amount of free fluid in the abdomen. Levels of C4 ( Conclusion In addition to a detailed comprehensive medical history, laboratory data and imaging studies are required to confirm a diagnosis of angioedema due to C1 esterase inhibitor deficiency.

  1. [Tranexamic acid as first-line emergency treatment for episodes of bradykinin-mediated angioedema induced by ACE inhibitors].

    Science.gov (United States)

    Beauchêne, C; Martins-Héricher, J; Denis, D; Martin, L; Maillard, H

    2018-05-04

    Episodes of acquired bradykinin-mediated angioedema due to angiotensin-converting enzyme (ACE) inhibitors may result in fatal outcomes. There is no consensus regarding emergency pharmacological management of these episodes. Treatment options include icatibant and C1INH concentrate. Tranexamic acid is administered for moderate episodes. Its efficacy in the treatment of ACE inhibitor-induced episodes of angioedema is not established. The aim of this retrospective study is to assess the benefits of emergency tranexamic acid administration in the management of ACE inhibitor-induced episodes of angioedema. Retrospective analysis of the medical files of patients who consulted between 2010 and 2016 in two French tertiary care hospitals for a bradykinic angioedema attributed to an ACE treatment. All of them had received tranexamic acid as a first line treatment. Thirty three patients who had experienced severe episode of angioedema were included. Twenty seven patients showed significant improvement when treated with tranexamic acid alone. The six remaining patients were treated with icatibant (5/33) or C1INH concentrate (1/33), due to partial improvement after tranexamic acid therapy. None of the patients were intubated, no fatalities were recorded and no side effects were reported. Tranexamic acid is an easily accessible and affordable therapy that may provide effective treatment for ACE inhibitor-induced episodes of angioedema. It may help while waiting for a more specific treatment (icatibant and C1INH concentrate) that is at times unavailable in emergency departments. Copyright © 2018 Société Nationale Française de Médecine Interne (SNFMI). Published by Elsevier SAS. All rights reserved.

  2. Depleção de célula B no tratamento de citopenias auto-imunes B-Cell depletion in the treatment of autoimmune cytopenias

    Directory of Open Access Journals (Sweden)

    Luciana Landeiro

    2005-06-01

    Full Text Available A morbidade associada ao tratamento de citopenias auto-imunes tornou necessária a busca por novas terapêuticas. Baseado no fato de que o rituximab reage especificamente contra o antígeno CD 20, induzindo depleção de células B e conseqüentemente levando à diminuição na produção de auto-anticorpos, cinco pacientes com citopenias auto-imunes foram tratados com esta droga. Os pacientes eram refratários à terapia convencional e receberam 375 mg/m² de rituximab semanalmente, por um período de quatro semanas. Todos os pacientes apresentaram melhora, seja pelo aumento do número de células (níveis de hemoglobina ou contagem de plaquetas, seja pela suspensão do uso de corticoesteróides. Não foram observadas reações importantes durante infusão do medicamento, ou mesmo episódios de infecção durante acompanhamento subseqüente. Desta forma, o rituximab se mostrou eficaz e seguro para pacientes portadores de anemia hemolítica e púrpura trombocitopênica de etiologia imunológica, sugerindo que esta droga deva fazer parte do arsenal terapêutico utilizado nestas doenças auto-imunes.The morbidity associated with the treatment of autoimmune cytopenias has created a need for new approaches. Based on the fact that rituximab reacts specifically against the CD 20 antigen and induces B-cell depletion interfering with the production of auto-antibodies, five patients with autoimmune cytopenias were treated. All patients were previously refractory to conventional therapy and received 375 mg/m² of rituximab infusion weekly, for four weeks. All patients improved either by increasing the number of cells or by being able to reach steroid suspension. No major reactions occurred during infusion, and no major infections occurred during the follow up. Rituximab appears to be active and safe for patients with autoimmune hemolytic anemia and thrombocytopenia, suggesting that this agent can play an important part in the therapeutic arsenal for

  3. Estimation of EuroQol 5-Dimensions health status utility values in hereditary angioedema

    Directory of Open Access Journals (Sweden)

    Aygören-Pürsün E

    2016-09-01

    Full Text Available Emel Aygören-Pürsün,1 Anette Bygum,2 Kathleen Beusterien,3 Emily Hautamaki,4 Zlatko Sisic,5 Henrik B Boysen,6 Teresa Caballero7 1Angioedema Centre, Department for Children and Adolescents, University Hospital Frankfurt, Goethe University, Frankfurt, Germany; 2Hereditary Angioedema Centre Denmark, Department of Dermatology and Allergy Centre, Odense University Hospital, Odense, Denmark; 3Outcomes Research Strategies in Health, Washington, DC, 4Patient Reported Outcomes, Oxford Outcomes Inc., an ICON plc company, Bethesda, MD, USA; 5ViroPharma Incorporated, Chatsworth House, Maidenhead, UK; 6HAEi – Hereditary Angioedema International Patient Organization for C1 Inhibitor Deficiencies, Skanderborg, Denmark; 7Allergy Department, Hospital La Paz Institute for Health Research (IdiPaz, Biomedical Research Network on Rare Diseases U754 (CIBERER, University Hospital La Paz, Madrid, Spain Objective: To estimate health status utility (preference weights for hereditary angioedema (HAE during an attack and between attacks using data from the Hereditary Angioedema Burden of Illness Study in Europe (HAE-BOIS-Europe survey. Utility measures quantitatively describe the net impact of a condition on a patient’s life; a score of 0.0 reflects death and 1.0 reflects full health.Study design and methods: The HAE-BOIS-Europe was a cross-sectional survey conducted in Spain, Germany, and Denmark to assess the real-world experience of HAE from the patient perspective. Survey items that overlapped conceptually with the EuroQol 5-Dimensions (EQ-5D domains (pain/discomfort, mobility, self-care, usual activities, and anxiety/depression were manually crosswalked to the corresponding UK population-based EQ-5D utility weights. EQ-5D utilities were computed for each respondent in the HAE-BOIS-Europe survey for acute attacks and between attacks.Results: Overall, a total of 111 HAE-BOIS-Europe participants completed all selected survey items and thus allowed for computation

  4. Transient angioedema of small bowel secondary to intravenous iodinated contrast medium

    Directory of Open Access Journals (Sweden)

    Kirankumar N Kulkarni

    2014-01-01

    Full Text Available We report the clinical details and imaging findings of a case of transient angioedema of the small bowel following intravenous administration of non-ionic iodinated contrast material in a 17 year old female with no predisposing risk factors. Findings included long segment, symmetric, circumferential, low-density, bowel wall thickening involving the duodenum, jejunum, and most of the ileum on computed tomography scan obtained at 7 min following intravenous contrast material injection. This entity is self-limiting with a favourable clinical outcome and requires no specific treatment but only aggressive clinical monitoring.

  5. Depressed activation of the lectin pathway of complement in hereditary angioedema

    DEFF Research Database (Denmark)

    Varga, L; Széplaki, G; Laki, J

    2008-01-01

    ) in three complement activation pathways. Functional activity of the CP, LP and AP were measured in the sera of 68 adult patients with hereditary angioedema (HAE) and 64 healthy controls. In addition, the level of C1q, MBL, MBL-associated serine protease-2 (MASP-2), C4-, C3- and C1INH was measured...... by standard laboratory methods. MBL-2 genotypes were determined by polymerase chain reaction. Besides the complement alterations (low CP and C1INH activity, low C4-, C1INH concentrations), which characterize HAE, the level of MASP-2 was also lower (P = 0.0001) in patients compared with controls. Depressed LP...

  6. The hereditary angioedema burden of illness study in Europe (HAE-BOIS- Europe)

    DEFF Research Database (Denmark)

    Bygum, Anette; Aygören-Pürsün, Emel; Caballero, Teresa

    2012-01-01

    ABSTRACT: BACKGROUND: Hereditary angioedema (HAE) is a rare but serious disease marked by swelling attacks in the extremities, face, trunk, airway, or abdominal areas that can be spontaneous or the result of trauma and other triggers. It can be life-threatening due to the risk of asphyxiation...... of HAE-I or HAE-II. Data collection includes: (i) a survey on individuals' health care resource use, direct and indirect medical costs, impact on work and school, treatment satisfaction, and emotional functioning (via the Hospital Anxiety and Depression Scale); and (ii) one-on-one interviews to collect...

  7. Idiopathic Non-histaminergic Angioedema: Successful Treatment with Omalizumab in Five Patients.

    Science.gov (United States)

    Faisant, Charles; Du Thanh, Aurélie; Mansard, Catherine; Deroux, Alban; Boccon-Gibod, Isabelle; Bouillet, Laurence

    2017-01-01

    Idiopathic non-histaminergic acquired angioedema (InH-AAE) is a rare disease characterized by AE resistant to antihistamines and a chronic course. We report five new cases of InH-AAE (two women and three men) with a rapid and dramatic response to the anti-immunoglobulin-E antibody omalizumab. In our literature review, we found 13 other relevant cases with a good response to this treatment. Overall, in 6 out of 18 patients, the doses of omalizumab required to prevent recurrences of attacks were higher than the licensed dose for chronic urticaria. No significant adverse effects have been reported.

  8. [Facial and oropharyngeal angioedema in patient with alimentary fish allergy. Diagnosis and treatment].

    Science.gov (United States)

    Pino Rivero, V; Rodríguez Carmona, M; Iglesias González, R J; del Castillo Beneyto, F

    2007-01-01

    Vegetal or animal food can produce hipersensibility reactions IgE mediated of diverse intensity. We report the case of a 54 years old woman without previous allergic antecedents who after eating frozen fish had to go to Emergencies due to angioedema especially in face and oropharynx. The ENT exploration by fibroscopia descarted laryngeal edema but the patient showed initially respiratory symptoms so she was treated with SC adrenalina and then steroids during her admission. The diagnosis of alimentary alergia would be confirmed after by Allergology with cutaneous test prick type.

  9. Allergic contact dermatitis mimicking angioedema due to paraphenylendiamine hypersensitivity: a case report.

    Science.gov (United States)

    Tukenmez Demirci, Gulsen; Kivanc Altunay, Ilknur; Atis, Guldehan; Kucukunal, Asli

    2012-09-01

    Active sensitization to paraphenylendiamine (PPD) and related compounds from temporary black henna tattoos has become an epidemic in the recent years. Hair dyes also include PPD like black henna tatoos which cause allergic contact dermatitis. Skin lesions of allergic contact dermatitis from PPD are mostly seen as an exudative erythema, an erythema multiforme-like eruption or a bullous contact dermatitis. We, herein, report a 27 year-old woman with an angioedema-like reaction occurring after the first exposure to hair dye who was unaware of being previously sensitized to PPD from black henna tattoo.

  10. Safety of C1-Esterase Inhibitor in Acute and Prophylactic Therapy of Hereditary Angioedema

    DEFF Research Database (Denmark)

    Busse, Paula; Bygum, Anette; Edelman, Jonathan

    2014-01-01

    BACKGROUND: The plasma-derived, pasteurized C1-inhibitor (C1-INH) concentrate, Berinert has a 4-decade history of use in hereditary angioedema (HAE), with a substantial literature base that demonstrates safety and efficacy. Thromboembolic events have rarely been reported with C1-INH products......, typically with off-label use or at supratherapeutic doses. OBJECTIVES: Active surveillance of safety and clinical usage patterns of pasteurized C1-inhibitor concentrate and the more recent pasteurized, nanofiltered C1-INH, with a particular interest in thromboembolic events. METHODS: A registry...

  11. Effect of omalizumab on angioedema in H1 -antihistamine-resistant chronic spontaneous urticaria patients: results from X-ACT, a randomized controlled trial.

    Science.gov (United States)

    Staubach, P; Metz, M; Chapman-Rothe, N; Sieder, C; Bräutigam, M; Canvin, J; Maurer, M

    2016-08-01

    Chronic spontaneous urticaria (CSU) severely impacts quality of life (QoL), especially in patients with wheals and angioedema. Omalizumab is approved as add-on therapy for CSU patients; however, its effect on patients who are double-positive for wheals and angioedema has not been systematically studied. The primary objective was to evaluate the efficacy of omalizumab vs placebo at week 28 using the Chronic Urticaria Quality of Life (CU-Q2oL) questionnaire. Number of angioedema-burdened days, time interval between successive angioedema episodes, disease activity, angioedema-specific and overall QoL impairment were secondary objectives. X-ACT was a phase III, randomized, double-blind study conducted in 24 centres (Germany), which selectively included CSU patients with angioedema and wheals. Patients were randomized (1 : 1) to omalizumab 300 mg or placebo (every 4 weeks up to week 24) (ClinicalTrials.gov number: NCT01723072). Of the 91 patients randomized to omalizumab (n = 44) or placebo (n = 47) at baseline, 68 completed the 28-week treatment phase (omalizumab, 35; placebo, 33). Omalizumab was superior to placebo in improving CU-Q2oL scores at week 28 (P omalizumab (0.3) vs placebo (1.1). The median time to first recurrence of angioedema was 57-63 days with omalizumab and Omalizumab significantly improved angioedema-specific QoL (P omalizumab. Omalizumab was an effective treatment option for patients with moderate-to-severe CSU symptoms and angioedema unresponsive to high doses of antihistamine treatment. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  12. The Use of Plasma-Derived Complement C1-Esterase Inhibitor Concentrate (Berinert®) in the Treatment of Angiotensin Converting Enzyme-Inhibitor Related Angioedema

    DEFF Research Database (Denmark)

    Hermanrud, Thorbjørn; Duus, Nicolaj; Bygum, Anette

    2016-01-01

    Angioedema of the upper airways is a severe and potentially life-threatening condition. The incidence has been increasing in the past two decades, primarily due to pharmaceuticals influencing the generation or degradation of the vasoactive molecule bradykinin. Plasma-derived C1-esterase inhibitor...... concentrate is a well-established treatment option of hereditary and acquired complement C1-esterase inhibitor deficiency, which are also mediated by an increased level of bradykinin resulting in recurrent angioedema. We here present a case of severe angiotensin converting enzyme-inhibitor related angioedema...

  13. Presença de auto-anticorpos não-tireóide-específicos no soro de pacientes com hipotireoidismo auto-imune Presence of nonthyroid-specific autoantibodies in autoimmune hypothyroidism

    Directory of Open Access Journals (Sweden)

    Débora Vieira Soares

    2003-01-01

    Full Text Available Auto-anticorpos contra componentes não-específicos da tireóide foram encontrados no soro de pacientes com doença auto-imune da tireóide. Neste estudo avaliamos a presença de auto-anticorpos antinucleares (ANA, antimúsculo liso (anti-ML e antimitocôndria (anti-Mc no soro de pacientes com hipotireoidismo auto-imune (HA, comparando-os a controles saudáveis. Estudamos 70 pacientes com hipotireoidismo auto-imune (tireoidite de Hashimoto ou tireoidite atrófica e 70 controles saudáveis (sem diagnóstico de doença auto-imune e tireoidiana, todos do sexo feminino, com média de idade de 50,2 anos (+ 15,9 e 49,6 anos (+ 14,4, respectivamente. O ANA, detectado através do sistema Inno-LIA™ ANA (Innogenetics, Bélgica, foi positivo em 26% dos pacientes com HA e em 14% dos controles, não sendo esta diferença significativa (p = 0,09. Não houve diferença entre tempo de doença ou idade entre os grupos ANA positivo ou negativo. Anticorpos anti-ML e anti-Mc foram negativos em todas as amostras, sendo analisados através de imunofluorescência indireta. Concluímos que pacientes com hipotireoidismo auto-imune não apresentaram maior incidência de auto-anticorpos não-específicos para tireóide do que controles saudáveis. Ressaltamos, contudo, que a associação entre doenças auto-imunes da tireóide e outras doenças auto-imunes é fato incontestável, podendo ocorrer em qualquer período no curso de sua evolução. Portanto avaliações regulares são recomendadas.Autoantibodies against nonthyroid-specific components were detected in sera of patients with autoimmune thyroid disease. In this study we investigated the presence of the antinuclear antibody (ANA, antismooth muscle antibody (anti-SM and antimitochondrial antibody (anti-Mc in the sera of patients with autoimmune hypothyroidism comparing them to a control group. We studied 70 patients with autoimmune hypothyroidism (Hashimoto's or atrophic thyroiditis and 70 healthy controls

  14. The establishment and utility of Sweha-Reg: a Swedish population-based registry to understand hereditary angioedema

    Directory of Open Access Journals (Sweden)

    Werner Sonja

    2007-11-01

    Full Text Available Abstract Background The importance of acquiring comprehensive epidemiological and clinical data on hereditary angioedema has increasingly caught the attention of physicians and scientists around the world. The development of networks and creation of comprehensive policies to improve care of people suffering from rare diseases, such as hereditary angioedema, is a stated top priority of the European Union. Hereditary angioedema is a rare disease, that it may be life-threatening. Although the exact prevalence is unknown, current estimates suggest that it is 1/10,000–1/150,000 individuals. The low prevalence requires combined efforts to gain accurate epidemiological data on the disease and so give us tools to reduce morbidity and mortality, and improve quality of life of sufferers. Methods Sweha-Reg is a population-based registry of hereditary angioedema in Sweden with the objectives of providing epidemiological data, and so creates a framework for the study of this disease. The registry contains individual-based data on diagnoses, treatments and outcomes. Conclusion The present manuscript seeks to raise awareness of the existence of Sweha-Reg to stimulate the international collaboration of registries. A synthesis of data from similar registries across several countries is required to approach an inclusive course understanding of HAE.

  15. Determinants of angiotensin-converting enzyme inhibitor (ACEI) intolerance and angioedema in the UK Clinical Practice Research Datalink

    NARCIS (Netherlands)

    Mahmoudpour, Seyed Hamidreza; Baranova, Ekaterina Vitalievna; Souverein, Patrick C.; Asselbergs, Folkert W.; de Boer, Anthonius; Maitland-van der Zee, Anke Hilse

    2016-01-01

    AimThe aim of the present study was to describe the occurrence and determinants of angiotensin-converting enzyme (ACE) inhibitor (ACEI) intolerance and angioedema (AE) among patients initiating ACEI therapy in a real-world primary care population. MethodsTwo nested case-control studies were

  16. ELISA to measure neutralizing capacity of anti-C1-inhibitor antibodies in plasma of angioedema patients

    NARCIS (Netherlands)

    Engel, Ruchira; Rensink, Irma; Roem, Dorina; Brouwer, Mieke; Kalei, Asma; Perry, Dawn; Zeerleder, Sacha; Wouters, Diana; Hamann, Dörte

    2015-01-01

    Neutralizing autoantibodies (NAbs) against plasma serpin C1-inhibitor (C1-inh) are implicated in the rare disorder, acquired angioedema (AAE). There is insufficient understanding of the process of antibody formation and its correlation with disease progression and severity. We have developed an

  17. A Case of Miller Fisher Syndrome, Thromboembolic Disease, and Angioedema: Association or Coincidence?

    Science.gov (United States)

    Salehi, Nooshin; Choi, Eric D; Garrison, Roger C

    2017-01-16

    BACKGROUND Miller Fisher Syndrome is characterized by the clinical triad of ophthalmoplegia, ataxia, and areflexia, and is considered to be a variant of Guillain-Barre Syndrome. Miller Fisher Syndrome is observed in approximately 1-5% of all Guillain-Barre cases in Western countries. Patients with Miller Fisher Syndrome usually have good recovery without residual deficits. Venous thromboembolism is a common complication of Guillain-Barre Syndrome and has also been reported in Miller Fisher Syndrome, but it has generally been reported in the presence of at least one prothrombotic risk factor such as immobility. A direct correlation between venous thromboembolism and Miller Fisher Syndrome or Guillain-Barre Syndrome has not been previously described. CASE REPORT We report the case of a 32-year-old Hispanic male who presented with acute, severe thromboembolic disease and concurrently demonstrated characteristic clinical features of Miller Fisher Syndrome including ophthalmoplegia, ataxia, and areflexia. Past medical and family history were negative for thromboembolic disease, and subsequent hypercoagulability workup was unremarkable. During the course of hospitalization, the patient also developed angioedema. CONCLUSIONS We describe a possible association between Miller Fisher Syndrome, thromboembolic disease, and angioedema.

  18. Recurrent Laryngeal Edema Imitating Angioedema Caused by Dislocated Screw after Anterior Spine Surgery

    Directory of Open Access Journals (Sweden)

    Piotr Wójtowicz

    2015-01-01

    Full Text Available The anterior cervical spine surgery is a common procedure to stabilize vertebrae damaged by various diseases. The plates and screws are usually used in the spine fixation. This kind of instrumentation may detach from the bones which is a rare but well-known complication. A 77-year-old male presented to the otorhinolaryngology department with throat pain, choking, and dysphagia. At first the angioedema was diagnosed and he was treated conservatively. The endoscopy revealed laryngeal edema, being more defined on the right side with right vocal fold paresis. CT scans showed the stabilizing plate with two screws attached tightly and the back-out of the third screw toward soft tissue of the neck. In the meantime, his condition deteriorated and he needed tracheotomy. In few days the surgical removal of the dislocated screw was performed successfully. Although two-month follow-up reported no obstruction of the larynx, the vocal folds paresis with gradual functional improvement was observed. Long-term complication of anterior spine surgery sometimes may suggest laryngeal angioedema at first. If the conservative treatment is ineffective and there is a history of anterior spine surgery, the clinicians should consider the displacement of the plate or screws in differential diagnosis.

  19. Doenças reumáticas auto-imunes em indivíduos infectados pelo HTLV-1 Autoimmune rheumatic diseases in HTLV-1 infected individuals

    Directory of Open Access Journals (Sweden)

    Mônica Martinelli Nunes de Carvalho

    2006-10-01

    Full Text Available O HTLV-1 foi o primeiro retrovírus humano a ser associado às doenças malignas leucemia e linfoma de células T do adulto (LLTA. Ele está relacionado também a uma doença inflamatória crônica do sistema nervoso central (SNC conhecida como paraparesia espástica tropical/mielopatia associada ao HTLV-1 (PET/MAH. O HTLV-1 tem sido implicado na patogênese de várias doenças auto-imunes, tais como: diabetes, esclerose múltipla, dermatite infectiva, uveíte e artropatia. Ao longo dos anos, a infecção retroviral tem assumido um importante papel na patogênese das doenças reumáticas auto-imunes. Partículas semelhantes aos retrovírus têm sido identificadas em tecidos de pacientes com artrite reumatóide (AR, síndrome de Sjögren, lúpus eritematoso sistêmico (LES e polimiosite. A síndrome de Sjögren e a AR têm sido as doenças reumáticas mais encontradas nos pacientes infectados pelo HTLV-1, sendo a freqüência mais elevada nos pacientes com mielopatia. A alta prevalência de síndrome de Sjögren e de AR entre os indivíduos com mielopatia sugere que a carga viral e a resposta inflamatória exacerbada, que concorrem para o desenvolvimento da mielopatia, devem também influenciar no desenvolvimento das doenças reumáticas auto-imunes.The HTLV-1 was the first human retrovirus associated with adult T-cell leukemia/lymphoma (LLTA. The virus also causes a chronic inflammatory disease of the central nervous system named HTLV-1-associated myelopathy or tropical spastic paraparesis (HAM/TSP. HTLV-1 has been implicated in the pathogenesis of many autoimmune diseases, such as diabetes, multiple sclerosis, infective dermatitis, uveitis and arthropathy. It has long been suggested that retroviral infection may play a role in the pathogenesis of autoimmune rheumatic diseases. Particles resembling retroviruses have been reported in tissue from patients with rheumatoid arthritis (RA, Sjögren’s syndrome, systemic lupus erythematosus (SLE and

  20. Métodos para la evaluación motora objetiva de pacientes con daño cerebral adquirido en neurorrehabilitación funcional

    OpenAIRE

    Villán Villán, Mailin Adriana

    2018-01-01

    El Daño Cerebral Adquirido (DCA) es una alteración de la actividad neuronal en áreas del cerebro que ocurre después del nacimiento. Las secuelas tras un episodio de DCA pueden ser motoras, cognitivas, sociales, entre otras, que pueden transformar la vida de los pacientes en los ámbitos educativo, laboral y familiar. Las causas del DCA pueden ser traumáticas y no traumáticas, siendo las más comunes el Accidente Cerebrovascular (ACV) o Ictus y el Traumatismo Craneoencefálico (TCE). El ACV es la...

  1. Psychometric Field Study of Hereditary Angioedema Quality of Life Questionnaire for Adults

    DEFF Research Database (Denmark)

    Prior, Nieves; Remor, Eduardo; Pérez-Fernández, Elia

    2016-01-01

    BACKGROUND: Hereditary angioedema due to C1 inhibitor deficiency (C1-INH-HAE) may affect health-related quality of life (HRQoL). A specific HRQoL questionnaire for adult patients with C1-INH-HAE, the HAE-QoL, has recently been developed in Spain. OBJECTIVE: The objective of this study...... was to perform a cross-cultural validation and psychometric study of the HAE-QoL in an international setting. METHODS: Cross-cultural adaptation of the Spanish HAE-QoL draft version and an international rating phase with experts were performed. The resultant version of the HAE-QoL, a clinical questionnaire...... with and without psychiatric and/or psychological care (median: 74 vs 103; P ≤ .001). CONCLUSIONS: The HAE-QoL, currently available in 18 languages, showed good reliability and validity evidence....

  2. Acutely Onset Amiodarone-Induced Angioedema in a Patient with New Atrial Fibrillation

    Directory of Open Access Journals (Sweden)

    Hossein Vakili

    2014-01-01

    Full Text Available A 50-year-old man was admitted to our emergency department due to new episode of palpitation. He had history of angioplasty of right coronary artery (RCA with drug eluting stent 2 years ago. His electrocardiogram revealed atrial fibrillation (AF. Intravenous amiodarone 150 mg during 10 minutes and then 1 mg/min infusion were started to achieve rate control and pharmacologic conversion to sinus rhythm. After 60 minutes of starting amiodarone infusion, he developed swelling of the skin around his mouth and eyes, and also mucosa of the mouth, eyes and tongue. To conclude, angioedema should be considered a rare side effect of amiodarone which is used broadly in cardiovascular field.

  3. The relationship between anxiety and quality of life in children with hereditary angioedema.

    Science.gov (United States)

    Kessel, Aharon; Farkas, Henriette; Kivity, Shmuel; Veszeli, Nóra; Kőhalmi, Kinga V; Engel-Yeger, Batya

    2017-11-01

    The severe life-threatening characteristics of hereditary angioedema (HAE) with C1-inhibitor deficiency (C1-INH-HAE) can affect anxiety levels among pediatric patients. This emotional burden together with the physical restrictions of C1-INH-HAE may decrease children's health-related quality of life (HRQoL). (i) To compare anxiety state and trait between children with C1-INH-HAE and healthy controls; (ii) to examine the relationship between the level of anxiety of children with C1-INH-HAE, their disease activity/affected sites and their HRQoL; and (iii) to predict the HRQoL of children with C1-INH-HAE based on their anxiety level and disease activity/affected sites METHODS: Thirty-three children with C1-INH-HAE (aged 5-18 years) and 52 healthy controls were recruited from Israel and Hungary. All children completed the State-Trait Anxiety Inventory for Children (STAIC), the Pediatric Quality of Life Inventory (Peds-QL) demographic questionnaire and a disease activity and site questionnaire . Disease activity was defined as the number of attacks in last year. Both anxiety state and trait were significantly higher among children with C1-INH-HAE as compared to the controls (44.74±10.56 vs 38.76±10.67, Panxiety state (F 56,2 =4.69, P=.001) and trait (F 56,2 =9.06, Panxiety trait was correlated with the number of angioedema-affected sites (r=.52, P=.003). The presence of HAE attacks and higher anxiety trait predicted a lower HRQoL in children with C1-INH-HAE. C1-INH-HAE children have higher anxiety trait and state, which correlate with reduced HRQoL domains. © 2017 EAACI and John Wiley and Sons A/S. Published by John Wiley and Sons Ltd.

  4. Primer aislamiento en Argentina de Staphylococcus aureus resistente a la meticilina adquirido en la comunidad con sensibilidad intermedia a la vancomicina y no sensibilidad a la daptomicina

    Directory of Open Access Journals (Sweden)

    Laura Errecalde

    Full Text Available Describimos el primer caso en Argentina de Staphylococcus aureus resistente a la meticilina adquirido en la comunidad con sensibilidad intermedia a la vancomicina y no sensibilidad a la daptomicina. Caso clínico: Paciente masculino, con antecedente de insuficiencia renal crónica en hemodiálisis y osteosíntesis de cadera debido a una fractura. Se internó por síndrome febril persistente luego del desplazamiento de la prótesis por un traumatismo. Se aisló de hemocultivos S. aureus resistente a la meticilina adquirido en la comunidad. Durante el tratamiento con vancomicina y daptomicina, se observó un aumento gradual de la CIM de vancomicina de 1 µg/ml (VSSA a 2 µg/ml (h-VISA y a 4 µg/ml (VISA, y la emergencia de no sensibilidad a daptomicina (CIM = 4 µg/ml. Al suspender la vancomicina y la daptomicina, la cepa revirtió al fenotipo de sensibilidad a ambas drogas. Es mandatorio evaluar por CIM la sensibilidad a vancomicina y a daptomicina intratratamiento cuando estas drogas se usan como terapia.

  5. International consensus on the diagnosis and management of pediatric patients with hereditary angioedema with C1 inhibitor deficiency

    OpenAIRE

    Farkas, H.; Martinez?Saguer, I.; Bork, K.; Bowen, T.; Craig, T.; Frank, M.; Germenis, A. E.; Grumach, A. S.; Luczay, A.; Varga, L.; Zanichelli, A.; Aberer, Werner; Andrejevic, Sladjana; Aygoeren?P?rs?n, Emel; Banerji, Alena

    2016-01-01

    BACKGROUND: The consensus documents published to date on hereditary angioedema with C1 inhibitor deficiency (C1-INH-HAE) have focused on adult patients. Many of the previous recommendations have not been adapted to pediatric patients. We intended to produce consensus recommendations for the diagnosis and management of pediatric patients with C1-INH-HAE.METHODS: During an expert panel meeting that took place during the 9th C1 Inhibitor Deficiency Workshop in Budapest, 2015 (www.haenet.hu), ped...

  6. Consenso brasileiro para transplante de células-tronco hematopoéticas para tratamento de doenças autoimunes Brazilian consensus on hematopoietic stem cell transplantation for autoimmune diseases

    Directory of Open Access Journals (Sweden)

    Júlio C. Voltarelli

    2010-05-01

    Full Text Available Neste trabalho, foram revisadas a literatura internacional e a experiência nacional com transplante de células-tronco hematopoéticas (TCTH para doenças autoimunes. A evidência acumulada indica que o TCTH autólogo pode beneficiar pacientes com esclerose múltipla em fase inflamatória, refratária aos tratamentos medicamentosos disponíveis, e pacientes com esclerose sistêmica cutânea difusa de caráter progressivo, com ou sem comprometimento sistêmico. Esse tratamento deveria ser disponibilizado na rede pública de saúde, numa fase inicial, em centros de referência com experiência em TCTH e no manejo clínico de doenças autoimunes sistêmicas graves.In this paper, international literature and national experience on hematopoietic stem cell transplantation (HSCT for autoimmune diseases were reviewed. Cumulative evidence indicates that autologous HSCT may benefit patients with inflammatory multiple esclerosis, refractory to available drug therapy, and progressive forms of diffuse cutaneous systemic sclerosis with or without systemic involvement. Initially, this treatment should be available in reference centers of the public health system, with experience in performing HSCT and in treating severe systemic autoimmune diseases.

  7. Approaches to the diagnosis and management of patients with a history of nonsteroidal anti-inflammatory drug-related urticaria and angioedema.

    Science.gov (United States)

    Kowalski, Marek L; Woessner, Katharine; Sanak, Marek

    2015-08-01

    Nonsteroidal anti-inflammatory drug (NSAID)-induced urticarial and angioedema reactions are among the most commonly encountered drug hypersensitivity reactions in clinical practice. Three major clinical phenotypes of NSAID-induced acute skin reactions manifesting with angioedema, urticaria, or both have been distinguished: NSAID-exacerbated cutaneous disease, nonsteroidal anti-inflammatory drug-induced urticaria/angioedema (NIUA), and single NSAID-induced urticaria and angioedema. In some patients clinical history alone might be sufficient to establish the diagnosis of a specific type of NSAID hypersensitivity, whereas in other cases oral provocation challenges are necessary to confirm the diagnosis. Moreover, classification of the type of cutaneous reaction is critical for proper management. For example, in patients with single NSAID-induced reactions, chemically nonrelated COX-1 inhibitors can be safely used. However, there is cross-reactivity between the NSAIDs in patients with NSAID-exacerbated cutaneous disease and NIUA, and thus only use of selective COX-2 inhibitors can replace the culprit drug if the chronic treatment is necessary, although aspirin desensitization will allow for chronic treatment with NSAIDs in some patients with NIUA. In this review we present a practical clinical approach to the patient with NSAID-induced urticaria and angioedema. Copyright © 2015 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

  8. Refractory Abdominal Pain in a Patient with Chronic Lymphocytic Leukemia: Be Wary of Acquired Angioedema due to C1 Esterase Inhibitor Deficiency

    Directory of Open Access Journals (Sweden)

    Abdullateef Abdulkareem

    2018-01-01

    Full Text Available Acquired angioedema due to C1 inhibitor deficiency (C1INH-AAE is a rare and potentially fatal syndrome of bradykinin-mediated angioedema characterized by episodes of angioedema without urticaria. It typically manifests with nonpitting edema of the skin and edema in the gastrointestinal (GI tract mucosa or upper airway. Edema of the upper airway and tongue may lead to life-threatening asphyxiation. C1INH-AAE is typically under-diagnosed because of its rarity and its propensity to mimic more common abdominal conditions and allergic reactions. In this article, we present the case of a 62-year-old male with a history of recently diagnosed chronic lymphocytic leukemia (CLL who presented to our hospital with recurrent abdominal pain, initially suspected to have Clostridium difficile colitis and diverticulitis. He received a final diagnosis of acquired angioedema due to C1 esterase inhibitor deficiency due to concomitant symptoms of lip swelling, cutaneous nonpitting edema of his lower extremities, and complement level deficiencies. He received acute treatment with C1 esterase replacement and icatibant and was maintained on C1 esterase infusions. He also underwent chemotherapy for his underlying CLL and did not experience further recurrence of his angioedema.

  9. Hypovolemic Shock Caused by Angiotensin-Converting Enzyme Inhibitor-Induced Visceral Angioedema: A Case Series and A Simple Method to Diagnose this Complication in the Emergency Department.

    Science.gov (United States)

    Myslinski, Joseph; Heiser, Andrew; Kinney, Ashley

    2018-03-01

    Visceral angioedema is a rarely reported side effect of angiotensin-converting-enzyme inhibitors (ACEI). Because signs and symptoms tend to be nonspecific, the diagnosis is difficult to make, especially in the emergency department (ED). We describe 2 patients presenting with signs of hypovolemic shock, in which the diagnosis of ACEI-induced visceral angioedema was made in the ED. We surmise that patients with abdominal pain, who present with hypovolemic shock and are taking medications that can predispose to angioedema, may have this complication if their hemoglobin level is elevated compared with their previous levels. An abdominal computed tomography scan, if it does not identify any other significant etiology, will increase the probability that ACEI-induced visceral angioedema is the diagnosis when there is nonspecific bowel wall thickening or edema. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Identification of ACEI-induced visceral angioedema in the ED will avoid prolonged admissions, unnecessary procedures, and future recurrences. Copyright © 2017 Elsevier Inc. All rights reserved.

  10. Estimation of EuroQol 5-Dimensions health status utility values in hereditary angioedema.

    Science.gov (United States)

    Aygören-Pürsün, Emel; Bygum, Anette; Beusterien, Kathleen; Hautamaki, Emily; Sisic, Zlatko; Boysen, Henrik B; Caballero, Teresa

    2016-01-01

    To estimate health status utility (preference) weights for hereditary angioedema (HAE) during an attack and between attacks using data from the Hereditary Angioedema Burden of Illness Study in Europe (HAE-BOIS-Europe) survey. Utility measures quantitatively describe the net impact of a condition on a patient's life; a score of 0.0 reflects death and 1.0 reflects full health. The HAE-BOIS-Europe was a cross-sectional survey conducted in Spain, Germany, and Denmark to assess the real-world experience of HAE from the patient perspective. Survey items that overlapped conceptually with the EuroQol 5-Dimensions (EQ-5D) domains (pain/discomfort, mobility, self-care, usual activities, and anxiety/depression) were manually crosswalked to the corresponding UK population-based EQ-5D utility weights. EQ-5D utilities were computed for each respondent in the HAE-BOIS-Europe survey for acute attacks and between attacks. Overall, a total of 111 HAE-BOIS-Europe participants completed all selected survey items and thus allowed for computation of EQ-5D-based utilities. The mean utilities for an HAE attack and between attacks were 0.44 and 0.72, respectively. Utilities for an acute attack were dependent on the severity of pain of the last attack (0.61 for no pain or mild pain, 0.47 for moderate pain, and 0.08 for severe pain). There were no significant differences across countries. Mean utilities derived from the study approach compare sensibly with other disease states for both acute attacks and between attacks. The impacts of HAE translate into substantial health status disutilities associated with acute attacks as well as between attacks, documenting that the detrimental effects of HAE are meaningful from the patient perspective. Results were consistent across countries with regard to pain severity and in comparison to similar disease states. The results can be used to raise awareness of HAE as a serious disease with wide-ranging personal and social impacts.

  11. Type I anaphylactic reaction due to contrast induced angioedema causing neck swelling: the role of sitting fiberoptic bronchoscopy in emergent intubation

    Directory of Open Access Journals (Sweden)

    Ali Dabbagh

    2016-07-01

    Full Text Available Contrast induced angioedema is a rapidly progressive state involving a number of organ systems including the upper airway tract; which is usually a type I anaphylactic reaction also known as immediate hypersensitivity reaction. Prompt preservation of the respiratory tract is the cornerstone of this situation. The use of fiberoptic bronchoscope for tracheal intubation though very helpful, has some special considerations due to the anatomic distortions created by edema.This manuscript describes a patient with contrast induced angioedema managed successfully. Serum levels of IgE were highly increased during the first hours after the event; while serum levels of complement were normal. However, rapid airway management and prophylactic intubation saved the patient and prevented the possible aftermath of airway obstruction.Keywords: airway management; type I anaphylactic reaction, angioedema; fiberoptic bronchoscope.Conflict of interest: none of the authors has any conflict of interest.

  12. Manifestações otorrinolaringológicas nas doenças reumáticas auto-imunes Otorhinolaryngologic manifestations of autoimmune rheumatic diseases

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    Daniela Bergamim Pereira

    2006-04-01

    Full Text Available As manifestações otorrinolaringológicas nas doenças reumáticas representam um desafio diagnóstico para o reumatologista, o otorrinolaringologista e o médico generalista. Comumente, sintomas otorrinolaringológicos representam um sinal inicial de uma doença assintomática ou uma desordem auto-imune não diagnosticada, que freqüentemente exige um imediato e agressivo tratamento imunossupressor. Distúrbios auditivos podem ser vistos em pacientes com lúpus eritematoso sistêmico (LES, granulomatose de Wegener (GW, policondrite recidivante (PR, poliarterite nodosa, síndrome de Cogan, síndrome de Sjögren e menos freqüentemente na síndrome de Churg-Strauss e doença de Behçet. O nariz e seios paranasais são variavelmente afetados durante o curso da GW, síndrome de Churg-Strauss, PR e sarcoidose. Ulcerações mucosas recorrentes são comuns no LES e doença de Behçet. Xerostomia é uma manifestação comum da síndrome de Sjögren primária e secundária; aumento da glândula salivar pode ser visto nesses pacientes, assim como nos pacientes com sarcoidose. A articulação cricoaritenóide pode ser envolvida durante o curso da artrite reumatóide, espondilite anquilosante e gota; alterações osteoartríticas também têm sido descritas. Disfunção do nervo trigeminal pode ocorrer em pacientes com síndrome de Sjögren, esclerose sistêmica, LES e doença mista do tecido conjuntivo. Paralisia facial periférica tem sido descrita como complicação do curso da síndrome de Sjögren e sarcoidose.Otorhinolaryngologics manifestations of rheumatologic disorders represent a diagnostic challenge for the rheumatologist, the otorhinolaryngologist, and the general practicioner. Not uncommonly otorhinolaryngologics symptoms represent the initial sign of an otherwise asymptomatic or even undiagnosed autoimmune disorder which often calls for prompt and aggressive immunosuppressive treatment. Hearing disturbances may be seen in patients with

  13. Hereditary angioedema as a metabolic liver disorder: novel therapeutic options and prospects for cure

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    Rohan Ameratuga

    2016-11-01

    Full Text Available Hereditary angioedema (HAE is a rare autosomal dominant disorder caused by mutations of the SERPING1 or the Factor 12 genes. It is potentially fatal, particularly if not identified at an early stage. Apart from androgens, which are contraindicated in children and in pregnant women, a range of effective, albeit very expensive treatments have recently become available for HAE patients. The cost of these new treatments is beyond the reach of most developing countries. At this time, there is no cure for the disorder. In spite of mutations of the SERPING1 gene, autoimmunity and infections are not prominent features of the condition. Here we present the argument that HAE should be viewed primarily as a metabolic liver disorder. This conceptual paradigm shift will stimulate basic research and may facilitate new therapeutic approaches to HAE outlined in this paper. We suggest several novel potential treatment options for HAE from the perspectives of clinical immunology, molecular biology and liver transplantation. Many of these offer the prospect of curing the disorder. The effectiveness of these options are rapidly improving in many cases and their risks are decreasing. Given the very high costs of treating HAE, some of these curative options may become feasible in the next decade.

  14. Severe angioedema in myxedema coma: a difficult airway in a rare endocrine emergency.

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    Lee, Christopher H; Wira, Charles R

    2009-10-01

    Myxedema coma is the most lethal manifestation of hypothyroidism. It is a true medical emergency and can result in profound hemodynamic instability and airway compromise. Myxedema coma currently remains a diagnostic challenge due to the rarity of cases seen today, and failure to promptly initiate therapy with replacement thyroid hormone can be fatal. As thyroid hormone therapy can take days or weeks to reverse the manifestations of myxedema coma, interim supportive therapy is critical while awaiting clinical improvement. Some patients will require endotracheal intubation in the emergency department (ED), and physicians should be aware that unanticipated posterior pharyngeal edema in myxedema coma could severely complicate airway management. Although mechanical ventilation is a well-described adjunctive therapy for myxedema coma, reports of the potential difficulty in securing a definitive airway in these patients are rare. We describe a case of an unidentified woman who presented to the ED with myxedema coma requiring urgent endotracheal intubation and was found to have extensive posterior pharyngeal angioedema inconsistent with her relatively benign external examination. This case highlights the typical features of myxedema coma and discusses our necessity for a rescue device in definitive endotracheal tube placement. Emergency physicians should anticipate a potentially difficult airway in all myxedema coma patients regardless of the degree of external facial edema present.

  15. Niveis sericos das vitaminas lipossoluveis (A, D e E) em pacientes com atresia biliar e hepatite auto-imune e a relação com o estado nutricional e indicadores clinicos e laboratoriais

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    Margareth Lopes Galvão Saron

    2008-01-01

    Resumo: As doenças hepáticas crônicas podem induzir à má-absorção de lipídios e vitaminas lipossolúveis e levar ao comprometimento do estado nutricional. O objetivo da pesquisa foi determinar os níveis séricos de vitaminas lipossolúveis (A, D e E) em crianças e adolescentes com atresia biliar (AB) e hepatite auto-imune (HAI) e verificar a relação com o estado nutricional e indicadores laboratoriais e clínicos. O estudo foi transversal e controlado e foram avaliados os pacientes com HAI (n=25...

  16. Ocorrência de doenças autoimunes tireoidianas em pacientes com doenças reumáticas Autoimmune thyroid disease in patients with rheumatic diseases

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    Teresa Cristina Martins Vicente Robazzi

    2012-06-01

    Full Text Available Anormalidades na função tireoidiana e presença de autoanticorpos da tireoide têm sido frequentemente descritas em pacientes com doenças reumatológicas autoimunes, como síndrome de Sjögren, artrite reumatoide, lúpus eritematoso sistêmico e esclerodermia. São limitados os dados sobre prevalência e características clínicas de tireoidite autoimune em outras doenças reumatológicas, tais como febre reumática e lúpus eritematoso sistêmico juvenil. Os autores revisaram as associações de doenças autoimunes endócrinas e reumáticas, avaliando as diversas faixas etárias e condições clínicas. O levantamento bibliográfico foi realizado por meio de busca por artigos científicos indexados em bancos de dados de ciências da saúde em geral, como Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS, Medline/PubMed e Scientific Eletronic Library Online (SciELO. Utilizaram-se os seguintes descritores: "rheumatic autoimmune diseases and autoimmune thyroid diseases", "thyroid disorders and rheumatic diseases", "thyroiditis and rheumatic diseases", "autoimmune diseases and thyroid", e "pediatric rheumatic diseases and autoimmune thyroid diseases". Este estudo mostrou que, apesar de resultados contraditórios na literatura, há maior prevalência da associação entre doenças autoimunes da tireoide e doenças reumáticas, destacando-se a possibilidade de mecanismos patogênicos comuns entre as doenças.Thyroid function abnormalities and thyroid autoantibodies have been frequently described in patients with rheumatologic autoimmune diseases, such as Sjögren's syndrome, rheumatoid arthritis, systemic lupus erythematosus and scleroderma. Limited data are available regarding the prevalence and clinical characteristics of autoimmune thyroiditis in other rheumatologic disorders, such as rheumatic fever and juvenile systemic lupus erythematosus. The authors review the association of endocrine autoimmune and rheumatic

  17. Importância da ecogenicidade da tireóide no diagnóstico da tireoidite crônica auto-imune Value of thyroid echogenicity in the diagnosis of chronic autoimmune thyroiditis

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    Danilo Bianchini Höfling

    2008-12-01

    Full Text Available A tireoidite crônica auto-imune é, atualmente, a principal causa de hipotireoidismo e seu diagnóstico baseia-se nas manifestações clínico-laboratoriais. O marcador laboratorial mais importante é a presença de anticorpos antitireoglobulina e antiperoxidase, sendo este último o teste mais sensível. A biópsia aspirativa apresenta alta sensibilidade e especificidade, porém, é um método invasivo e, por isso, reservado para quando há presença de nódulo ou bócio de crescimento rápido. A cintilografia é desnecessária para o diagnóstico, já que apresenta baixa sensibilidade e especificidade. A ultra-sonografia, tanto ao modo B como ao dúplex-Doppler colorido, evoluiu de forma muito rápida e tornou-se um método simples, não-invasivo, reprodutível e com alta sensibilidade para o diagnóstico da tireoidite crônica auto-imune. Ao modo B, a ecogenicidade é um parâmetro de extrema importância, já que, além de apresentar alta correlação com o quadro citopatológico, também apresenta alta sensibilidade para o diagnóstico da tireoidite crônica auto-imune. Embora este parâmetro não seja específico da tireoidite crônica auto-imune, pois também pode estar presente na doença de Graves, na tireoidite pós-parto e na tireoidite subaguda, tais desordens podem ser facilmente diferenciadas tanto pelo quadro clínico-laboratorial quanto pelo dúplex-Doppler colorido. Assim, este artigo tem o objetivo de revisar a importância do estudo da ecogenicidade no diagnóstico da tireoidite crônica auto-imune.Chronic autoimmune thyroiditis is currently considered as the main cause for hypothyroidism and its diagnosis is based on clinical manifestations and laboratory tests results. The most significant laboratory marker for this disease is the presence of anti-thyroperoxidase and anti-thyroglobulin antibodies, the latter being the most sensitive one. Aspiration biopsy shows high sensitivity and specificity but, considering the

  18. Anemia hemolítica auto-imune e outras manifestações imunes da leucemia linfocítica crônica Autoimmune hemolytic anemia and other autoimmune diseases related to chronic lymphocytic leukemia

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    José O. Bordin

    2005-12-01

    Full Text Available A leucemia linfocítica crônica (LLC é freqüentemente associada a manifestações auto-imunes principalmente relacionadas às células do sistema hematopoético causando anemia hemolítica auto-imune (AHAI, púrpura trombocitopênica imune (PTI, aplasia pura de série vermelha (APSV, e neutropenia imune. A LLC é diagnosticada em até 15% dos pacientes com AHAI, e em cerca de 50% dos pacientes com AHAI secundária a doença maligna. A PTI ocorre em 2%, e a APSV em 1% dos pacientes com LLC. Prednisona é o tratamento inicial de escolha para a citopenia imune associada à LLC. Para cerca de 60% dos pacientes que apresentam recidiva da manifestação auto-imune tem sido utilizada esplenectomia, imunoglobulina endovenosa, ou ciclosporina. Embora as evidências sobre fisiopatologia sejam limitadas, os mecanismos fisiopatológicos da auto-imunidade na LLC estão relacionados à atividade dos linfócitos B leucêmicos que atuam como células apresentadoras de antígeno aberrantes, e são eficientes em processar e apresentar proteínas da membrana de hemácias e de plaquetas às células TH auto-reativas. Linfócitos TH específicos para certos auto-antígenos podem escapar de mecanismos de controle de auto-tolerância, e, se ativados, podem causar doença auto-imune. O diagnóstico de AHAI contra-indica o uso de fludarabina em pacientes com LLC, pois esse análogo da purina tem sido associado ao desenvolvimento de AHAI grave e fatal, com risco consideravelmente mais alto para pacientes mais imunossuprimidos devido a vários tratamentos anteriores.Chronic lymphocytic leukemia (CLL is frequently associated with autoimmune diseases directed against hematopoietic cells, including autoimmune hemolytic anemia (AIHA, immune thrombocytopenic purpura (ITP, pure red cell aplasia (PRCA, and immune neutropenia. CLL represents the diagnosis in up to 15% of the patients with AIHA, and in 50% of the patients with AIHA secondary to malignancy. ITP occurs in 2% and

  19. Health-related quality of life in relation to disease activity in adults with hereditary angioedema in Sweden.

    Science.gov (United States)

    Nordenfelt, Patrik; Nilsson, Mats; Lindfors, Anders; Wahlgren, Carl-Fredrik; Björkander, Janne

    2017-11-30

    Health-related quality of life (HR-QoL) is impaired in patients with hereditary angioedema (HAE) but has not yet been satisfactorily described. To study HR-QoL in patients with HAE by combining different HR-QoL instruments with disease activity assessment. All adults in the Swedish HAE registry were invited to take part in this questionnaire study, which used the generic HR-QoL instruments, EuroQol 5 Dimensions 5 Level (EQ-5D-5L) and the RAND Corporation Short Form 36 (RAND-36), the disease-specific Angioedema Quality of Life instrument (AE-QoL), the recently introduced Angioedema Activity Score (AAS) form, and questionnaires on sick leave and prophylactic medication. Sixty-four of 133 adults (26 men, 38 women) between 18 and 91 years old responded. The most affected HR-QoL dimensions in the EQ-5D-5L were pain/discomfort and anxiety/depression; in the RAND-36, energy/fatigue, general health, pain; and, in the AE-QoL, fears/shame and fatigue/mood. Women had lower HR-QoL in the RAND-36 for general health and energy/fatigue (p 0 had significantly impaired HR-QoL. There were significant associations (p depression, and fatigue/mood are important aspects of HAE but the AE-QoL disregards pain. HR-QoL was not significantly affected by prophylaxis. Increased disease activity was associated with impaired HR-QoL, which justifies more active disease management.

  20. Facial Oedema Is Not Always Angioedema: A Case of Spontaneous Pneumomediastinum with Subcutaneous Emphysema during COPD Exacerbation

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    Sarah Damanti

    2015-10-01

    Full Text Available We report a case of acute facial oedema in an elderly hospitalized patient which was initially misdiagnosed as angioedema secondary to antibiotics in a patient with an allergic diathesis. We describe the differential aetiologies and then the true cause of the oedema, which was an uncommon complication of a very common condition in the elderly: a pneumomediastinum with subcutaneous emphysema probably due to rupture of an emphysematous lung bulla during chronic obstructive pulmonary disease (COPD exacerbation. Lastly, we focus on the therapeutic procedures instituted for the treatment of the pneumomediastinum.

  1. Hereditary angioedema attacks resolve faster and are shorter after early icatibant treatment.

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    Marcus Maurer

    Full Text Available BACKGROUND: Attacks of hereditary angioedema (HAE are unpredictable and, if affecting the upper airway, can be lethal. Icatibant is used for physician- or patient self-administered symptomatic treatment of HAE attacks in adults. Its mode of action includes disruption of the bradykinin pathway via blockade of the bradykinin B(2 receptor. Early treatment is believed to shorten attack duration and prevent severe outcomes; however, evidence to support these benefits is lacking. OBJECTIVE: To examine the impact of timing of icatibant administration on the duration and resolution of HAE type I and II attacks. METHODS: The Icatibant Outcome Survey is an international, prospective, observational study for patients treated with icatibant. Data on timings and outcomes of icatibant treatment for HAE attacks were collected between July 2009-February 2012. A mixed-model of repeated measures was performed for 426 attacks in 136 HAE type I and II patients. RESULTS: Attack duration was significantly shorter in patients treated <1 hour of attack onset compared with those treated ≥ 1 hour (6.1 hours versus 16.8 hours [p<0.001]. Similar significant effects were observed for <2 hours versus ≥ 2 hours (7.2 hours versus 20.2 hours [p<0.001] and <5 hours versus ≥ 5 hours (8.0 hours versus 23.5 hours [p<0.001]. Treatment within 1 hour of attack onset also significantly reduced time to attack resolution (5.8 hours versus 8.8 hours [p<0.05]. Self-administrators were more likely to treat early and experience shorter attacks than those treated by a healthcare professional. CONCLUSION: Early blockade of the bradykinin B(2 receptor with icatibant, particularly within the first hour of attack onset, significantly reduced attack duration and time to attack resolution.

  2. Optimum Use of Acute Treatments for Hereditary Angioedema: Evidence-Based Expert Consensus

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    Hilary Longhurst

    2018-03-01

    Full Text Available Acute treatment of hereditary angioedema due to C1 inhibitor deficiency has become available in the last 10 years and has greatly improved patients’ quality of life. Two plasma-derived C1 inhibitors (Berinert and Cinryze, a recombinant C1 inhibitor (Ruconest/Conestat alpha, a kallikrein inhibitor (Ecallantide, and a bradykinin B2 receptor inhibitor (Icatibant are all effective. Durably good response is maintained over repeated treatments and several years. All currently available prophylactic agents are associated with breakthrough attacks, therefore an acute treatment plan is essential for every patient. Experience has shown that higher doses of C1 inhibitor than previously recommended may be desirable, although only recombinant C1 inhibitor has been subject to full dose–response evaluation. Treatment of early symptoms of an attack, with any licensed therapy, results in milder symptoms, more rapid resolution and shorter duration of attack, compared with later treatment. All therapies have been shown to be well-tolerated, with low risk of serious adverse events. Plasma-derived C1 inhibitors have a reassuring safety record regarding lack of transmission of virus or other infection. Thrombosis has been reported in association with plasma-derived C1 inhibitor in some case series. Ruconest was associated with anaphylaxis in a single rabbit-allergic volunteer, but no further anaphylaxis has been reported in those not allergic to rabbits despite, in a few cases, prior IgE sensitization to rabbit or milk protein. Icatibant is associated with high incidence of local reactions but not with systemic effects. Ecallantide may cause anaphylactoid reactions and is given under supervision. For children and pregnant women, plasma-derived C1 inhibitor has the best evidence of safety and currently remains first-line treatment.

  3. Optimum Use of Acute Treatments for Hereditary Angioedema: Evidence-Based Expert Consensus.

    Science.gov (United States)

    Longhurst, Hilary

    2017-01-01

    Acute treatment of hereditary angioedema due to C1 inhibitor deficiency has become available in the last 10 years and has greatly improved patients' quality of life. Two plasma-derived C1 inhibitors (Berinert and Cinryze), a recombinant C1 inhibitor (Ruconest/Conestat alpha), a kallikrein inhibitor (Ecallantide), and a bradykinin B2 receptor inhibitor (Icatibant) are all effective. Durably good response is maintained over repeated treatments and several years. All currently available prophylactic agents are associated with breakthrough attacks, therefore an acute treatment plan is essential for every patient. Experience has shown that higher doses of C1 inhibitor than previously recommended may be desirable, although only recombinant C1 inhibitor has been subject to full dose-response evaluation. Treatment of early symptoms of an attack, with any licensed therapy, results in milder symptoms, more rapid resolution and shorter duration of attack, compared with later treatment. All therapies have been shown to be well-tolerated, with low risk of serious adverse events. Plasma-derived C1 inhibitors have a reassuring safety record regarding lack of transmission of virus or other infection. Thrombosis has been reported in association with plasma-derived C1 inhibitor in some case series. Ruconest was associated with anaphylaxis in a single rabbit-allergic volunteer, but no further anaphylaxis has been reported in those not allergic to rabbits despite, in a few cases, prior IgE sensitization to rabbit or milk protein. Icatibant is associated with high incidence of local reactions but not with systemic effects. Ecallantide may cause anaphylactoid reactions and is given under supervision. For children and pregnant women, plasma-derived C1 inhibitor has the best evidence of safety and currently remains first-line treatment.

  4. The humanistic burden of hereditary angioedema: results from the Burden of Illness Study in Europe.

    Science.gov (United States)

    Caballero, Teresa; Aygören-Pürsün, Emel; Bygum, Anette; Beusterien, Kathleen; Hautamaki, Emily; Sisic, Zlatko; Wait, Suzanne; Boysen, Henrik B

    2014-01-01

    Hereditary angioedema (HAE) is a rare but potentially life-threatening disease marked by spontaneous, recurrent attacks of swelling. The broad range of consequences of HAE on patients' lives is not well understood. The study objective was to comprehensively characterize the burden of illness and impact of HAE types I and II from the patient perspective. The HAE Burden of Illness Study in Europe was conducted in Spain, Germany, and Denmark to assess the real-world experience of HAE from the patient perspective via a one-time survey, which included items on clinical characteristics and physical and emotional impacts. One hundred eighty-six patients participated; 59% reported having an attack at least once a month, 67% reported moderate-to-severe pain during their last attack, and 74% reported moderate-to-severe swelling. The most common sites of the last attack were the abdomen and extremities; 24% experienced an attack in more than one site. The impact of HAE on daily activities was high during attacks and did not vary significantly by body site affected; patients also reported that HAE impacted their daily activities between attacks. Patients reported substantial anxiety about future attacks, traveling, and passing HAE to their children. Based on Hospital Anxiety and Depression Scale scores, 38 and 14% had clinically meaningful anxiety and depression, respectively. Despite standard of care, HAE patients still have frequent and painful attacks. Patients experience substantial impairment physically and emotionally both during and between attacks. A better understanding of these effects may help in the clinical management of HAE patients.

  5. The hereditary angioedema burden of illness study in Europe (HAE-BOIS-Europe: background and methodology

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    Bygum Anette

    2012-04-01

    Full Text Available Abstract Background Hereditary angioedema (HAE is a rare but serious disease marked by swelling attacks in the extremities, face, trunk, airway, or abdominal areas that can be spontaneous or the result of trauma and other triggers. It can be life-threatening due to the risk of asphyxiation. While there have been major advancements in our understanding of the immunogenetics of HAE, there are significant gaps in the literature regarding understanding of the humanistic and economic impact of the disease, particularly in Europe. The purpose of the HAE Burden of Illness Study-Europe (HAE-BOIS-Europe, the development and methodology of which is described here, is to better understand the management and impact of HAE from the patient perspective in Europe. Methods/Design This is a cross-sectional study in which retrospective data were also collected being conducted in Denmark, Germany and Spain. The study is open to patients ages 12 and older with a diagnosis of HAE-I or HAE-II. Data collection includes: (i a survey on individuals’ health care resource use, direct and indirect medical costs, impact on work and school, treatment satisfaction, and emotional functioning (via the Hospital Anxiety and Depression Scale; and (ii one-on-one interviews to collect detailed descriptive data and patient testimonials on the impact of HAE on patients’ health-related quality of life. Discussion The present manuscript describes the development and plans for implementing a multi-country European study with the aim of characterizing the humanistic and economic burden of HAE from the patient perspective. This study will help raise awareness of HAE as a rare but debilitating condition with wide-ranging impacts.

  6. The hereditary angioedema burden of illness study in Europe (HAE-BOIS-Europe): background and methodology.

    Science.gov (United States)

    Bygum, Anette; Aygören-Pürsün, Emel; Caballero, Teresa; Beusterien, Kathleen; Gholizadeh, Shadi; Musingarimi, Patience; Wait, Suzanne; Boysen, Henrik

    2012-04-26

    Hereditary angioedema (HAE) is a rare but serious disease marked by swelling attacks in the extremities, face, trunk, airway, or abdominal areas that can be spontaneous or the result of trauma and other triggers. It can be life-threatening due to the risk of asphyxiation. While there have been major advancements in our understanding of the immunogenetics of HAE, there are significant gaps in the literature regarding understanding of the humanistic and economic impact of the disease, particularly in Europe. The purpose of the HAE Burden of Illness Study-Europe (HAE-BOIS-Europe), the development and methodology of which is described here, is to better understand the management and impact of HAE from the patient perspective in Europe. This is a cross-sectional study in which retrospective data were also collected being conducted in Denmark, Germany and Spain. The study is open to patients ages 12 and older with a diagnosis of HAE-I or HAE-II. Data collection includes: (i) a survey on individuals' health care resource use, direct and indirect medical costs, impact on work and school, treatment satisfaction, and emotional functioning (via the Hospital Anxiety and Depression Scale); and (ii) one-on-one interviews to collect detailed descriptive data and patient testimonials on the impact of HAE on patients' health-related quality of life. The present manuscript describes the development and plans for implementing a multi-country European study with the aim of characterizing the humanistic and economic burden of HAE from the patient perspective. This study will help raise awareness of HAE as a rare but debilitating condition with wide-ranging impacts.

  7. Patients perception of self-administrated medication in the treatment of hereditary angioedema.

    Science.gov (United States)

    Wang, Adrian; Fouche, Andrew; Craig, Timothy J

    2015-08-01

    Early therapy of hereditary angioedema (HAE) decreases morbidity, improves outcomes, decreases absenteeism, and possibly decreases mortality. This can be accomplished best with self-therapy. Previously, the authors examined barriers to self-therapy from the perspective of the nurse and the physician, but data are lacking on what patients perceive as major barriers to self-administered therapy for HAE. To identify those barriers in a prospective fashion by patient interview. After approval from the institutional review board, a telephone survey was performed of patients with HAE from a database of patients who were recently seen in the clinic. The survey focused on anxiety, depression, stress, concerns regarding method of administration, the ability to inject themselves, and what they perceived as barriers to providing self-care. Ninety-two patients were contacted and 59 agreed to participate. With 69% of those patients currently undergoing self-administered treatment, the results showed minimal depression and anxiety, a high satisfaction with treatment, and significant compliance with treatment. Most of those not yet on self-administered therapy wanted to start despite being satisfied with the care received in the emergency department. They also believed care at home would be optimal. The main concern of the 2 groups was not being able to treat themselves in the event of an HAE attack. From these data, it is obvious that most patients are willing to self-treat. This suggests that physicians should encourage self-treatment of HAE to improve outcomes and quality of life of patients with HAE. Copyright © 2015 American College of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

  8. Kininogen Cleavage Assay: Diagnostic Assistance for Kinin-Mediated Angioedema Conditions.

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    Rémi Baroso

    Full Text Available Angioedema without wheals (AE is a symptom characterised by localised episodes of oedema presumably caused by kinin release from kininogen cleavage. It can result from a hereditary deficiency in C1 Inhibitor (C1Inh, but it can present with normal level of C1Inh. These forms are typically difficult to diagnose although enhanced kinin production is suspected or demonstrated in some cases.We wanted to investigate bradykinin overproduction in all AE condition with normal C1Inh, excluding cases with enhanced kinin catabolism, and to propose this parameter as a disease biomarker.We retrospectively investigated high molecular weight kininogen (HK cleavage pattern, using gel electrophoresis and immunorevelation. Plasma samples were drawn using the same standardised procedure from blood donors or AE patients with normal C1Inh conditions, normal kinin catabolism, and without prophylaxis.Circulating native HK plasma concentrations were similar in the healthy men (interquartile range: 98-175μg/mL, n = 51 and in healthy women (90-176μg/mL, n = 74, while HK cleavage was lower (p14.4% HK cleavage for men; 33.0% HK cleavage for women, with >98% specificity achieved for all parameters. In plasma from patients undergoing recovery two months after oestrogen/progestin combination withdrawal (n = 13 or two weeks after AE attack (n = 2, HK cleavage was not fully restored, suggesting its use as a post-attack assay.As a diagnostic tool, HK cleavage can offer physicians supportive arguments for kinin production in suspected AE cases and improve patient follow-up in clinical trials or prophylactic management.

  9. Audit report and systematic review of orolingual angioedema in post-acute stroke thrombolysis.

    Science.gov (United States)

    Lekoubou, Alain; Philippeau, Frédéric; Derex, Laurent; Olaru, Angel; Gouttard, Michel; Vieillart, Anne; Kengne, Andre Pascal

    2014-07-01

    Post-intravenous recombinant tissue plasminogen activator (r-tPA) orolingual angioedema (PIROLA), including the life-threatening form, is an underappreciated complication of ischaemic stroke treatment. We present an audit report and a systematic review of published observational studies on PIROLA occurrence in acute ischaemic stroke patients. Clinical files of patients treated in the stroke unit of Bourg-en-Bresse General Hospital (France) from January 2010 to December 2012 were reviewed, and MEDLINE (inception to May 2013) were searched and bibliographies/citations of retrieved articles examined for evidence of PIROLA. Of the 129 acute ischaemic stroke patients treated at Bourg-en-Bresse between 2010 and 2012, four patients, all receiving angiotensin converting enzyme inhibitor (ACEI), developed a PIROLA (cumulative incidence rate: 32‰). The complication started within an hour of receiving r-tPA and integrally resolved within 3-24 hours, with antihistamines/steroid treatment in two patients. The systematic review identified 27 studies, totalising with ours, over 9050 acute ischaemic stroke patients from 12 countries, among whom 100 (cumulative incidence rate: 17‰; 95% confidence intervals: 8-26), developed a PIROLA within 6-240 minutes of receiving r-tPA, 0-100% of them occurring among patients on ACEI. The complication was contralateral to the stroke location in 47% cases, ipsilateral in 14%, and bilateral in 39%; and resolved within 24 hours with treatment in 90%. No related death was recorded. About 17‰ acute ischaemic stroke patients receiving r-tPA develop PIROLA, occurring essentially among those on concomitant ACEI. PIROLA occurrence should be actively monitored, particularly within the first few hours as some may require urgent lifesaving procedures.

  10. Evidence-based recommendations for the therapeutic management of angioedema owing to hereditary C1 inhibitor deficiency: consensus report of an International Working Group

    NARCIS (Netherlands)

    Cicardi, M.; Bork, K.; Caballero, T.; Craig, T.; Li, H. H.; Longhurst, H.; Reshef, A.; Zuraw, B.; Werner, Aberer; Aygören-Pürsün, Emel; Banerji, Aleena; Bjorkander, Janne; Boccon-Gibod, Isabelle; Konrad, Bork; Bouillet, Laurence; Bova, Maria; Bowen, Tom; Branco Ferreira, Manuel; Bygum, Anette; Caballero, Teresa; Cancian, Mauro; Castel-Branco, Maria Graça; Cicardi, Marco; Craig, Timothy; de Carolis, Caterina; Mihály, Enikö; Josè, Fabiani; Farkas, Henriette; Gompels, Mark; Gower, Richard; Groffik, Adriane; Grumach, Anete; Guillarte, Mar; Hernandez Landeros, Maria Esthela; Kaplan, Allen; Leibovich, Iris; Li, Henry; Lock, Bob; Longhurst, Hilary; Lumry, William; Malbran, Alejandro; Martinez-Saguer, Immaculada; Campos, Matta; Maurer, Marcus; Moldovan, Dumitru; Montinaro, Vincenzo; Nieto, Sandra; Nordenfelt, Patrik; Obtulovicz, Krystana; Zeerleder, Sacha

    2012-01-01

    Angioedema owing to hereditary deficiency of C1 inhibitor (HAE) is a rare, life-threatening, disabling disease. In the last 2 years, the results of well-designed and controlled trials with existing and new therapies for this condition have been published, and new treatments reached the market.

  11. Daño cerebral adquirido: percepción del familiar de las secuelas y su malestar psicológico

    Directory of Open Access Journals (Sweden)

    Elena López de Arróyabe Castillo

    2013-01-01

    Full Text Available Este estudio tuvo como objetivo evaluar la percepción que el familiar tiene de los problemas de la persona afectada por un daño cerebral adquirido y su asociación a sus propios síntomas de estrés, depresión y duelo. Participaron 223 familiares (cuidadores principales. Se desarrolló un inventario de 36 secuelas percibidas estructuradas en 6 factores: déficits cognitivos y sensoriales, cambios de personalidad, dependencia, actividad disminuida, trastornos emocionales y autoconciencia y percepción social disminuida. Los resultados mostraron que las secuelas percibidas tienen relativamente poco impacto en el malestar psicológico del familiar. Las secuelas con mayor asociación a los síntomas psicológicos fueron dependencia, asociada significativamente a sentimientos actuales de duelo, y la actividad disminuida, que se asocia a las respuestas involuntarias de estrés de aproximación y alejamiento. Estos datos contradicen la literatura que sostiene la relación causal entre secuelas percibidas y síntomas en los familiares, sugiriendo otro tipo de factores implicados.

  12. Tratamento cirúrgico de estrabismo restritivo adquirido na infância: relato de caso Surgical treatment of acquired restrictive strabismus in infancy: case report

    Directory of Open Access Journals (Sweden)

    Juliano Vescovi Damasceno

    2009-02-01

    Full Text Available Os autores relatam um caso raro e grave de estrabismo restritivo, adquirido nos primeiros meses de vida, em criança previamente normal, com intenso acometimento da musculatura extraocular e tecidos adjacentes. Discutem a possibilidade de doença inflamatória ou infecciosa como causa etiológica. A dificuldade da abordagem cirúrgica do caso, descrita nos três procedimentos anteriores, foi resolvida na última cirurgia, pela cooperação de cirurgiões de estrabismo e órbita, utilizando-se incisão ampla para cirurgia orbitária.The authors describe a severe and rare case of restrictive strabismus, acquired during the first semester of life, in a previously normal baby. They discuss the possibility of inflammatory or infectious disease as the primary cause. Surgical management was challenging, after three procedures and required the cooperation of strabismus and orbit specialists and also a wide incision for orbital surgery.

  13. The Complex Interaction Between Polycystic Ovary Syndrome and Hereditary Angioedema: Case Reports and Review of the Literature.

    Science.gov (United States)

    Iahn-Aun, Marina; Aun, Marcelo Vivolo; Motta, Antonio Abílio; Kalil, Jorge; Giavina-Bianchi, Pedro; Hayashida, Sylvia Asaka; Baracat, Edmund Chada; Maciel, Gustavo Arantes

    2017-07-01

    Hereditary angioedema (HAE) is a rare but severe disease, with high risk of death, and attacks have been associated to high estrogen levels. Polycystic ovary syndrome (PCOS) is a common hyperandrogenic condition, which is frequently treated with combined oral contraceptives. The aim of this study was to describe 2 clinical cases of young women diagnosed as having PCOS who developed HAE attacks after the introduction of combined estrogen-progestin pills to treat PCOS symptoms. Literature review of sex hormones' role in genesis of HAE attacks and possible mechanisms involved. In the cases reported, after initiation of combined contraceptives, patients presented with facial swelling with airway involvement (laryngeal edema) and abdominal pain. They had a familial history of angioedema and normal C1 inhibitor (C1-INH) levels, leading to the diagnosis of HAE with normal C1-INH (HAEnC1-INH) or HAE type III. After suspension of exogenous estrogen, patients remained asymptomatic from HAE. HAEnC1-INH is an estrogen-dependent form of HAE. It is well established that exogenous estrogen triggers attacks of all types of HAE. However, this is the first description of the association between PCOS and HAE, in which PCOS could be masking HAE symptoms. We propose that PCOS might have a protective role regarding HAE attacks, because of its particular hormonal features, that is, hyperandrogenism and relative stable levels of estradiol. The use of combined estrogen-progestin compounds in women with PCOS and HAE must be avoided, and treatment must be individualized.

  14. Neurobiologia da síndrome de Tourette: a hipótese auto-imune pós-estreptocócica Neurobiology of Tourette's syndrome: the autoimmune post-streptococcal hypothesis

    Directory of Open Access Journals (Sweden)

    Fernando Machado Vilhena Dias

    2008-01-01

    Full Text Available CONTEXTO: A síndrome de Tourette (ST caracteriza-se pela presença de tiques motores e pelo menos um tique fônico. Algumas semelhanças clínicas com a coréia reumática ou de Sydenham (CS incentivaram a formulação da hipótese da existência de um grupo de transtornos neuropsiquiátricos associados a processo auto-imune decorrente de infecção estreptocócica (PANDAS. OBJETIVO: Revisar a literatura quanto às evidências em relação à hipótese de que mecanismos auto-imunes pós-estreptocócicos estão envolvidos na etiopatogênese da ST. MÉTODOS: Revisão sistemática na base de dados MedLine com os termos "Tourette", "tic", "PANDAS", "antibodies", "streptococcal" e "rheumatic". RESULTADOS: Retornaram 238 artigos da busca. Selecionaram-se 53 trabalhos, os quais tiveram suas referências bibliográficas também revisadas. São apresentados os resultados de estudos que avaliaram aspectos imunes na ST, incluindo anticorpos antiestreptocócicos e antinúcleos da base, e sua terapêutica imunebaseada, discutindo a validade do conceito de PANDAS. CONCLUSÕES: As evidências ainda não são satisfatórias no que tange a uma base auto-imune pós-estreptocócica para a ST. Um aprimoramento dos métodos investigativos e na seleção das amostras pode trazer maiores contribuições à questão.BACKGROUND: Tourette's syndrome (TS is characterized by the presence of motor tics and at least one phonic tic. Some clinical similarities with Sydenham's chorea (SC lead to the hypothesis of a new group of disorders associated with an autoimmune process due to a streptococcal infection (PANDAS. Objective: To review the literature in search of evidence on the existence of post-streptococcal autoimmune mechanisms involved with the etiopathogenesis of TS. METHODS: A systematic review with the terms "Tourette", "tic", "PANDAS", "antibodies", "streptococcal" and "rheumatic" was carried on using the MedLine. RESULTS: The search found 238 articles. Fifty and

  15. Clinical Features of Hereditary and Mast Cell-mediated Angioedema Focusing on the Differential Diagnosis in Japanese Patients.

    Science.gov (United States)

    Ohsawa, Isao; Honda, Daisuke; Hisada, Atsuko; Inoshita, Hiroyuki; Onda-Tsueshita, Kisara; Mano, Satoshi; Sato, Nobuyuki; Nakamura, Yuya; Shimizu, Tatsuo; Gotoh, Hiromichi; Goto, Yoshikazu; Suzuki, Yusuke; Tomino, Yasuhiko

    2018-02-01

    Objective The present study was designed to identify the clinical characteristics that permit the differential diagnosis of hereditary angioedema (HAE) and mast cell-mediated angioedema (Mast-AE) during the first consultation. Methods The medical histories and laboratory data of 46 patients with HAE and 41 patients with Mast-AE were compared. Results The average age of onset in the HAE group (19.8±9.0 years) was significantly lower than that in the Mast-AE group (35.2±12.0 years). The incidence of familial angioedema (AE) in the HAE group (73.9%) was significantly higher than that in the Mast-AE group (9.7%). The frequency of history of AE in the extremities, larynx, or gastrointestinal tract was significantly higher in the HAE group. The frequency of AE episodes of the lips and eyelids was significantly lower in the HAE group. The serum C4 concentration and CH50 titer were lower than the normal limit in 91.3% and 45.6% of the patients in the HAE group, respectively; in Mast-AE group the serum C4 concentration and CH50 titer were significantly lower than the normal limit in 4.8% and 0% of the patients, the difference between the two groups was statistically significant. A C1-inhibitor (C1-INH) activity level of <50% was observed in all of the HAE patients, but none of the Mast-AE patients. The mean serum IgE titer in the HAE group (120.8±130.5 IU/mL) was significantly lower than that in the Mast-AE group (262.2±314.9 IU/mL). Conclusion The parameters within the patients' medical histories, such as the age at the onset of AE, a family history of AE, and the locations of past AE episodes are critical for the successful diagnosis of the disease. Measurements of the C4 and C1-INH activity are very useful for differential diagnosis of HAE from Mast-AE.

  16. Pie plano-valgo adquirido

    OpenAIRE

    Albiol Ferrer, Josep Maria; Giralt de Veciana, Enrique; Marugán de los Bueis, Montse; Novel Martí, Virginia; Ogalla, José Manuel; Zalacain, Antonio

    1990-01-01

    Es la patología del pie que tiene mayor incidencia durante la infancia. Su recuperación eficaz, además de precisar un largo período de tratamiento, requiere un diagnóstico precoz. Durante la lactancia, a partir de los tres meses, y después, durante la infancia, hasta los tres años aproximadamente, una gruesa y blanda capa de panlculo adiposo determina una configuración que rellena la bóveda y ofrece una falsa imagen de pie plano.

  17. Hematopoietic stem cell transplantation for autoimmune diseases in Brazil: current status and future prospectives O transplante de células precursoras hematopoéticas em doenças autoimunes no Brasil: estado atual e perspectivas

    Directory of Open Access Journals (Sweden)

    Júlio C. Voltarelli

    2002-01-01

    Full Text Available In this paper, we discuss the launching of a cooperative protocol of hematopoietic stem cell transplantation for autoimmune diseases in Brazil. We present specific conditions of the country's health system which would affect the trial, preliminary results of the first nine patients transplanted under the protocol (4 systemic lupus, 3 multiple sclerosis, one systemic sclerosis and one overlapping lupus + systemic sclerosis and future prospectives of organizing phase III randomized trials to answer specific scientific questions pending in the field.Neste trabalho, discutimos a implantação de um protocolo cooperativo de transplante de células tronco hematopoéticas para doenças auto-imunes no Brasil. Apresentamos as condições específicas do sistema de saúde do país que poderiam afetar o projeto, resultados preliminares dos primeiros nove pacientes transplantados (quatro com lúpus sistêmico, três com esclerose múltipla, um com esclerose sistêmica e um com superposição de lúpus com esclerose sistêmica e perspectivas futuras de organização de estudos randomizados de fase III para responder questões específicas pendentes nesta área.

  18. Angioedema hereditario en Medellín, Colombia: evaluación clínica y de la calidad de vida

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    María Dulfary Sánchez

    2015-09-01

    Conclusión. Este estudio provee información sobre la primera familia caracterizada con angioedema hereditario de tipo 1 en el Valle de Aburrá, Colombia. Aunque para ello se usó un instrumento genérico, se confirmó, además, el efecto negativo de la enfermedad en la calidad de vida de los individuos que la padecen.

  19. Efecto de un programa de actividad físico deportiva sobre la salud de personas con daño cerebral adquirido en fase crónica

    OpenAIRE

    Pérez Rodríguez, Marta

    2017-01-01

    El Daño Cerebral Adquirido (DCA) es una discapacidad con gran incidencia en nuestra sociedad, de gran complejidad y grandes costes sanitarios, siendo las dos etiologías más comunes el ictus y el traumatismo craneoencefálico (TCE). El resto de etiologías de lesión cerebral son menos frecuentes, aunque generan demandas de recuperación similares. Los avances en el área de la neurorrehabilitación han logrado establecer una propuesta eficaz para la mejora funcional sobre los diferentes déficits fí...

  20. Transplante de células tronco hematopoéticas para doenças auto-imunes no Brasil Hematopoietic stem cell transplantation for autoimmune diseases in Brazil

    Directory of Open Access Journals (Sweden)

    Júlio C. Voltarelli

    2002-03-01

    Full Text Available O transplante de células progenitoras hematopoéticas apresenta bases sólidas para ser indicado no tratamento das doenças autoimunes. No relato são apresentados estes dados e a seqüência de eventos que tem contribuído para a implantação de um protocolo brasileiro do procedimento na modalidade autogênica utilizando regimes de mobilização uniforme com Ciclofosfamida 2g/m2 mais fator estimulador de colônias granulocitárias e condicionamentos particulares para o lúpus eritematoso sistêmico, esclerose sistêmica e esclerose múltipla. As entidades descritas anteriormente foram escolhidas para o início do protocolo cooperativo após amplos debates em encontros ocorridos em Ribeirão Preto e São Francisco, EUA.Hematopoietic Stem Cell Transplantation presents a solid basis to be indicated for the treatment of autoimmune diseases. In this work data related to the procedure and the sequence of events which have contributed to the implantation of a Brazilian protocol are discussed. Included is a discussion of the autogenic procedure using uniform mobilization regimens with Cyclophosphamide 2g/m2 plus granulocyte-colony stimulation factor and particular conditioning for systemic lupus erythematosus, systemic sclerosis and multiple sclerosis. The formerly described entities were chosen for the beginning of a cooperative protocol after wide-ranging debates which took place both in Ribeirão Preto and San Francisco, USA.

  1. Púrpura trombocitopênica e anemia hemolítica auto-imune em pacientes internados com lúpus eritematoso sistêmico juvenil Trombocytopenic purpura and autoimmune hemolytic anemia in hospitalized patients with juvenile systemic lupus erythematosus

    Directory of Open Access Journals (Sweden)

    Jochebed Kyoung Kim

    2007-02-01

    Full Text Available OBJETIVO: avaliar o comprometimento hematológico (CHE em pacientes internados com lúpus eritematoso sistêmico juvenil (LESJ. MÉTODOS: durante o período de 1994 a 2005, ocorreram 195 internações de 77 pacientes com LESJ (critérios do Colégio Americano de Reumatologia e foram acompanhadas pela Unidade de Reumatologia Pediátrica do Instituto da Criança - Universidade de São Paulo. Essas internações foram avaliadas com relação à presença de CHE inicial ou evolutivo: anemia hemolítica auto-imune ou púrpura trombocitopênica. Todos os pacientes realizaram dois ou mais hemogramas. O diagnóstico de anemia hemolítica auto-imune (AHAI foi estabelecido pela queda acentuada dos níveis de hemoglobina (acima de 2 g/dl, reticulocitose, aumento de desidrogenase láctica (DHL, aumento de bilirrubina indireta e teste de Coombs positivo. As manifestações hematológicas associadas à infecção, neoplasia e anemia aplásica foram excluídas. RESULTADOS: o CHE ocorreu em 14 pacientes (18,9%, com 15 internações. Destes, 11 eram do sexo feminino, sete apresentaram púrpura trombocitopênica, cinco, anemia hemolítica auto-imune e dois, síndrome de Evans. O CHE, como manifestação inicial e isolada do LESJ, foi evidenciado em três pacientes. Todos os pacientes com púrpura trombocitopênica apresentaram sangramento cutâneo (petéquias e/ou equimoses. Todos estavam em atividade da doença e apresentavam simultaneamente outras manifestações do LESJ, particularmente nefrite e vasculite. Inicialmente, todos receberam pulsoterapia com metilprednisolona e, posteriormente, prednisona. Em três pacientes, o tratamento foi predominantemente realizado para controle das manifestações hematológicas, com gamaglobulina endovenosa. Os imunossupressores mais utilizados foram pulsoterapia endovenosa com ciclosfosfamida, ciclosporina e azatioprina. Óbito ocorreu em uma paciente por sangramento de sistema nervoso central. Nenhum paciente necessitou de

  2. Health-Related Quality of Life with Subcutaneous C1-Inhibitor for Prevention of Attacks of Hereditary Angioedema.

    Science.gov (United States)

    Lumry, William R; Craig, Timothy; Zuraw, Bruce; Longhurst, Hilary; Baker, James; Li, H Henry; Bernstein, Jonathan A; Anderson, John; Riedl, Marc A; Manning, Michael E; Keith, Paul K; Levy, Donald S; Caballero, Teresa; Banerji, Aleena; Gower, Richard G; Farkas, Henriette; Lawo, John-Philip; Pragst, Ingo; Machnig, Thomas; Watson, Douglas J

    2018-01-31

    Hereditary angioedema with C1-inhibitor deficiency (C1-INH-HAE) impairs health-related quality of life (HRQoL). The objective of this study was to assess HRQoL outcomes in patients self-administering subcutaneous C1-INH (C1-INH[SC]; HAEGARDA) for routine prevention of HAE attacks. Post hoc analysis of data from the placebo-controlled, crossover phase III COMPACT study (Clinical Studies for Optimal Management of Preventing Angioedema with Low-Volume Subcutaneous C1-Inhibitor Replacement Therapy). Ninety patients with C1-INH-HAE were randomized to 1 of 4 treatment sequences: C1-INH(SC) 40 or 60 IU/kg twice weekly for 16 weeks, preceded or followed by 16 weeks of twice weekly placebo injections. All HAE attacks were treated with open-label on-demand treatment as necessary. HRQoL assessments at week 14 (last visit) included the European Quality of Life-5 Dimensions Questionnaire (EQ-5D-3L), the Hospital Anxiety and Depression Scale (HADS), the Work Productivity and Activity Impairment Questionnaire (WPAI), and the Treatment Satisfaction Questionnaire for Medication (TSQM). Compared with placebo (on-demand treatment alone), treatment with twice weekly C1-INH(SC) (both doses combined) was associated with better EQ-5D visual analog scale general health, less HADS anxiety, less WPAI presenteeism, work productivity loss, and activity impairment, and greater TSQM effectiveness and overall treatment satisfaction. More patients self-reported a "good/excellent" response during routine prevention with C1-INH(SC) compared with on-demand only (placebo prophylaxis) management. For each HRQoL measure, a greater proportion of patients had a clinically meaningful improvement during C1-INH(SC) treatment compared with placebo. In patients with frequent HAE attacks, a treatment strategy of routine prevention with self-administered twice weekly C1-INH(SC) had a greater impact on improving multiple HAE-related HRQoL impairments, most notably anxiety and work productivity, compared with on

  3. The humanistic burden of hereditary angioedema: Impact on health-related quality of life, productivity, and depression.

    Science.gov (United States)

    Lumry, William R; Castaldo, Anthony J; Vernon, Margaret K; Blaustein, Marc B; Wilson, David A; Horn, Patrick T

    2010-01-01

    Hereditary angioedema (HAE) is a rare, autosomal dominant disorder characterized by recurrent acute attacks of swelling of the larynx, abdomen, and periphery. This study was designed to assess the humanistic burden of illness associated with HAE. HAE burden was assessed via a web-based survey of patients that solicited information on attack characterization, treatment, side effects, pain, and functional and emotional burden of disease management. In addition to HAE-specific sections, the survey used three standardized instruments to compare HAE patient data to normative (healthy) and chronic disease populations: the 12-Item Short Form (SF-12) Health Survey, the Work Productivity and Activity Impairment-General Health (WPAI-GH) questionnaire, and the Hamilton Depression Inventory-Short Form (HDI-SF). A total of 457 HAE patients responded to the survey (response rate, ∼19%). Patients reported significantly poorer health-related quality of life versus population norms, based on the SF-12 Physical Component Summary (mean, 43.7 versus 49.6; p 8.5, indicative of depressive symptomatology. Productivity was also markedly impaired in all WPAI-GH categories, including 34% overall work impairment. Because of their most recent HAE attack, workers lost a mean of 3.3 days; students lost a mean of 1.9 days. HAE results in considerable humanistic burden to patients across physical and mental health domains; negatively impacts education, career, and work productivity; and compounds the substantial economic burdens that are reported separately.

  4. Use of a C1 Inhibitor Concentrate in Adults ≥65 Years of Age with Hereditary Angioedema

    DEFF Research Database (Denmark)

    Bygum, Anette; Martinez-Saguer, Inmaculada; Bas, Murat

    2016-01-01

    BACKGROUND: Treatment of hereditary angioedema (HAE) in 'older adults' (those aged ≥65 years) has not been well studied. The international Berinert Patient Registry collected data on the use of intravenous plasma-derived, pasteurized, nanofiltered C1-inhibitor concentrate (pnfC1-INH; Berinert......(®)/CSL Behring) in patients of any age, including many older adults. METHODS: This observational registry, conducted from 2010 to 2014 at 30 US and seven European sites, gathered prospective (post-enrollment) and retrospective (pre-enrollment) usage and adverse event (AE) data on subjects treated with pnfC1-INH....... RESULTS: The registry documented 1701 pnfC1-INH infusions in 27 older adults. A total of 1511 HAE attacks treated with pnfC1-INH administration were reported among 25 of the 27 (92.6 %) older adults. Among the older adults, mean (standard deviation [SD]) (8.8 [4.1] IU/kg) and median (6.4 IU/kg) pnfC1-INH...

  5. Obstetrical Complications and Outcome in Two Families with Hereditary Angioedema due to Mutation in the F12 Gene

    Directory of Open Access Journals (Sweden)

    Olivier Picone

    2010-01-01

    Full Text Available Backgroud. Hereditary angioedema (HAE is characterized by recurrent swelling of the skin, the abdomen (causing severe acute pain, and the airways. A recently discovered type caused by mutations in the factor XII gene (designated as HAE type III occurs mainly in women. Estrogens may play an important role, but few obstetrical complications have been reported. Case. We report the symptoms and obstetrical complications of women in two families with HAE attributable to the p. Thr328Lys mutation in the F12 gene. Clinical manifestations included acute and severe maternal abdominal pain, with transient ascites, laryngeal edema, and fetal and neonatal deaths. Patients had normal C4 levels and a normal C1 inhibitor gene. Administration of C1-inhibitor concentration twice monthly decreased the attack rate in one mother, and its predelivery administration (1000 U led to the delivery of healthy girls. Conclusions. Obstetricians and anesthesiologists should be aware of this rare cause of unexplained maternal ascites and in utero or fetal death associated with edema.

  6. In Vitro Fertilization Using Luteinizing Hormone-Releasing Hormone Injections Resulted in Healthy Triplets without Increased Attack Rates in a Hereditary Angioedema Case

    Directory of Open Access Journals (Sweden)

    Ceyda Tunakan Dalgıç

    2018-01-01

    Full Text Available Hereditary angioedema due to C1-inhibitor deficiency (C1-INH-HAE is a rare, autosomal dominant disorder. The management of pregnant patients with C1-INH-HAE is a challenge for the physician. Intravenous plasma-derived nanofiltered C1-INH (pdC1INH is the only recommended option throughout pregnancy, postpartum, and breastfeeding period. In order to increase pregnancy rates, physicians use fertilization therapies increasing endogen levels of estrogens. Therefore, these techniques can provoke an increase in the number and severity of edema attacks in C1-INH-HAE. Our patient is a 32-year-old female, diagnosed with C1-INH-HAE type 1 since 2004. She had been taking danazol 50–200 mg/day for 9 years. Due to her pregnancy plans in 2013, danazol was discontinued. PdC1INH was prescribed regularly for prophylactic purpose. Triplet pregnancy occurred by in vitro fertilization using luteinizing hormone-releasing hormone (LHRH injections. In our patient, LHRH injections were done four times without causing any severe attack during in vitro fertilization. Angioedema did not worsen during pregnancy and delivery due to the prophylactic use of intravenous pdC1INH in our patient. According to the attack frequency and severity, there was no difference between the three pregnancy trimesters. To our knowledge, this is the first published case of C1-INH-HAE receiving in vitro fertilization therapies without any angioedema attacks during pregnancy and delivery and eventually having healthy triplets with the prophylactic use of intravenous pdC1INH.

  7. Cold agglutinin disease (CADwith autoimmune haemolytic anaemia: a case report of a coronary artery disease patient Doença por aglutininas a frio (DAC com anemia hemolítica auto-imune: relato de caso de um coronariopata

    Directory of Open Access Journals (Sweden)

    Leandro A. Barbosa

    2008-02-01

    Full Text Available Cold agglutinin disease (CAD with autoimmune haemolytic anemia is characterized by the production of harmful cold autoantibodies associated with increased red cell destruction during exposure to cold. The treatment of CAD is very difficult and a great effort is required to obtain therapeutic success. Cyclophosphamide is a potent immunosuppressive agent which is widely used in all bone marrow transplantation conditioning regimens for patients with acquired severe aplastic anemia. In this report, we describe the case of a coronary artery disease patient with severe CAD, but without lymphoproliferative disease, in which general measures and immunosuppressive therapies were adopted, there by avoiding blood transfusions.A doença por aglutininas a frio (CAD cursando com anemia hemolítica auto-imune (AHAI é decorrente da produção de autoanticorpos que reagem muito bem a baixas temperaturas, dirigidos contra hemácias autólogas. A habilidade desses anticorpos em destruir as hemácias encontra-se diretamente relacionada à sua capacidade em fixar complemento durante a exposição do paciente a baixas temperaturas. A AHAI por anticorpos frios pode ser idiopática - ausência de doença de base - ou secundária, geralmente associada a desordens linfoproliferativas de células B ou determinados processos infecciosos. A hemólise é intravascular, através de aglutininas da classe IgM, com teste direto da antiglobulina humana positivo para complemento. O tratamento da CAD é difícil, exigindo um esforço contínuo, necessário para se obter sucesso terapêutico. A ciclofosfamida é um agente imunossupressor potente, amplamente utilizado em transplantes de medula óssea, particularmente nos portadores de anemia aplástica. Descrevemos o caso de um coronariopata portador de CAD severa, cuja exploração diagnóstica excluiu doença linfoproliferativa. Adotamos medidas gerais de suporte e terapia imunossupressora, coibindo o uso de hemotransfusões.

  8. Nutritional status of patients with biliary atresia and autoimmune hepatitis related to serum levels of vitamins A, D and E Estado nutricional de pacientes com atresia biliar e hepatite autoimune e relação com os níveis séricos de vitaminas A, D e E

    Directory of Open Access Journals (Sweden)

    Margareth L. G. Saron

    2009-03-01

    Full Text Available CONTEXT: Chronic liver disease may induce to malabsorption of lipids and fat-soluble vitamins, leading to injury of nutritional status. OBJECTIVES: To evaluate the nutritional status of pediatric-age patients with autoimmune hepatitis and biliary atresia related to serum levels of vitamins A, D and E and the disease severity. METHODS: This controlled transverse study, evaluated the patients with autoimmune hepatitis and biliary atresia and a reference group paired by sex and age. The patients underwent anthropometric evaluation, alimentary inquiry and determination of serum levels of vitamins A, D and E by high performance liquid chromatography. The Mann-Whitney test, Spearman correlation coefficients and variance analysis (ANOVA were utilized for data treatment, regarding significant difference if PCONTEXTO: As doenças hepáticas crônicas podem induzir à má absorção de lipídios e vitaminas lipossolúveis e levar ao comprometimento do estado nutricional. OBJETIVOS: Avaliar o estado nutricional e relacionar com os níveis séricos de vitaminas (A, D e E e a gravidade da doença em pacientes com atresia biliar e hepatite autoimune na faixa etária pediátrica. MÉTODOS: O estudo foi transversal controlado e foram avaliados os pacientes com hepatite autoimune e atresia biliar e um grupo controle pareado por sexo e idade. Foi realizada avaliação antropométrica, aplicação do inquérito alimentar e determinação dos níveis séricos das vitaminas A, D e E pela técnica de cromatografia líquida de alta eficiência. Foram empregados os testes de Mann-Whitney, o coeficiente de correlação de Spearman e análise de variância (ANOVA, sendo considerada diferença significativa se P<0,05. RESULTADOS: O déficit nutricional mais grave foi observado nos pacientes com atresia biliar, principalmente com colestase. Em relação às vitaminas, no grupo controle, constatou-se que os níveis séricos das vitaminas A e E variaram com a idade. Os n

  9. Utilidad de un programa de rehabilitación neuropsicológica de la memoria en daño cerebral adquirido (Usefulness of a Program of Neuropsychological Rehabilitation of Memory in Acquired Brain Damage

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    Carlos José De los Reyes-Aragón

    2013-12-01

    Full Text Available RESUMEN: Este estudio evaluó la utilidad de un programa de rehabilitación cognitiva y funcional de memoria para pacientes con daño cerebral adquirido. Diez participantes con deterioro cognitivo leve o moderado participaron en el estudio, cinco de ellos asistieron durante cuatro meses a un programa semanal de rehabilitación, mientras que los otros cinco no recibieron intervención neuropsicológica. Los resultados mostraron que el grupo de rehabilitación mejoró la puntuación en la Escala de Memoria de Wechsler III. De igual forma, se encontró que la puntuación en la escala de fallos de memoria de la vida diaria solo mejoró en el grupo que recibió rehabilitación. Los resultados sugieren que el programa de rehabilitación de la memoria resulta útil en el tratamiento de las secuelas tanto cognitivas como funcionales resultantes del daño cerebral adquirido. ABSTRACT: This study evaluated the usefulness of a cognitive and functional rehabilitation of memory program for patients with acquired brain injury. Ten participants with mild- to -moderate cognitive impairment participated in the study; five of them for four months attended a weekly rehabilitation program, while the other five did not receive any neuropsychological intervention. The results showed that the rehabilitation group improved the score in the Wechsler III Memory Scale. Similarly, it was found that the score on the memory scale of failure of the daily life only improved in the group that received rehabilitation. The results suggest that memory rehabilitation program is useful in the treatment of both cognitive and functional sequels resulting from acquired brain damage.

  10. Icatibant, an inhibitor of bradykinin receptor 2, for hereditary angioedema attacks: prospective experimental single-cohort study.

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    Campos, Regis Albuquerque; Valle, Solange Oliveira Rodrigues; França, Alfeu Tavares; Cordeiro, Elisabete; Serpa, Faradiba Sarquis; Mello, Yara Ferreira; Malheiros, Teresinha; Toledo, Eliana; Mansour, Elie; Fusaro, Gustavo; Grumach, Anete Sevciovic

    2014-01-01

    Hereditary angioedema (HAE) with C1 inhibitor deficiency manifests as recurrent episodes of edema involving the skin, upper respiratory tract and gastrointestinal tract. It can be lethal due to asphyxia. The aim here was to evaluate the response to therapy for these attacks using icatibant, an inhibitor of the bradykinin receptor, which was recently introduced into Brazil. Prospective experimental single-cohort study on the efficacy and safety of icatibant for HAE patients. Patients with a confirmed HAE diagnosis were enrolled according to symptoms and regardless of the time since onset of the attack. Icatibant was administered in accordance with the protocol that has been approved in Brazil. Symptom severity was assessed continuously and adverse events were monitored. 24 attacks in 20 HAE patients were treated (female/male 19:1; 19-55 years; median 29 years of age). The symptoms were: subcutaneous edema (22/24); abdominal pain (15/24) and upper airway obstruction (10/24). The time taken until onset of relief was: 5-10 minutes (5/24; 20.8%); 10-20 (5/24; 20.8%); 20-30 (8/24; 33.4%); 30-60 (5/24; 20.8%); and 2 hours (1/24; 4.3%). The time taken for complete resolution of symptoms ranged from 4.3 to 33.4 hours. Adverse effects were only reported at injection sites. Mild to moderate erythema and/or feelings of burning were reported by 15/24 patients, itching by 3 and no adverse effects in 6. HAE type I patients who received icatibant responded promptly; most achieved improved symptom severity within 30 minutes. Local adverse events occurred in 75% of the patients.

  11. Icatibant, an inhibitor of bradykinin receptor 2, for hereditary angioedema attacks: prospective experimental single-cohort study

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    Regis Albuquerque Campos

    Full Text Available CONTEXT AND OBJECTIVE: Hereditary angioedema (HAE with C1 inhibitor deficiency manifests as recurrent episodes of edema involving the skin, upper respiratory tract and gastrointestinal tract. It can be lethal due to asphyxia. The aim here was to evaluate the response to therapy for these attacks using icatibant, an inhibitor of the bradykinin receptor, which was recently introduced into Brazil.DESIGN AND SETTING: Prospective experimental single-cohort study on the efficacy and safety of icatibant for HAE patients.METHODS: Patients with a confirmed HAE diagnosis were enrolled according to symptoms and regardless of the time since onset of the attack. Icatibant was administered in accordance with the protocol that has been approved in Brazil. Symptom severity was assessed continuously and adverse events were monitored.RESULTS: 24 attacks in 20 HAE patients were treated (female/male 19:1; 19-55 years; median 29 years of age. The symptoms were: subcutaneous edema (22/24; abdominal pain (15/24 and upper airway obstruction (10/24. The time taken until onset of relief was: 5-10 minutes (5/24; 20.8%; 10-20 (5/24; 20.8%; 20-30 (8/24; 33.4%; 30-60 (5/24; 20.8%; and 2 hours (1/24; 4.3%. The time taken for complete resolution of symptoms ranged from 4.3 to 33.4 hours. Adverse effects were only reported at injection sites. Mild to moderate erythema and/or feelings of burning were reported by 15/24 patients, itching by 3 and no adverse effects in 6.CONCLUSION: HAE type I patients who received icatibant responded promptly; most achieved improved symptom severity within 30 minutes. Local adverse events occurred in 75% of the patients.

  12. International consensus on the diagnosis and management of pediatric patients with hereditary angioedema with C1 inhibitor deficiency.

    Science.gov (United States)

    Farkas, H; Martinez-Saguer, I; Bork, K; Bowen, T; Craig, T; Frank, M; Germenis, A E; Grumach, A S; Luczay, A; Varga, L; Zanichelli, A

    2017-02-01

    The consensus documents published to date on hereditary angioedema with C1 inhibitor deficiency (C1-INH-HAE) have focused on adult patients. Many of the previous recommendations have not been adapted to pediatric patients. We intended to produce consensus recommendations for the diagnosis and management of pediatric patients with C1-INH-HAE. During an expert panel meeting that took place during the 9th C1 Inhibitor Deficiency Workshop in Budapest, 2015 (www.haenet.hu), pediatric data were presented and discussed and a consensus was developed by voting. The symptoms of C1-INH-HAE often present in childhood. Differential diagnosis can be difficult as abdominal pain is common in pediatric C1-INH-HAE, but also commonly occurs in the general pediatric population. The early onset of symptoms may predict a more severe subsequent course of the disease. Before the age of 1 year, C1-INH levels may be lower than in adults; therefore, it is advisable to confirm the diagnosis after the age of one year. All neonates/infants with an affected C1-INH-HAE family member should be screened for C1-INH deficiency. Pediatric patients should always carry a C1-INH-HAE information card and medicine for emergency use. The regulatory approval status of the drugs for prophylaxis and for acute treatment is different in each country. Plasma-derived C1-INH, recombinant C1-INH, and ecallantide are the only agents licensed for the acute treatment of pediatric patients. Clinical trials are underway with additional drugs. It is recommended to follow up patients in an HAE comprehensive care center. The pediatric-focused international consensus for the diagnosis and management of C1-INH-HAE patients was created. © 2016 The Authors. Allergy Published by John Wiley & Sons Ltd.

  13. Exposure‐Response Model of Subcutaneous C1‐Inhibitor Concentrate to Estimate the Risk of Attacks in Patients With Hereditary Angioedema

    Science.gov (United States)

    Tortorici, Michael A.; Pawaskar, Dipti; Pragst, Ingo; Machnig, Thomas; Hutmacher, Matthew; Zuraw, Bruce; Cicardi, Marco; Craig, Timothy; Longhurst, Hilary; Sidhu, Jagdev

    2018-01-01

    Subcutaneous C1‐inhibitor (HAEGARDA, CSL Behring), is a US Food and Drug Administration (FDA)‐approved, highly concentrated formulation of a plasma‐derived C1‐esterase inhibitor (C1‐INH), which, in the phase III Clinical Studies for Optimal Management in Preventing Angioedema with Low‐Volume Subcutaneous C1‐inhibitor Replacement Therapy (COMPACT) trial, reduced the incidence of hereditary angioedema (HAE) attacks when given prophylactically. Data from the COMPACT trial were used to develop a repeated time‐to‐event model to characterize the timing and frequency of HAE attacks as a function of C1‐INH activity, and then develop an exposure–response model to assess the relationship between C1‐INH functional activity levels (C1‐INH(f)) and the risk of an attack. The C1‐INH(f) values of 33.1%, 40.3%, and 63.1% were predicted to correspond with 50%, 70%, and 90% reductions in the HAE attack risk, respectively, relative to no therapy. Based on trough C1‐INH(f) values for the 40 IU/kg (40.2%) and 60 IU/kg (48.0%) C1‐INH (SC) doses, the model predicted that 50% and 67% of the population, respectively, would see at least a 70% decrease in the risk of an attack. PMID:29316335

  14. Conocimientos previos acerca de métodos anticonceptivos y su relación con conocimientos adquiridos después de una intervención educativa con simulador

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    María Neyfeth Posada Morales

    2015-01-01

    Full Text Available Introducción. El objetivo de este trabajo es relacionar conocimientos previos (pre-saberes acerca de métodos anticonceptivos con los conocimientos adquiridos (saberes, después una intervención educativa con simulador.Método. Es un estudio realizado con 295 adolescentes escolarizados que cursan noveno, décimo y undécimo en una institución educativa pública. Es de tipo descriptivo. El proceso estuvo compuesto por tres fases; en la primera se midió conocimientos o saberes previos acerca de métodos anticonceptivos, mediante un cuestionario auto-informado; en la segunda se definió los contenidos y actividades de intervención para mejorar los conocimientos previos, y en la tercera fase de post-intervención educativa, se reevaluó los saberes adquiridos con el simulador. Resultados. Se detectó que los pre-saberes en métodos anticonceptivos son deficientes independientemente de la edad y la escolaridad, lo cual requiere planeación, desarrollo y evaluación de la estrategia de aprendizaje colectivo y cooperativo mediante talleres. En cuanto a los post-saberes, se obtuvo una calificación de deficientes a regulares, en el caso del condón masculino, mientras que el reconocimiento de métodos modernos como parche, anillo vaginal, dispositivo intrauterino, entre otros, se dio gracias al contacto directo con el simulador.Conclusiones. Se recalca que a pesar de las  diferencias de edad y escolaridad, no hubo hallazgos relevantes que demostraran diferencias de conocimiento. En los pre-saberes, se encontró niveles de conocimiento deficientes sobre métodos anticonceptivos. El uso de simuladores como herramienta de aprendizaje demostró eficacia en los talleres; en cuanto a los simuladores posibilitan la ruptura de la barrera cognitiva, dado que el adolescente, en este caso, puede explorar y adquirir conocimiento al interaccionar con el objeto de aprendizaje.

  15. Técnicas de rehabilitación neuropsicológica en daño cerebral adquirido: ayudas de memoria externas y recuperación espaciada

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    Karol Gutiérrez Ruíz

    2009-01-01

    Full Text Available Este artículo tuvo como objetivo realizar una revisión de las técnicas de recuperación espaciada y de ayudas de memoria externas, para la rehabilitación de personas con daño cerebral adquirido. Inicialmente se expusieron las alteraciones cognitivas y funcionales comunes en personas con daño cerebral y, posteriormente se describieron cada una de las técnicas, indicando en qué consiste cada una de ellas y mostrando los resultados de las investigaciones revisadas. Se determinó que la principal utilidad de las técnicas de recuperación espaciada y ayudas de memoria externas fue en el tratamiento de dificultades de memoria, aunque sólo en algunas ocasiones se evaluaron mejorías en medidas neuropsicológicas. La utilización de ayudas de memoria externas fue la técnica que en más ocasiones demostró ganancias en funcionalidad y mantenimiento a largo plazo.

  16. Development of a disease-specific quality of life questionnaire for adult patients with hereditary angioedema due to C1 inhibitor deficiency (HAE-QoL): Spanish multi-centre research project.

    Science.gov (United States)

    Prior, Nieves; Remor, Eduardo; Gómez-Traseira, Carmen; López-Serrano, Concepción; Cabañas, Rosario; Contreras, Javier; Campos, Ángel; Cardona, Victoria; Cimbollek, Stefan; González-Quevedo, Teresa; Guilarte, Mar; de Rojas, Dolores Hernández Fernández; Marcos, Carmen; Rubio, María; Tejedor-Alonso, Miguel Ángel; Caballero, Teresa

    2012-07-20

    There is a need for a disease-specific instrument for assessing health-related quality of life in adults with hereditary angioedema due to C1 inhibitor deficiency, a rare, disabling and life-threatening disease. In this paper we report the protocol for the development and validation of a specific questionnaire, with details on the results of the process of item generation, domain selection, and the expert and patient rating phase. Semi-structured interviews were completed by 45 patients with hereditary angioedema and 8 experts from 8 regions in Spain. A qualitative content analysis of the responses was carried out. Issues raised by respondents were grouped into categories. Content analysis identified 240 different responses, which were grouped into 10 conceptual domains. Sixty- four items were generated. A total of 8 experts and 16 patients assessed the items for clarity, relevance to the disease, and correct dimension assignment. The preliminary version of the specific health-related quality of life questionnaire for hereditary angioedema (HAE-QoL v 1.1) contained 44 items grouped into 9 domains. To the best of our knowledge, this is the first multi-centre research project that aims to develop a specific health-related quality of life questionnaire for adult patients with hereditary angioedema due to C1 inhibitor deficiency. A preliminary version of the specific HAE-QoL questionnaire was obtained. The qualitative analysis of interviews together with the expert and patient rating phase helped to ensure content validity. A pilot study will be performed to assess the psychometric properties of the questionnaire and to decide on the final version.

  17. Understanding Hereditary Angioedema

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    American Academy of Allergy Asthma & Immunology Menu Search Main navigation Skip to content Conditions & Treatments Allergies Asthma Primary Immunodeficiency Disease Related Conditions Drug Guide Conditions Dictionary Just ...

  18. Avaliação terapêutica e posológica da levotiroxina sódica em cães com hipotiroidismo primário adquirido

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    Viviani De Marco

    2012-10-01

    Full Text Available O hipotireoidismo primário adquirido é uma endocrinopatia frequentemente diagnosticada na espécie canina. A terapia consiste na suplementação oral com levotiroxina sódica (L-tiroxina, no entanto vários protocolos terapêuticos têm sido propostos pela literatura, com doses variando 11 a 44µg/kg uma a duas vezes ao dia, visto à grande variabilidade de absorção e meia-vida plasmática do fármaco. Foram estudados 30 cães com hipotiroidismo primário adquirido (13 machos e 17 fêmeas, idade média de 7,9±1,9 anos e peso médio de 19,1±12,6 kg atendidos no Hospital Veterinário da Universidade Guarulhos (UnG e no Serviço de Endocrinologia de duas clínicas particulares da cidade de São Paulo (2009-2011, com o objetivo de avaliar a posologia e a frequência de administração da L-tiroxina, mais frequentemente utilizada, capaz de garantir um controle terapêutico satisfatório, avaliado através dos sinais clínicos e do teste pós-tiroxina, além de correlacionar a dose de tiroxina empregada com o peso dos animais. A dose média de tiroxina utilizada em nossa casuística foi de 16,9±3,1µg/kg, sendo a frequência de administração a cada 12 horas em 50% dos casos. Para se investigar uma possível correlação entre o peso e a dosagem de tiroxina utilizada, uma vez que cães de pequeno porte apresentam maior taxa metabólica que cães de grande porte, os animais foram agrupados em grupo A, cães com peso 10 kg (n=18/30, 26,8±10,7 kg. A dose média de tiroxina empregada nos grupos A e B não apresentaram diferença estatística e foram, respectivamente, 16±3µg/kg e 17±3µg/kg. A frequência de administração foi 50% a cada 24 horas e 50% a cada 12 horas para ambos os grupos. Dessa forma, a dose de tiroxina não parece se correlacionar com o peso do animal, sendo imprevisível quem deverá receber dose e frequência máxima da medicação. O protocolo deve ser individualizado e o paciente devidamente monitorado.

  19. Análises químicas e organolépticas de vinhos de mesa brancos e tintos adquiridos no comércio Characteristics of Brazilian white and red wines

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    Odette Zardetto de Toledo

    1963-01-01

    Full Text Available São apresentados os resultados organolépticos e analíticos de 15 amostras de vinhos de mesa brancos e 15 de tintos, adquiridos no comércio de Campinas, em 1960. Foram encontradas poucas amostras com características inteiramente satisfatórias, notando-se, principalmente, deficiências de clarificação e de filtração. Das 15 marcas de vinhos brancos, só três se apresentaram perfeitamente brilhantes, e sete, ligeira ou completamente turvos. Nos tintos, em geral, foi maior a turbidez. Verificou-se, também, a presença, entre os brancos, de vinhos com acidez volátil acima do limite permitido pela legislação brasileira. Foi notada a ausência de anidrido sulfuroso total e livre. Os resultados dos outros componentes mostraram-se, todavia, bastante satisfatórios. Foram ainda observados o comprimento insuficiente das rôlhas para garantir a boa conservação do vinho, e a desuniformidade das garrafas quanto a tipo, forma, capacidade e côr.Fifteen hrands of white and 15 of red wines were collected from groceries for analysis and flavor tests. Very few samples were satisfactory. Most of the wines had been poorly clarified and filtered. Only three of the 15 samples of white wines were brilliant; seven were classified as slightly cloudy or cloudy. Cloudiness was higher among the red wines. Two samples of the white wines had a high volatile acidity, above the limit permitted by the Brazilian regulation. Lack af free and total sulfur dioxide was observed. As far as the other wines constituents are concerned, all analysed samples were satisfactory. The corks utilized were generally shorter than it is desirable to seal the bottles satisfactorily. Also, the bottles were not uniform in type, shape, capacity, and color.

  20. Development and content validity testing of a patient-reported outcomes questionnaire for the assessment of hereditary angioedema in observational studies.

    Science.gov (United States)

    Bonner, Nicola; Abetz-Webb, Linda; Renault, Lydie; Caballero, Teresa; Longhurst, Hilary; Maurer, Marcus; Christiansen, Sandra; Zuraw, Bruce

    2015-07-01

    Hereditary Angioedema (HAE), a rare genetic disease, manifests as intermittent, painful attacks of angioedema. Attacks vary in frequency and severity and include skin, abdominal and life-threatening laryngeal swellings. This study aimed to develop a patient reported outcome (PRO) tool for the assessment of HAE attacks, including their management and impact on patients' lives, for use in clinical studies, or by physicians in general practice. The results of open-ended face to face concept elicitation interviews with HAE patients in Argentina (n = 10) and the US (n = 33) were used to develop the first draft questionnaire of the HAE patient reported outcomes questionnaire (HAE PRO). Subsequently, in-depth cognitive debriefing interviews were performed with HAE patients in the UK (n = 10), Brazil (n = 10), Germany (n = 11) and France (n = 12). Following input from eight multinational clinical experts further cognitive interviews were conducted in the US (n = 12) and Germany (n = 12). Patients who experienced abdominal, cutaneous or laryngeal attacks of varying severity levels were included in all rounds of interviews. Across the rounds of interviews patients discussed their HAE attack symptoms, impacts and treatments. Cognitive debriefing interviews explored patient understanding and relevance of questionnaire items. All interviews were conducted face to face following a pre-defined semi-structured interview guide in the patient's native language. Patients reported a variety of HAE symptoms, attack triggers, warning signs, attack impacts and treatment options which were used to develop the HAE PRO. The HAE PRO was revised and refined following input from patients and clinical experts. The final 18-item HAE PRO provides an assessment of the HAE attack experience including symptoms, impacts, treatment requirements, healthcare resource use and loss of productivity caused by HAE attacks. Patient and expert input has contributed to the

  1. Factores de riesgo para el desarrollo de infección de vías urinarias por microorganismos productores de betalactamasas de espectro extendido adquiridos en la comunidad, en dos hospitales de Bogotá D.C., Colombia

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    Mariana Pineda-Posada

    Full Text Available Abstract Objetivo: Determinar factores de riesgo para infección urinaria por microorganismos productores de betalactamasas de espectro extendido (BLEE adquirida en la comunidad en pacientes adultos. Material y método: Estudio de casos y controles, en el período comprendido entre enero de 2012 a mayo de 2015, en dos hospitales de Bogotá D.C., Colombia. Pareo por edad, año del aislamiento, microorganismo y género. Se excluyeron pacientes con antecedente de infección por un microorganismo productor de BLEE en el último mes e infección urinaria asociada al cuidado de la salud. Resultados: Se analizaron 555 pacientes: 185 casos y 370 controles. 462 pacientes (83,2% de la Fundación Clínica Shaio y 93 (16,8% del Hospital Santa Clara. Factores de riesgo identificados: Infección urinaria recurrente (OR 2,13 con IC de 1,48 a 3,07, enfermedad renal crónica (OR 1,56, IC del 95% de 1,07 a 2,27, uso previo de antibióticos (OR 3,46, IC del 95% de 2,48 a 5,35, hospitalización reciente (OR 3,0, IC del 95% de 1,96 a 2,45, diabetes mellitus (OR 1,61 con IC del 95% de 1,06 a 2,45 e infección urinaria alta (OR 2,64 con IC del 95% de 1,61 a 4,32. Conclusiones: Los factores de riesgo para microorganismos productores de BLEE adquiridos en la comunidad fueron en orden de frecuencia: antecedente de antibioticoterapia reciente, hospitalización previa, presencia de infección urinaria alta, así como los antecedentes de infección urinaria recurrente, enfermedad renal crónica y diabetes mellitus, lo que concuerda con los principales hallazgos descritos en la literatura mundial.

  2. Hipotireoidismo adquirido tratado como obesidade exógena: a importância do controle do crescimento Acquired hypothyroidism treated as exogen obesity: the importance of growth follow-up

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    Mariana Porto Zambon

    2009-03-01

    Full Text Available OBJETIVO: Demonstrar a importância da interpretação do acompanhamento pôndero-estatural de crianças e adolescentes obesos DESCRIÇÃO DO CASO: Menina de 12 anos e 11 meses encaminhada a um ambulatório terciário para acompanhamento de obesidade e dislipidemia. Referia ganho de peso a partir de oito anos, negava fazer atividade física e possuía alimentação adequada. Relatava obesidade na família do pai. Ao exame, bom estado geral, diminuição da pilificação e mixedema generalizados, pele ressecada e áspera. Peso com percentil entre 90 e 97, índice de massa corpórea (IMC acima do percentil 97 e estatura abaixo do canal de crescimento. EXAMES LABORATORIAIS: T4: 0,04ng/ dL, TSH: >100uUI/mL, colesterol total: 326mg/ dL, HDL colesterol: 34mg/ dL, LDL colesterol: 45mg/ dL, triglicérides: 1599mg/ dL, glicemia em jejum: 81mg/dL e hemograma com discreta anemia normocrômica e normocítica. Fez-se o diagnóstico de hipotireoidismo e introduziu-se hormônio tireoidiano com boa resposta. A paciente trouxe 23 medidas prévias de peso e estatura, mostrando comprometimento de estatura e aumento de peso não valorizado. COMENTÁRIOS: A análise dos gráficos de crescimento é fundamental para o acompanhamento de todas as crianças e adolescentes, principalmente aquelas com sobrepeso e obesidade. A desaceleração da curva de crescimento em altura sugere doença associada; neste caso, o hipotireoidismo adquirido.OBJECTIVE: To show the value of using the follow-up growth charts in clinical evaluation of obese children and adolescents. CASE DESCRIPTION: A 12 years and 11 months-old girl referred to a tertiary out-patient clinic to evaluate obesity and lipid abnormalities. She had weight gain since eight years old, had no physical activity and followed adequate eating habits. Obesity was referred in father's family. In physical examination, she looked well, with lack of body hair, generalized mixedema, dry and rough skin. Weight was between

  3. Effectiveness of icatibant for treatment of hereditary angioedema attacks is not affected by body weight: findings from the Icatibant Outcome Survey, a cohort observational study.

    Science.gov (United States)

    Caballero, Teresa; Zanichelli, Andrea; Aberer, Werner; Maurer, Marcus; Longhurst, Hilary J; Bouillet, Laurence; Andresen, Irmgard

    2018-01-01

    Icatibant is a bradykinin B2-receptor antagonist used for the treatment of hereditary angioedema attacks resulting from C1-inhibitor deficiency. Treatment is not adjusted by body weight however the impact of body mass index (BMI) on the effectiveness of icatibant is not documented in the literature. We examined disease characteristics and icatibant treatment effectiveness in patients stratified by BMI in the Icatibant Outcome Survey, an ongoing, international, observational study monitoring the real-world safety and effectiveness of icatibant. Attack and treatment characteristics as well as outcomes following treatment with icatibant were compared among patients with underweight, normal, overweight, and obese BMI. Data from 2697 icatibant-treated attacks in 342 patients (3.5, 44.7, 34.8, and 17.0% patients of underweight, normal, overweight, and obese BMI, respectively) were analyzed. There was no significant difference in the frequency and severity of attacks across BMI groups, although obese patients tended to have more attacks of high severity. There was no impact of BMI on the frequency of laryngeal attacks, but patients with normal BMI had fewer cutaneous attacks and more abdominal attacks. Most attacks (71.9-83.8%) were treated with a single icatibant injection without the need for rescue with plasma-derived C1-inhibitor (pdC1-INH), regardless of BMI. Patients with obese BMI used pdC1-INH as rescue treatment more often (P < 0.0001; P = 0.0232 excluding 2 outliers) and treated attacks earlier than patients with normal BMI (P = 0.007). Furthermore, time to resolution and duration of attack were shorter for patients with high BMI (P < 0.001 for overweight and P < 0.05 for obese versus normal). Overall, icatibant was comparatively effective in treating attacks in patients across all BMI groups. Trial registration NCT01034969.

  4. Availability of and access to orphan drugs: an international comparison of pharmaceutical treatments for pulmonary arterial hypertension, Fabry disease, hereditary angioedema and chronic myeloid leukaemia.

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    Blankart, Carl Rudolf; Stargardt, Tom; Schreyögg, Jonas

    2011-01-01

    Market authorization does not guarantee patient access to any given drug. This is particularly true for costly orphan drugs because access depends primarily on co-payments, reimbursement policies and prices. The objective of this article is to identify differences in the availability of orphan drugs and in patient access to them in 11 pharmaceutical markets: Australia, Canada, England, France, Germany, Hungary, the Netherlands, Poland, Slovakia, Switzerland and the US. Four rare diseases were selected for analysis: pulmonary arterial hypertension (PAH), Fabry disease (FD), hereditary angioedema (HAE) and chronic myeloid leukaemia (CML). Indicators for availability were defined as (i) the indications for which orphan drugs had been authorized in the treatment of these diseases; (ii) the application date; and (iii) the date upon which these drugs received market authorization in each country. Indicators of patient access were defined as (i) the outcomes of technology appraisals; (ii) the extent of coverage provided by healthcare payers; and (iii) the price of the drugs in each country. For PAH we analysed bosentan, iloprost, sildenafil, treprostinil (intravenous and inhaled) as well as sitaxentan and ambrisentan; for FD we analysed agalsidase alfa and agalsidase beta; for HAE we analysed icatibant, ecallantide and two complement C1s inhibitors; for CML we analysed imatinib, dasatinib and nilotinib. Most drugs included in this study had received market authorization in all countries, but the range of indications for which they had been authorized differed by country. The broadest range of indications was found in Australia, and the largest variations in indications were found for PAH drugs. Authorization process speed (the time between application and market authorization) was fastest in the US, with an average of 362 days, followed by the EU (394 days). The highest prices for the included drugs were found in Germany and the US, and the lowest in Canada, Australia and

  5. Socioeconomic burden of hereditary angioedema

    DEFF Research Database (Denmark)

    Aygören-Pürsün, Emel; Bygum, Anette; Beusterien, Kathleen

    2014-01-01

    who were working or in school (n = 120), 72 provided work/school absenteeism data, resulting in an estimated 20 days missing from work/school on average per year; 51% (n = 84) indicated that HAE has hindered their career/educational advancement. CONCLUSION: HAE poses a considerable burden on patients...... and their families in terms of direct medical costs and indirect costs related to lost productivity. This burden is substantial at the time of attacks and in between attacks....

  6. Avaliação clínica, endoscópica e manométrica da deglutição em pacientes com miastenia grave autoimune adquirida Clinical, endoscopical and manometric evaluation of swallowing in patients with myasthenia gravis

    Directory of Open Access Journals (Sweden)

    Adriana Leico Oda

    2002-12-01

    Full Text Available Apresentamos 22 pacientes com diagnóstico de miastenia grave autoimune adquirida (MGAA, com queixa de disfagia orofaríngea, avaliados pela análise fonoaudiológica, nasofibrolaringoscópica e manométrica de esfíncter esofágico superior, com o objetivo de avaliar as fases do processo de deglutição e os aspectos anatômicos e funcionais do sistema estomatognático. A idade dos pacientes variou de 19 a 74 anos; 19 (86,4% eram do sexo feminino e 3 (13,6% do masculino. Os principais achados foram: (1 correlação entre avaliação fonoaudiológica e nasofibrolaringoscópica; (2 alterações do sistema estomatognático, em 100% dos casos; (3 desordens da mastigação / deglutição presentes em 100% dos pacientes, à avaliação fonoaudiológica e em 81,8%, à nasofibrolaringoscópica; (4 associação entre penetração/aspiração e episódios de pneumonia; (5 comprometimento muscular do sistema estomatognático, acúmulo de resíduos, escape precoce do bolo para a faringe e episódios de penetração/aspiração apresentaram correlação nítida com diminuição da contração faríngea. Estes achados justificam a necessidade de avaliar as fases do processo de deglutição em pacientes com MGAA, com o objetivo de propiciar uma orientação adequada e prevenir episódios de pneumonia aspirativa, desnutrição e desidratação, devido à administração inadequada de alimentação via oral.Dysphagia, or difficulty swallowing, is a common problem following myasthenia gravis (MG and may lead to aspiration of saliva, food or liquids. We herein present 22 MG patients, with complaint of dysphagia, evaluated by phonoaudiological evaluation, nasofibrolaryngoscopical analysis and manometry of upper esophageal sphincter. The main objective was to evaluate the phases of the swallowing process and anatomical and functional aspects of oropharyngeal musculature. The age of patients varied from 19 to 74 years; being 19 female and 3 male. The main data were

  7. Diagnóstico laboratorial da anemia hemolítica auto-imune: características do teste manual direto do PolybreneÒ Laboratory diagnosis of auto-immune hemolytic anemia: characteristics of the manual direct test of PolybreneTM

    Directory of Open Access Journals (Sweden)

    G.W. Braga

    1998-03-01

    Full Text Available O teste manual direto do PolybreneÒ (TDP e o teste de Coombs direto (TCD foram utilizados para a detecção de IgG na superfície de hemácias de pacientes com diagnóstico clínico e laboratorial de anemia hemolítica auto-imune (AHAI. OBJETIVO: Comparar a sensibilidade e especificidade do TPD e do TCD no diagnóstico da AHAI. MÉTODO: Foram estudados 18 pacientes com diagnóstico clínico-laboratorial de AHAI. Como indivíduos controles, foram testados 20 doadores de sangue assintomáticos e 20 pacientes com anemia falciforme. RESULTADOS: O TCD foi positivo em 14 pacientes e negativo em quatro indivíduos, enquanto o TDP foi positivo em 17 pacientes e negativo em um indivíduo que apresentava TCD positivo devido a fixação de complemento (C3d nas hemácias. Todos os eluatos positivos realizados com a técnica de diclorometano revelaram anticorpos quentes com especificidade "anti-Rh". A sensibilidade do TDP (94% para detectar fixação de IgG in vivo foi significantemente maior (pThe direct manual PolybreneTM test (DPT and the direct antiglobulin tests (DAT were employed to detect antibody sensitizing red blood cell (RCB in patients with clinical and laboratorial findings of autoimmune hemolytic anemia (AIHA. PURPOSE: To compare the sensitivity and specificity of DPT and DAT in the diagnosis of AIHA. METHODS: Eighteen consecutive patients with diagnosis of AIHA were evaluated. The control group consisted of 20 normal volunteers blood donors and 20 patients with sickle cell anemia. All patients and controls were submitted to DPT and DAT. All DAT positive samples were further tested using monospecific reagents ( anti-IgG heavy chain and anti-C3d. Positive samples for either DPT or DAT were evaluated by eluate technique using. The dichloromethane (DCM. RESULTS: The DAT was positive in 14 patients and negative in 4 subjects, while the DPT was positive in 17 patients and negative in 1 individual who had a positive DAT owing to complement (C3d. All

  8. Aproximación a las unidades con significado en el campo de la informática adquirido por extensión metafórica en los diccionarios generales de inglés y español

    Directory of Open Access Journals (Sweden)

    María Teresa Ortego Antón

    2015-07-01

    Full Text Available En las últimas décadas la revolución científico-tecnológica ha dado lugar a la aparición de nuevos conceptos y, por ende, de infinidad de denominaciones. El conocimiento experto suele producirse en inglés, si bien surge la necesidad de traducirlo a otras lenguas como el español. Durante el transvase interlingüístico, las unidades con significados adquiridos por extensión metafórica pueden convertirse en un obstáculo para los usuarios, que acuden a los diccionarios generales bilingües en busca de soluciones, a pesar de que ésta no es la única herramienta ni la más aconsejable. En consecuencia, en el presente trabajo nos centramos en el estudio de dichas unidades en el campo de la informática, con el objetivo de obtener una aproximación del tratamiento que de dichos significados se ofrece en dos diccionarios generales bilingües de inglés y de español. De los resultados que se desprendan esperamos obtener datos relevantes que incidan en una implementación de la información recogida en las obras de referencia.

  9. A case of familial transmission of community-acquired methicillin-resistant Staphylococcus aureus carrying the lnu(A gene in Santa Fe city, Argentina Caso de transmisión familiar de Staphylococcus aureus resistente a la meticilina adquirido en la comunidad portador del gen lnu(A en la ciudad de Santa Fe, Argentina

    Directory of Open Access Journals (Sweden)

    Emilce de los A Méndez

    2012-12-01

    Full Text Available Community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA is increasingly recognized as an important pathogen causing skin and soft tissue infections as well as necrotizing pneumonia. We describe a case of familial transmission of CA-MRSA between a 6-month-old boy and his mother in Santa Fe City, Argentina. Both isolates showed an identical antimicrobial susceptibility profile, carried type IV SCCmec and harboured the pvl and the lnu(A genes. Isolates showed indistinguishable SmaI-PFGE patterns confirming their genetic relationship. These results corroborate the intrafamilial transmission of CA-MRSA and might associate this strain with the repetitive events of furunculosis within the family.Staphylococcus aureus resistente a la meticilina adquirido en la comunidad (SARM-AC es reconocido como un patógeno importante que causa infecciones de piel y partes blandas y neumonía necrotizante. Describimos un caso de transmisión familiar de SARM-AC entre un nino de 6 meses de edad y su madre en la ciudad de Santa Fe, Argentina. Ambos aislamientos mostraron idéntico perfil de sensibilidad a los antimicrobianos, tenían el SCCmec tipo IV, y contenían los genes pvl y lnu(A. Los aislamientos presentaron patrones de SmaI-PFGE indistinguibles entre sí, lo cual confirmó su relación genética. Estos resultados corroboran la transmisión intrafamiliar de SARM-AC; asimismo, este aislamiento podría asociarse con los eventos repetitivos de furunculosis en la familia.

  10. Staphylococcus aureus meticilino resistente adquirido na comunidade: um problema mundial

    Directory of Open Access Journals (Sweden)

    Síntia de Souza Evangelista

    2015-02-01

    Full Text Available Objetivo: descrever a epidemiologia dos casos de CA-MRSA no Brasil de forma a compreender sua ocorrência, fatores de risco associados e formas de manejo em relação à situação mundial. Método: revisão integrativa e para seleção dos estudos utilizou-se as bases de dados: Scopus, Science direct, Isi Web of Knowledge, PUBMED e BVS. Resultados: foram identificados dez artigos nacionais que descreveram 21 casos de CA-MRSA principalmente em crianças, adolescentes e adultos com quadro de infecção de pele e tecidos moles evoluindo para infecções graves relacionados ao clone Oceania Southwest Pacific Clone (OSPC que resultaram em hospitalização. Conclusão: apesar do CA-MRSA ser considerado um micro-organismo de relevância mundial verificou-se a escassez de dados publicados sobre sua epidemiologia no Brasil, o que dificultam o delineamento da realidade do país frente ao CA-MRSA.

  11. Trabajo social sanitario y daño cerebral adquirido

    OpenAIRE

    Ruiz-Prados Víbora, Lucía

    2014-01-01

    La figura del profesional del trabajo social sanitario, ocupa un puesto rezagado en la sociedad, cuyo desconocimiento ocasiona la pérdida de sus conocimientos aplicados a su trabajo. Este trabajo fundamenta, la razón de su utilidad e importancia. Por un lado, centrándose más específicamente en el ámbito de la sanidad, resaltando la figura del/la profesional en cuanto a la continuidad de cuidados ante el alta hospitalaria y, posteriormente, haciendo hincapié en todo lo que respe...

  12. Prevalence of serological markers for celiac disease (IgA and IgG class antigliadin antibodies and IgA class antiendomysium antibodies in patients with autoimmune rheumatologic diseases in Belo Horizonte, MG, Brazil Pesquisa de anticorpos antigliadina (classes IgA e IgG e anticorpos antiendomísio classe IgA, em pacientes com doenças reumatológicas autoimunes em Belo Horizonte, Brasil

    Directory of Open Access Journals (Sweden)

    Victor de Barros Koehne

    2010-09-01

    to AGA IgA optical density readings or AGA IgG readings. These drugs were associated with fewer positive EmA tests. CONCLUSIONS: Positive AGAA, AGAG or EmA results are probably nonspecific for the presence of celiac disease among autoimmune rheumatologic disease patients. The intake of prednisone and immunosuprressant drugs seems to reduce the prevalence of IgA EmA, but it does not interfere with antigliadin antibodies tests.Further studies are required to estimate more accurately the prevalence of this disease in rheumatologic patients.CONTEXTO: Tanto os pacientes com doenças reumatológicas autoimunes quanto os com doença celíaca costumam apresentar vários tipos de autoanticorpos, muitos deles ainda sem papel definido na etiopatogênese dessas afecções. Apesar de tratar-se de assunto controverso, é bastante citada na literatura a maior prevalência da doença celíaca em diversos grupos de pacientes reumatológicos. OBJETIVO: Investigar a prevalência de marcadores sorológicos positivos para doença celíaca: anticorpos antigliadina (AGA classes IgA e IgG (AGAA e AGAG e anticorpos antiendomísio classe IgA (EmA, em pacientes com doenças reumatológicas autoimunes. Procurou-se também avaliar a correlação entre a positividade dos testes sorológicos com o uso de prednisona e de medicamentos imunossupressores. MÉTODOS: Foram avaliados 190 pacientes adultos e pediátricos com doenças reumatólogicas variadas (lúpus eritematoso sistêmico, artrite reumatóide, artrite reumatóide juvenil e espondiloartropatias. Em todos foram realizadas pesquisas de AGAA e AGAG e de EmA, encaminhando-se os casos positivos para biopsias endoscópica duodenal e estudos histológicos. RESULTADOS: Houve quatro soros positivos (2,1% para AGAA, todos com resultados negativos para AGAG e EmA. Três soros (1,6% tiveram resultados positivos para AGAG, todos com resultados negativos para AGAA e EmA. Na pesquisa de EmA, a diluição do soro em 1:2,5 mostrou resultados positivos em

  13. O papel do Fator de Necrose Tumoral Alfa (TNF-alfa no processo de erosão óssea presente no colesteatoma adquirido da orelha média The role of Tumor Necrosis Factor -Alpha (TNF- alpha in bone resorption present in middle ear cholesteatoma

    Directory of Open Access Journals (Sweden)

    Rodrigo Faller Vitale

    2007-02-01

    Full Text Available O colesteatoma adquirido da orelha média causa erosão óssea, com altas taxas de morbidade e mortalidade. O TNF-alfa (TNF-alfa lambda uma das principais citocinas envolvidas neste processo. OBJETIVO: Avaliar o papel do TNF-alfa na reabsorsão óssea e a ação dele no colesteatoma. MATERIAL E MÉTODOS: Foi realizado um levantamento e uma revisão crítica da literatura. RESULTADOS: Todos os autores estudados concordam com a importância do TNF-alfa no processo de reabsorção óssea presente no colesteatoma e com o grau de destruição observado. Diferentes trabalhos demonstraram que o TNF-alfa é capaz de provocar erosão óssea, através de diferentes vias de ação. Ele pode estimular a diferenciação e a maturação dos osteoclastos ou, ainda, agir na matriz óssea expondo-a à ação dos osteoclastos. Existe a possibilidade de inibir a ação do TNF-alfa, diminuindo seus efeitos e prevenindo a perda óssea em doenças como a artrite reumatóide. Não existe, entretanto, trabalhos específicos em colesteatoma. Não existe consenso sobre a sua localização. Estas diferenças, provavelmente, ocorrem devido à distribuição dos receptores. CONCLUSÃO: O TNF-alfa, presente no colesteatoma promove a reabsorsão óssea, juntamente com outras citocinas (RANKL e IL-1, estando relacionado com a presença de complicações.Cholesteatoma may cause bone erosion, with high morbidity and mortality rates. Tumor Necrosis Factor -Alpha (TNF-a is one of the main cytokines involved in this process. Our goal was to evaluate the role of TNF-a in Bone Resorption and its effect on cholesteatoma. MATERIAL AND METHODS: analysis and critical literature review. RESULTS: Different studies have demonstrated that TNF-a is capable of causing bone erosion. It may stimulate the differentiation and maturation of osteoclasts or it may act on the bone matrix, exposing it to the action of the osteoclasts. It is possible to inhibit TNF-a, reducing its effects and prevent

  14. Imunoexpressão da citoqueratina 16 e do antígeno nuclear Ki-67 no colesteatoma adquirido da orelha média Expression patterns of cytokeratin 16 and the nuclear antigen Ki-67 in acquired middle ear cholesteatoma

    Directory of Open Access Journals (Sweden)

    Celina S. B. Pereira

    2002-08-01

    Full Text Available Introdução: Ocolesteatoma da orelha média é caracterizado pela presença de epitélio escamoso estratificado queratinizado nesta cavidade, causando destruição óssea e podendo levar a complicações. Algumas substâncias como a citoqueratina 16 e o Ki-67, marcadores de proliferação celular, vêm sendo utilizadas para estudar essa doença. A CK 16 é um filamento protéico, situado no citoplasma das células epiteliais, característico de epitélios hiperproliferativos. O Ki-67 é um antígeno nuclear que aparece nas células em estágio de proliferação. Objetivo: O objetivo deste trabalho foi estudar a imunoexpressão da CK 16 e do Ki-67 no colesteatoma adquirido. Forma de estudo: Clínico prospectivo. Material e Método: Foram colhidas amostras de colesteatoma de 31 pacientes submetidos à cirurgia otológica, sendo 20 adultos e 11 crianças, no período de 1998 e 2000. Essas amostras foram submetidas à análise histológica e imuno-histoquímica para estudo da expressão da CK 16 e do Ki-67 na matriz do colesteatoma. Resultado: A análise dos resultados mostrou a presença da CK 16 nas camadas suprabasais da matriz do colesteatoma e, do Ki-67, na camada basal, estendendo-se para as camadas suprabasais e, inclusive, para a camada apical da matriz. A reação aos anticorpos anti-CK 16 e Ki-67 foi heterogênea. A correlação entre a CK 16 e o Ki-67 suprabasal com variáveis morfológicas, como acantose do epitélio e hiperplasia da camada basal formando cones epiteliais em direção à perimatriz, foi positiva e significativa. Também houve relação positiva e significativa entre a CK 16 e o Ki-67 suprabasal e apical. Conclusão: Esses resultados permitem concluir que o colesteatoma tem características hiperproliferativas, expressando a CK 16 e o Ki-67 na sua matriz.Introduction: Cholesteatomas of the middle ear are characterized by the presence of stratified squamous epithelium in this cavity presenting with highly invasive

  15. Photos & Graphics: Urticaria (Hives) and Angioedema

    Science.gov (United States)

    ... Conditions Drug Guide Conditions Dictionary Just for Kids Library School Tools Videos Virtual Allergist Education & Training Careers in ... Support the AAAAI Foundation Donate Utility navigation Español Journals Annual Meeting Member Login / My Membership Search navigation ...

  16. Burden of Illness in Hereditary Angioedema

    DEFF Research Database (Denmark)

    Bygum, Anette; Aygören-Pürsün, Emel; Beusterien, Kathleen

    2015-01-01

    of HAE on health-related quality of life (HRQoL): (i) unnecessary treatments and procedures, (ii) symptom triggers, (iii) attack impacts, (iv) caregiver impacts, and (v) long-term impacts. Patients for example experienced unnecessary medical procedures due to diagnostic delays, anxiety and fear about...... attacks, and passing HAE to children, reduced work/school productivity, and limited career/educational achievement. Patient caregivers also experienced worry and work/activity interruption during the attacks. In conclusion, a conceptual model was developed illustrating the hypothesized relationships among...

  17. The humanistic burden of hereditary angioedema

    DEFF Research Database (Denmark)

    Caballero, Teresa; Aygören-Pürsün, Emel; Bygum, Anette

    2014-01-01

    and impact of HAE types I and II from the patient perspective. The HAE Burden of Illness Study in Europe was conducted in Spain, Germany, and Denmark to assess the real-world experience of HAE from the patient perspective via a one-time survey, which included items on clinical characteristics and physical......, traveling, and passing HAE to their children. Based on Hospital Anxiety and Depression Scale scores, 38 and 14% had clinically meaningful anxiety and depression, respectively. Despite standard of care, HAE patients still have frequent and painful attacks. Patients experience substantial impairment...

  18. Effects of Intermittent Fasting on Experimental Autoimune Encephalomyelitis in C57BL/6 Mice.

    Science.gov (United States)

    Razeghi Jahromi, Soodeh; Ghaemi, Amir; Alizadeh, Akram; Sabetghadam, Fatemeh; Moradi Tabriz, Hedieh; Togha, Mansoureh

    2016-06-01

    Several religions recommend periods of fasting. One of the most frequently asked questions of MS patients before the holy month of Ramadan is weather fasting might have an unfavorable effect on their disease course. This debate became more challenging after the publication of experimental studies suggesting that calorie restriction prior to disease induction attenuates disease severity. We conducted this study to assess early and late effects of fasting on the animal model of MS, known as autoimmune encephalomyelitis. EAE was induced in the C57BL/6 mice, using Myelin Oligodendrocyte Glycopeptide  (MOG) 35-55 and they fasted every other day either after the appearance of the first clinical sign or 30 days after disease induction for ten days. Thereafter, the mice were sacrificed for further histological and immunological evaluations. Intermittent fasting after the establishment of EAE did not have any unfavorable effect on the course of disease. Moreover, fasting at the early phase of disease alleviated EAE severity by ameliorating spinal cord demyelination. Fasting suppressed the secretion of IFN-γ, TNF-α and raised IL-10 production in splenocytes. Fasting was also associated with a lower percent of cytotoxicity. Intermittent fasting not only had no unfavorable effect on EAE but also reduced EAE severity if started at early phase of disease.

  19. Reconstrução da parede torácica nos defeitos adquiridos

    Directory of Open Access Journals (Sweden)

    Marcus Vinicius H. de Carvalho

    Full Text Available Acquired chest wall defects present a challenging problem for thoracic surgeons. Many of such defects can be repaired with the use of local and regional musculocutaneous flaps, but larger defects compromising skeletal structure require increasingly sophisticated reconstructive techniques. The following discussion will review the options for repair acquired chest wall defects based in literature. The authors searched the Pubmed (www.pubmed.com and found citations from January 1996 to February 2008. By reading the titles and the abstracts most of the citations were discharged because they focused in congenital chest wall defects or were cases report. However, many papers were found describing the outcome of large series of patients with acquired chest wall deformities. A review of recent literature shows that the repair of chest wall defects with soft tissues, if possible, remains the treatment of choice. Large chest wall defects require skeletal reconstruction to prevent paradoxical respiration. The selection of the most appropriate flap is primary dictated by the location and the size of the defect. It is important to transfer tissue with good vitality, so understanding the vascular supply is imperative. Autogenous grafts have been used in the past for skeletal reconstruction but a combination of synthetic materials with musculocutaneous flaps has been used lately. Based in the literature, the use of prosthetic material in chest wall reconstruction does not significantly increases the risk of wound infection.

  20. Factores determinantes del nivel de compromiso medioambiental voluntario adquirido por los hoteles cotizados europeos

    OpenAIRE

    Patricia Milanés Montero; Esteban Pérez Calderón; Francisco Javier Ortega Rossell

    2012-01-01

    Ante las importantes presiones que la actividad hotelera ejerce sobre el medioambiente, la ausencia de regulación de las actuaciones responsables y la escasez de investigaciones al respecto aparece la imperiosa necesidad de aportar luz en este sentido. Por ello, en este trabajo se analiza el compromiso medioambiental corporativo de los hoteles cotizados europeos; se utiliza como metodología el análisis de contenidos y se detectan los factores determinantes de las actuaciones responsables con ...

  1. Factores determinantes del nivel de compromiso medioambiental voluntario adquirido por los hoteles cotizados europeos

    Directory of Open Access Journals (Sweden)

    Patricia Milanés Montero

    2012-01-01

    Full Text Available Ante las importantes presiones que la actividad hotelera ejerce sobre el medioambiente, la ausencia de regulación de las actuaciones responsables y la escasez de investigaciones al respecto aparece la imperiosa necesidad de aportar luz en este sentido. Por ello, en este trabajo se analiza el compromiso medioambiental corporativo de los hoteles cotizados europeos; se utiliza como metodología el análisis de contenidos y se detectan los factores determinantes de las actuaciones responsables con el medioambiente con el propósito de contribuir a la construcción de un marco de referencia objetivo de medida de los avances en sostenibilidad de la actividad turística. Además, se contribuye al "argumento comercial" analizando la relación existente entre la rentabilidad empresarial y el desempeño medioambiental. Los resultados muestran que la mayoría de los hoteles analizados carece de política de protección medioambiental; asimismo, el tamaño, la normativa contable adoptada y la pertenencia a grupos son factores determinantes de la adopción de una postura más o menos responsable. Por otro lado, la rentabilidad empresarial resulta ser una de las ventajas de la integración de las cuestiones medioambientales en la estrategia corporativa de las empresas.

  2. Safety and Usage of C1-Inhibitor in Hereditary Angioedema

    DEFF Research Database (Denmark)

    Riedl, Marc A; Bygum, Anette; Lumry, William

    2016-01-01

    , international patient registry documented widespread implementation of pnfC1-INH self-administration outside of a health care setting consistent with current HAE guidelines. These real-world data revealed pnfC1-INH usage for a variety of reasons in patients with HAE and showed a high level of safety regardless...... of this study was to describe safety and usage patterns of pnfC1-INH. METHODS: A multicenter, observational, registry was conducted between 2010 and 2014 at 30 United States and 7 European sites to obtain both prospective (occurring after enrollment) and retrospective (occurring before enrollment) safety...... and usage data on subjects receiving pnfC1-INH for any reason. RESULTS: Of 343 enrolled patients, 318 received 1 or more doses of pnfC1-INH for HAE attacks (11,848 infusions) or for prophylaxis (3142 infusions), comprising the safety population. Median dosages per infusion were 10.8 IU/kg (attack treatment...

  3. Urticaria and Angioedema – More than just Skin Deep!

    African Journals Online (AJOL)

    approach, and then touch on current guidelines and recent developments ... as is evident in the family name of the Urticaceae stinging .... patients respond to treatment.1,2 A single cause is seldom found .... desloratidine, fexofenadine or rupatidine, as first line therapy.16 ... Cancer Risk in Patients with Chronic Urticaria: A.

  4. The Humanistic, Societal, and Pharmaco-economic Burden of Angioedema

    DEFF Research Database (Denmark)

    Longhurst, Hilary; Bygum, Anette

    2016-01-01

    is sought. This has lead to reduced health-seeking behavior and alternative coping strategies, sometimes even denial, in many families, while a minority of HAE-affected patients have become serial emergency room attenders with chronic pain and ongoing requirement for opiate-based painkillers. Both...

  5. Benefits and risks of danazol in hereditary angioedema

    DEFF Research Database (Denmark)

    Bork, Konrad; Bygum, Anette; Hardt, Jochen

    2008-01-01

    the benefits and risks of long-term treatment with danazol. METHODS: Data were generated retrospectively from 118 German and Danish patients who had HAE due to C1 inhibitor deficiency and were treated with danazol from 2 months to 30 years. The frequency and severity of acute attacks were registered before......, headache, depression, and/or liver adenomas) occurred in 93 of the 118 patients and led to discontinuation of danazol therapy in 30 patients. CONCLUSIONS: Danazol is highly beneficial in patients with frequent and severe attacks of HAE. Because the risk of adverse effects is high, close monitoring...

  6. Guía Argentina de urticaria y angioedema

    Directory of Open Access Journals (Sweden)

    Jorge Máspero

    2014-08-01

    Full Text Available Se actualiza el diagnóstico de la urticaria crónica (UC y los conceptos, definiciones y sugerencias basados en la evidencia para su tratamiento. La urticaria ocurre en al menos 20% de la población en algún momento de la vida. Su etiología difiere en la forma aguda (menos de 6 semanas, y en la crónica. No es posible pronosticar si las formas agudas evolucionarán a UC, ya que todas son agudas al comienzo. La UC ocurre como espontánea (UCE o inducible (UCI. El diagnóstico es sencillo, pero incluye un minucioso estudio para descartar diagnósticos diferenciales; para UCI son útiles las pruebas de provocación en la caracterización y manejo. Los estudios complementarios se deben limitar y orientar según sospecha clínica. El tratamiento se divide en tres enfoques: evitación, eliminación o tratamiento del estímulo desencadenante o de la causa, y tratamiento farmacológico. Recientemente éste se modificó, con empleo de antihistamínicos de segunda generación como primera línea y aumento de dosis de antihistamínicos H1 no sedantes, hasta 4 veces, como segunda línea. Los antihistamínicos son fundamentales para tratar la UC; sin embargo, un 40% de los pacientes no logra un buen control pese al aumento de dosis y requiere otro medicamento adicional. La evidencia más reciente considera que un grupo de fármacos puede utilizarse como tercera línea en estos casos, para mejorar la calidad de vida y limitar la toxicidad por el uso frecuente o crónico de esteroides sistémicos. Se recomiendan para esta tercera línea solo 3 fármacos: omalizumab, ciclosporina A o antileucotrienos.

  7. Angiotensin converting enzyme induced angioedema: The need for ...

    African Journals Online (AJOL)

    The complication can be life threatening with serious morbidity and mortality if not promptly diagnosed from drug history and properly handled within the emergency unit. Apart from taking drug history concerning ACE inhibitor use in patients with heart failure, coronary heart disease and hypertension, a history of angiotensin ...

  8. Surgical correction of strabismus in Lambert-Eaton myasthenic syndrome: case reports Correção cirúrgica do estrabismo na síndrome de Lambert-Eaton: relato de dois casos

    Directory of Open Access Journals (Sweden)

    Fernanda Teixeira Krieger

    2009-02-01

    Full Text Available Lambert-Eaton myasthenic syndrome is a rare and acquired autoimmune disorder. We describe two female patients with medial rectus paresis as the only ocular manifestation. After a unilateral medial rectus recession and lateral rectus resection procedure, both patients recovered normal adduction. To our knowledge, this is the first report of surgery for extraocular muscle paresis in Lambert-Eaton myasthenic syndrome.A síndrome de Lambert-Eaton é um distúrbio autoimune raro e adquirido. Apresentamos duas pacientes com paresia do reto medial como única manifestação ocular. Após retrocesso do reto lateral e ressecção do reto medial, unilateral, ambas as pacientes apresentaram normalização da adução. Até onde sabemos, este é o primeiro relato de cirurgia para paresia do reto medial na síndrome de Lambert-Eaton.

  9. Integración de componentes genéticos y adquiridos en la cognición social

    OpenAIRE

    Garay, Carlos Alberto

    2011-01-01

    El ser humano reúne en sí una naturaleza biológica y una naturaleza cultural. Enfrentamos el problema de la fragmentación del conocimiento como consecuencia de la linealidad de las trayectorias de formación científica y la hiperespecialización. Más específicamente, enfrentamos los problemas derivados de la división entre ciencias naturales y ciencias sociales o humanas. Esta división proviene, en parte, de los fracasos de las estrategias reduccionistas de unificación de las ciencias (Agazzi, ...

  10. Paludismo por Plasmodium falciparum adquirido en África subsahariana Plasmodium falciparum malaria acquired in Subsaharian Africa

    Directory of Open Access Journals (Sweden)

    Ricardo Durlach

    2009-02-01

    Full Text Available El objetivo de este trabajo es presentar los casos de paludismo por Plasmodium falciparum ocurridos en viajeros provenientes del África tropical, atendidos en el Hospital Alemán. Se definió paludismo de origen africano como la infección adquirida en un país del África subsahariana, diagnosticado y tratado en la Argentina. El diagnóstico se realizó por la clínica y la microscopía óptica en frotis de sangre periférica coloreados con Giemsa. Se revieron las historias clínicas de 11 pacientes adultos -cinco turistas y seis marineros mercantes- no oriundos de área endémica, sin condición inmunosupresora, ni morbilidad asociada, internados entre 1993 y 2007. El rango de edad fue de 21 a 48 años; nueve hombres y dos mujeres. Los pacientes fueron clasificados retrospectivamente en malaria grave (seis o no grave (cinco según cumplieran con uno o más de los criterios de gravedad de la Organización Mundial de la Salud. Todos presentaron fiebre como signo más significativo. Como complicaciones graves se observaron casos de insuficiencia renal, epistaxis, hemoglobinuria, hipoglucemia, edema pulmonar, acidosis y coma. Tres pacientes requirieron internación en la unidad de terapia intensiva. Todos sobrevivieron y solamente tres habían recibido la quimioprofilaxis correcta antes de viajar. El tratamiento se realizó con una o más de las siguientes drogas: mefloquina, quinidina, clindamicina y cotrimoxazol.The purpose of this paper is to present the cases of malaria caused by Plasmodium falciparum in travelers coming from tropical Africa, who were treated at the Hospital Alemán (Buenos Aires. African malaria was defined as an infection acquired in any country within Africa, diagnosed and treated in Argentina. Diagnostic tools included clinical features and optic microscopy with Giemsa stained peripheral blood films. We reviewed the medical records of 11 adult patients -five tourists and six sailors- with no history of malaria, immunosuppressive condition or associated morbidity, admitted from 1993 to 2007. The age ranged from 21 to 48 years old, nine of them were males and two females. The patients were retrospectively classified into severe malaria -six of them- or mild malaria -five of them- according to severity criteria established by the World Health Organization, within the first three days of the beginnings of the symptoms. All patients presented fever; severe complications included encephalitis, renal failure, bleeding, haemoglobinuria, hypoglycemia, and pulmonary edema. Three patients required admission at the intensive care unit; no patient died. Only three off them had received properly chemoprophylaxis before traveling; all received treatment with at least one of the following drugs: mefloquine, quinidine, clyndamicine and cotrimoxazol.

  11. A evicção de bens adquiridos em hasta pública e a responsabilidade sobre seus riscos

    Directory of Open Access Journals (Sweden)

    Maiara Amaral dos Santos

    2006-12-01

    Full Text Available A evicção é uma figura jurídica admitida desde o direito romano. Porém a responsabilidade, diante de sua ocorrência em aquisições como a arrematação, sempre foi questão cabível de várias alterações e divergências ao longo do tempo. Geralmente atrelada aos contratos onerosos, sua ocorrência em aquisições através de hasta pública foi positivada apenas no Novo Código Civil no ordenamento jurídico brasileiro. Apesar disso, os questionamentos a respeito da atribuição de responsabilidade em tais alienações continuam admitindo diferentes entendimentos de acordo com as correntes teóricas seguidas Estas, trazem alienante, adquirente e Estado, assumindo diferentes papéis, e com base nisso imputam suas responsabilidades. Partindo das divergências apresentadas é que se propõe o presente artigo, que objetiva discutir o tema.

  12. Libros adquiridos por don Pedro Fermín de Vargas en sus viajes por las Antillas

    Directory of Open Access Journals (Sweden)

    Sergio Elías Ortíz

    1962-04-01

    Full Text Available Entre los papeles relacionados con la vida de Don Pedro Fermín de Vargas, que pueden consultarse en el Archivo General de Indias de Sevilla, hay una carta de él y una lista de libros que envía al Administrador de Correos de la Habana, Don José Fuertes, antiguo amigo suyo, luego su corresponsal y a la  vez espía de sus pasos para aprisionarlo, con el objeto de que se los guardase “en algún rincón de sus casa”.

  13. Alteraciones de la conciencia tras el daño cerebral adquirido: Una revisión sobre la anosognosia

    Directory of Open Access Journals (Sweden)

    Itsaso Colás Blanco

    2015-06-01

    Full Text Available Después de una lesión cerebral, los pacientes pueden experimentar una gran variedad de secuelas, ya sean físicas, cognitivas o emocionales. La rehabilitación neuropsicológica se encarga de proporcionar herramientas que permitan a los afectados recuperar o compensar las capacidades perdidas. Pero, ¿qué ocurre cuando la lesión impide precisamente que el paciente sea consciente de sus déficits? En el presente artículo realizamos una revisión sobre la anosognosia, destacando sus implicaciones en la rehabilitación y sus posibles mecanismos neurales.

  14. Últimas investigaciones sobre fotofobia asociada a daño cerebral adquirido y su tratamiento

    OpenAIRE

    Pardo López, Clara María

    2016-01-01

    La fotofobia se define como intolerancia dolorosa a las condiciones de luz normales. En individuos sanos la fotofobia puede existir de forma transitoria, producirse en respuesta a cualquier luz brillante o deslumbramiento y puede servir como función protectora. Sus mecanismos neurales aún son desconocidos, pero hay muchos factores que se sabe que causan fotofobia patológica, los cuales suelen estar asociados con anormalidad en cualquier lugar o estructura de la vía visual, desde la película l...

  15. Hereditary angioedema by C1 inhibitor-deficit: Diagnostic and therapeutic challenges. Case report

    Directory of Open Access Journals (Sweden)

    Álvaro José Mayorga

    2017-12-01

    Conclusion: The delay diagnosis involves considerable risk in these patients; the importance of long-term prophylactic treatment is ratified in the use of androgens, being as an available option in developing countries.

  16. A novel assay to diagnose hereditary angioedema utilizing inhibition of bradykinin-forming enzymes

    DEFF Research Database (Denmark)

    Joseph, Kusumam; Bains, Sonia; Tholanikunnel, Baby G

    2015-01-01

    . This was evident regardless whether we measured factor XIIa-C1-INH or kallikrein-C1-INH complexes, and the two assays were in close agreement. By contrast, testing the same samples utilizing the commercial method (complex ELISA, Quidel Corp.) revealed levels of C1-INH between 0 and 57% of normal (mean, 38%) and 42...

  17. Clinical characteristics and real-life diagnostic approaches in all Danish children with hereditary angioedema

    DEFF Research Database (Denmark)

    Aabom, Anne; Andersen, Klaus E; Fagerberg, Christina

    2017-01-01

    at onset was 4 [1-11] years. The first attack was peripheral in 8/14 children and abdominal in 6/14 children, i.e. no one had their first attacks in the upper airways. Most children had less than one attack per month. All of the symptomatic children had been treated with tranexamic acid and/or C1 inhibitor...

  18. Misdiagnosis trends in patients with hereditary angioedema from the real-world clinical setting

    DEFF Research Database (Denmark)

    Zanichelli, Andrea; Longhurst, Hilary J; Maurer, Marcus

    2016-01-01

    . OBJECTIVE: To evaluate the history of misdiagnosis in patients participating in the Icatibant Outcome Survey (IOS). METHODS: The IOS is an observational study in which safety and effectiveness of icatibant have been evaluated since 2009. As part of the IOS, patients record any misdiagnoses received before...

  19. Health-related quality of life in Danish children with hereditary angioedema

    DEFF Research Database (Denmark)

    Aabom, Anne; Nguyen, Dan; Fisker, Niels

    2017-01-01

    have considerable impact on the health-related quality of life (HRQoL) in adult patients. Half the patients with C1-INH-HAE develop symptoms before the age of 10 years. However, the HRQoL in children with C1-INH-HAE is almost unexplored. Objective: To investigate HRQoL in Danish children with C1...... were the PedsQL (Child Self-Report and Parent Proxy-Report forms); the Children's Dermatology Life Quality Index; a nonvalidated, diseasespecific quality-of-life questionnaire; and two visual analog scales that rated general health. Results: The HRQoL scores in our study were comparable with the normal...... the Parent Proxy-Report form carried the disease. Conclusion: Overall, the children assessed on average had a normal HRQoL and better than those with other common skin disorders. However, according to our findings, health care providers should be especially attentive to HRQoL when children with C1-INH...

  20. A Case of Miller Fisher Syndrome, Thromboembolic Disease, and Angioedema: Association or Coincidence?

    OpenAIRE

    Salehi, Nooshin; Choi, Eric D.; Garrison, Roger C.

    2017-01-01

    Patient: Male, 32 Final Diagnosis: Miller Fisher syndrome Symptoms: Ataxia ? headache ? ophthalmoplegia Medication: ? Clinical Procedure: Plasmapheresis Specialty: Neurology Objective: Rare co-existance of disease or pathology Background: Miller Fisher Syndrome is characterized by the clinical triad of ophthalmoplegia, ataxia, and areflexia, and is considered to be a variant of Guillain-Barre Syndrome. Miller Fisher Syndrome is observed in approximately 1?5% of all Guillain-Barre cases in Wes...

  1. Activation of the ficolin-lectin pathway during attacks of hereditary angioedema

    DEFF Research Database (Denmark)

    Csuka, Dorottya; Munthe-Fog, Lea; Hein, Estrid

    2014-01-01

    enrolled. We analyzed blood samples drawn during attacks, and obtained 35 samples from the same patients during symptom-free periods. The serum levels of ficolin-2, ficolin-3, MASP-2, ficolin-3/MASP-2 complex, C1-INH, and C4, as well as the extent of ficolin-3-mediated terminal complement complex (FCN3-TCC......) deposition, were measured using ELISA-based methods. RESULTS: Levels of MASP-2 and of the ficolin-3/MASP-2 complex were elevated (P TCC was lower (P TCC...

  2. Análisis de la instancia ideológica en el conocimiento histórico adquirido. Estudio de un caso: Manuela Sáenz

    OpenAIRE

    Rojas Aldana, María Consuelo

    2014-01-01

    This article is part of a historiographic research of Manuela Sáenz. The research was presented as part of the degree requierement to earn the title "historian" at the Pontificia Universidad Javeriana. The article compares, quantitatively and qualitatively, the information and explainations contained regarding the life of Manuela, and to research the manner in which ideology rethents her importance, the thematic movement over time and reiterative use of certain works as sources. .

  3. Intervenciones basadas en realidad virtual para el entrenamiento de las estrategias de equilibrio en sujetos crónicos con daño cerebral adquirido

    OpenAIRE

    Lloréns Rodríguez, Roberto

    2014-01-01

    El equilibrio se define como el estado en el cual el centro de gravedad (CDG) del cuerpo se encuentra dentro de los límites de estabilidad. La gestión del equilibrio es un claro ejemplo del control motor humano, donde la información sensorial es procesada por el sistema nervioso central para generar la actividad muscular adecuada para producir los mecanismos de anticipación y/o compensación que preserven este estado. El equilibrio tiene una gran implicación en las actividades de la vida diari...

  4. Convenios internacionales y equidad de género: un análisis de los compromisos adquiridos por México

    OpenAIRE

    Maier, Elizabeth

    2007-01-01

    El presente artículo se refiere a la relación entre la organización de las mujeres como sujetos genéricos, la elaboración y precisión de categorías y conceptos que interpretan la posición subalterna del género femenino y la instrumentación de convenios y acuerdos internacionales que inciden en la revisión y reorganización de la tradicional economía política sexual, sus símbolos, representaciones y códigos jurídicos. En especial, analiza los significados sociales y simbólicos de las obligacion...

  5. Variação inter-individual nos níveis de bilirrubina: o papel dos factores genéticos e adquiridos

    OpenAIRE

    Rodrigues, Carina; Vieira, Emília; Santos, Rosário; Carvalho, João; Santos-Silva, Alice; Elísio, Costa; Bronze-da-Rocha, Elsa

    2011-01-01

    A bilirrubina é um pigmento biliar que deriva principalmente do catabolismo da hemoglobina. É um marcador bioquímico de doenças hepáticas e hematológicas e tem vindo a ser alvo de interesse devido à sua capacidade antioxidante. O objectivo deste trabalho foi avaliar a contribuição de vários factores para a variação da concentração da bilirrubina sérica na população portuguesa. Foi analisado o contributo dos polimorfismo genéticos no promotor do gene UGT1A1 (c.-41_40...

  6. ANO IMPERFORADO Y CATARATA CONGÉNITA EN EL SÍNDROME DE JOHNSON-MCMILLIN HALLAZGOS NO REPORTADOS O ADQUIRIDOS

    Directory of Open Access Journals (Sweden)

    Francisco Cammarata-Scalisi

    2013-08-01

    Full Text Available Johnson et al. en 1983, describieron 16 casos en una familia que presentó alopecia, anosmia o hiposmia, sordera de conducción, microtia y/o atresia de conducto auditivo externo e hipogonadismo hipogonadrotófico, que mostraba un patrón de herencia autosómico dominante, con expresividad variable. Otras manifestaciones menos constantes incluyeron asimetría facial, retardo mental, cardiopatía congénita, paladar hendido y estenosis de coanas. Aparte de estos casos, solo siete pacientes con el síndrome de Johnson-McMillin han sido reportados hasta el momento. La patogénesis de esta entidad es incierta y el diagnóstico diferencial es amplio. Se describe un nuevo caso en una lactante femenina de ocho meses en el cual la alopecia universal, la microcefalia, la parálisis facial, el paladar blando hendido y las alteraciones a nivel de pabellones auriculares fueron significativos para establecer el diagnósticoLa paciente también presentó otros signos clínicos no asociados al síndrome, como el ano imperforado y la catarata congénita bilateral.

  7. ANO IMPERFORADO Y CATARATA CONGÉNITA EN EL SÍNDROME DE JOHNSON-MCMILLIN HALLAZGOS NO REPORTADOS O ADQUIRIDOS

    Directory of Open Access Journals (Sweden)

    Francisco Cammarata-Scalisi

    2012-01-01

    Full Text Available Johnson et al. en 1983, describieron 16 casos en una familia que presentó alopecia, anosmia o hiposmia, sordera de conducción, microtia y/o atresia de conducto auditivo externo e hipogonadismo hipogonadrotófico, que mostraba un patrón de herencia autosómico dominante, con expresividad variable. Otras manifestaciones menos constantes incluyeron asimetría facial, retardo mental, cardiopatía congénita, paladar hendido y estenosis de coanas. Aparte de estos casos, solo siete pacientes con el síndrome de Johnson-McMillin han sido reportados hasta el momento. La patogénesis de esta entidad es incierta y el diagnóstico diferencial es amplio. Se describe un nuevo caso en una lactante femenina de ocho meses en el cual la alopecia universal, la microcefalia, la parálisis facial, el paladar blando hendido y las alteraciones a nivel de pabellones auriculares fueron significativos para establecer el diagnósticoLa paciente también presentó otros signos clínicos no asociados al síndrome, como el ano imperforado y la catarata congénita bilateral.

  8. Disease: H01006 [KEGG MEDICUS

    Lifescience Database Archive (English)

    Full Text Available H01006 Hereditary angioedema Hereditary angioedema (HAE) is a rare genetic disorde...r, manifested by recurrent episodes of angioedema localized to the skin or mucosa of the gastrointestinal tr...act or larynx. The laryngeal angioedema is potentially lethal. The classic forms, HAE types I and II, result...6100 PMID:14572810 (description, gene) ... AUTHORS ... Davis AE 3rd ... TITLE ... The pathogenesis of hereditary angioedema... (drug) ... AUTHORS ... Antoniu SA ... TITLE ... Therapeutic approaches in hereditary angioedema. ... JOURNAL ... Clin

  9. Estado nutricional de pacientes com atresia biliar e hepatite autoimune e relação com os níveis séricos de vitaminas A, D e E

    OpenAIRE

    Saron, Margareth L. G.; Godoy, Helena T.; Hessel, Gabriel

    2009-01-01

    CONTEXT: Chronic liver disease may induce to malabsorption of lipids and fat-soluble vitamins, leading to injury of nutritional status. OBJECTIVES: To evaluate the nutritional status of pediatric-age patients with autoimmune hepatitis and biliary atresia related to serum levels of vitamins A, D and E and the disease severity. METHODS: This controlled transverse study, evaluated the patients with autoimmune hepatitis and biliary atresia and a reference group paired by sex and age. The patients...

  10. Associação de imunodeficiências primárias com doenças auto-imunes na infância Primary immunodeficiencies and autoimmune diseases association in childhood

    Directory of Open Access Journals (Sweden)

    Adriana Almeida de Jesus

    2007-12-01

    Full Text Available INTRODUÇÃO: Sintomas musculoesqueléticos podem representar a primeira manifestação de imunodeficiências humorais primárias. A freqüência de deficiência seletiva de IgA em pacientes com artrite idiopática juvenil (AIJ símile e lúpus eritematoso sistêmico juvenil (LESJ é de 2% a 4% e de 1% a 4%, respectivamente. OBJETIVO: Descrever pacientes que apresentaram artrite como primeiro sinal de uma imunodeficiência humoral primária e determinar a prevalência de deficiência seletiva de IgA em pacientes com diagnóstico de AIJ e LESJ. PACIENTES E MÉTODOS: Entre janeiro de 1983 e dezembro de 2006, 4.876 pacientes foram acompanhados na Unidade de Reumatologia Pediátrica. Uma avaliação retrospectiva foi realizada em pacientes que apresentaram artrite como primeira manifestação de imunodeficiência. As imunodeficiências humorais foram classificadas em: deficiência seletiva de IgA, hipogamaglobulinemia e deficiência de subclasses de IgG. RESULTADOS: Onze (0,2% pacientes apresentaram imunodeficiências humorais: deficiência seletiva de IgA ocorreu em oito, imunodeficiência comum variável em dois e deficiência de subclasses de IgG em um. Cinco dos 11 pacientes apresentaram artrite aguda e seis apresentaram artrite crônica não-erosiva (AIJ símile. Dosagem de imunoglobulinas foi realizada em 70 dos 253 pacientes com AIJ e deficiência seletiva de IgA (IgA sérica INTRODUCTION: Rheumatologic findings may be the first manifestation of primary humoral immunodeficiencies. The frequency of selective IgA deficiency in patients with juvenile idiopathic arthritis (JIA like and juvenile systemic lupus erithematosus (JSLE is 2% to 4% and 1% to 4%, respectively. OBJECTIVE: To describe patients with primary humoral immunodeficiencies associated with arthritis and to determine the prevalence of selective IgA deficiency within JIA and JSLE patients. PATIENTS AND METHODS: From January 1983 to December 2006, 4.876 patients were followed at the Pediatric Rheumatology Unit. A retrospective evaluation was performed in patients that presented arthritis as the first clinical manifestation of immunodeficiency. The humoral immunodeficiencies were classified into selective IgA deficiency, hypogammaglobulinemia and IgG subclass deficiency. RESULTS: Eleven patients (0.2% had primary immunodeficiency: selective IgA deficiency occurred in 8, common variable immunodeficiency in two, and IgG subclass deficiency in one. Five of the 11 patients had an acute arthritis and six patients a chronic nonerosive arthritis (JIA-like. From the 253 JIA patients evaluated, 70 had IgA level evaluation done and 6 (8.5% presented complete IgA deficiency (serum IgA < 7 mg/dl (JIA-like. From the 45 JSLE patients with IgA levels evaluated, 3 (6.6% had selective IgA deficiency diagnosis. CONCLUSION: The present study showed a low prevalence of humoral immunodeficiency in patients with rheumatic diseases. However, this association suggests that similar defects in immune response could be related to both diseases and that prospective studies are needed to elucidate this hypothesis.

  11. Elucidating the Mechanism of Gain of Toxic Function From Mutant C1 Inhibitor Proteins in Hereditary Angioedema

    Science.gov (United States)

    2017-10-01

    antibodies to 5 specifically blot wild-type C1INH in the pathologic polymers.. A FLAG tag was placed into the wild-type C1INH cDNA located immediately...resulted in decreased secretion of the 3x-FLAG-WT-C1INH when cotransfected with the mutant cDNA . This was an important confirmation of our...C1INH plus mutant C1INH cDNA in the presence or absence of a lactacystin, a proteasome inhibitor. As shown in figure 2, blocking degradation of

  12. Long-term safety of icatibant treatment of patients with angioedema in real-world clinical practice

    DEFF Research Database (Denmark)

    Zanichelli, A; Maurer, M; Aberer, W

    2017-01-01

    . A total of 143 SAEs occurred in 59 (10.6%) patients; only three events (drug inefficacy, gastritis, and reflux esophagitis) in two patients were considered related to icatibant. Notably, no SAEs related to icatibant occurred in patients with cardiovascular disease, nor in those using icatibant...

  13. International consensus on the diagnosis and management of pediatric patients with hereditary angioedema with C1 inhibitor deficiency

    DEFF Research Database (Denmark)

    Farkas, H; Martinez-Saguer, I; Bork, K

    2017-01-01

    : The symptoms of C1-INH-HAE often present in childhood. Differential diagnosis can be difficult as abdominal pain is common in pediatric C1-INH-HAE, but also commonly occurs in the general pediatric population. The early onset of symptoms may predict a more severe subsequent course of the disease. Before...

  14. La logística de distribución aplicada a la entrega de artículos adquiridos en Ecuador a través de tiendas virtuales

    OpenAIRE

    Durango Espinoza, Rayner; Pesantes Monserrate, Luis; Espinal Santana, Albert

    2009-01-01

    El comercio, sinónimo de desarrollo y progreso desde la pre-historia ha presentado a lo largo de tiempo grandes cambios que ha afectado a la humanidad, llegando a evolucionar a definiciones cada vez más eficientes y formales de negociación, como la compra y venta. A medida que el desarrollo tecnológico y nuevos conceptos (como la Globalización) ganaban terreno en el mundo moderno, de igual manera surgían nuevas y novedosas formas de hacer negocios a la par de éstas nuevas y revolucionari...

  15. Experimental comparison of profiles of acquired small fields with ionization chambers, diodes, radiochromic s and TLD films; Comparacion experimental de perfiles de campos pequenos adquiridos con camaras de ionizacion, diodos, peliculas radiocromicas y TLD

    Energy Technology Data Exchange (ETDEWEB)

    Venencia, D.; Garrigo, E. [Instituto Privado de Radioterapia, Obispo Oro 423, X5000BFI Cordoba (Argentina); Filipuzzi, M. [Instituto Balseiro, Centro Atomico Bariloche, Av. Bustillo 9500, 8400 Bariloche - Rio Negro (Argentina); Germanier, A., E-mail: devenencia@radioncologia-zunino.org [Centro de Excelencia en Productos y Procesos, Santa Maria de Punilla, 5164 Cordoba (Argentina)

    2014-08-15

    The use of radiation small fields, introduced by new techniques, can bring a considerable uncertainty in the precision of the acquired profiles, due to the conditions of lateral electronic non-equilibrium and the perturbations introduced by the detectors (volume effect and alteration of the charged particles flowing) [Das et al., 2007]. The development of new miniature detectors looks to diminish the uncertainty created by the material and the size of the sensitive volume of the dosimeter. For this reason, comparative measurements for three sizes of square field were carried out (20 mm, 10 mm and 5 mm, of side) using a detectors series: 3 ionization chambers (PTW-31003, IBA-CC04, PTW-31016), 2 diodes (PTW-60012, IBA-Sfd), thermoluminescent detectors micro-cubes of 1 mm of edge (TLD-700) and radiochromic s films EBT-3. These last two were used as reference detectors, due to their spatial high resolution and similar performance with Monte Carlo simulations [Francescon et al., 1998]. So much the thermoluminescent detectors as the radiochromic films resolved the profiles in a similar way. Both diodes responded correctly, but the rest of the detectors overestimated the gloom of the fields, which allows conclude that the used TLD (and both diodes) can resolve field sizes correctly, usually utilized in radio-surgery, without producing significant alterations in the acquired data. (author)

  16. Evaluation of the quality of picture in studies of sect brain acquired with various collimators; Evaluacion de la calidad de imagen en estudios de spect cerebral adquiridos con distintos colimadores

    Energy Technology Data Exchange (ETDEWEB)

    Moran Velasco, V.; Prieto Azcarete, E.; Barbes Fernandez, B.; Sancho rodriguez, L.; Ribelles Segura, M. J.; Richter echevarria, J. A.; Arbizu Lostao, J.; Marti-Climent, J. M.

    2015-07-01

    On the practice clinic , the performance of the systems SPECT depends on in large measurement of the quality of image. The goal of East study was evaluate how affect the parameters of reconstruction of studies SPECT of perfusion brain acquired with a collimator of holes parallel (LEHR) and other of holes in fan (Fan-Beam). (Author)

  17. Corrección de temperatura en el altiplano peruano utilizando análisis Wavelet Multiresolución sobre datos adquiridos por percepción remota

    OpenAIRE

    Barreda Polar, Carolina Elena

    2015-01-01

    Universidad Nacional Agraria La Molina. Escuela de Posgrado. Maestría en Meteorología Aplicada Datos de temperatura de día y de noche, estimados por MODIS, fueron corregidos para obtener la temperatura máxima y mínima del aire, en la región del Altiplano peruano, en el periodo 2001-2012. El modelo conceptual basado en el análisis wavelet multiresolución, propone el ensamble entre las señales de temperatura de MODIS y la temperatura medida en estación. Imágenes MODIS-LST (MOD11C2) de te...

  18. Type tests to the automatic system of thermoluminescent dosimetry acquired by the CPHR for personnel dosimetry; Pruebas tipo al sistema de dosimetria termoluminiscente automatico adquirido por el CPHR para dosimetria personal

    Energy Technology Data Exchange (ETDEWEB)

    Molina P, D.; Pernas S, R. [Centro de Proteccion e Higiene de las Radiaciones (CPHR), Calle 20, No. 4113 e/ 41 y 47, Miramar, Ciudad de la Habana (Cuba)]. e-mail: daniel@cphr.edu.cu

    2005-07-01

    The CPHR individual monitoring service acquired an automatic RADOS TLD system to improve its capacities to satisfy the increasing needs of their national customers. The TLD system consists of: two automatic TLD reader, model DOSACUS, a TLD irradiator and personal dosimeters card including slide and holders. The dosimeters were composed by this personal dosimeters card and LiF: Mg,Cu,P (model GR-200) detectors. These readers provide to detectors a constant temperature readout cycle using hot nitrogen gas. In order to evaluate the performance characteristics of the system, different performance tests recommended by the IEC 1066 standard were carried out. Important dosimetric characteristics evaluated were batch homogeneity, reproducibility, detection threshold, energy dependence, residual signal and fading. The results of the tests showed good performance characteristics of the system. (Author)

  19. Type tests to the automatic thermoluminescent dosimetry system acquired by the CPHR for personal dosimetry; Pruebas tipo al sistema de dosimetria termoluminiscente automatico adquirido por el CPHR para dosimetria personal

    Energy Technology Data Exchange (ETDEWEB)

    Molina P, D.; Pernas S, R.; Martinez G, A. [Centro de Proteccion e Higiene de las Radiaciones (CPHR), Calle 20 No. 4113 e/41 y 47. Playa, C.P. 11300, A.P. 6195, C.P. 10600 La Habana (Cuba)

    2006-07-01

    The CPHR individual monitoring service acquired an automatic RADOS TLD system to improve its capacities to satisfy the increasing needs of their national customers. The TLD system consists of: two automatic TLD reader, model DOSACUS, a TLD irradiator and personal dosimeters card including slide and holders. The dosimeters were composed by this personal dosimeters card and LiF:Mg,Cu,P (model GR-200) detectors. These readers provide to detectors a constant temperature readout cycle using hot nitrogen gas. In order to evaluate the performance characteristics of the system, different performance tests recommended by the IEC 1066 standard were carried out. Important dosimetric characteristics evaluated were batch homogeneity, reproducibility, detection threshold, energy dependence, residual signal and fading. The results of the tests showed good performance characteristics of the system. (Author)

  20. Biometria, caracterização física e rendimento lipídico do fruto de Licania rigida Benth adquiridos no município de Pombal-PB

    Directory of Open Access Journals (Sweden)

    T. S. S. Almeida

    2015-12-01

    Full Text Available Resumo: Licânia rigida Benth, popularmente oiticica, é uma vegetação típica no sertão nordestino. Destaca-se pelo alto teor de óleos em seus frutos e boa produtividade mesmo em épocas de seca, sendo capaz de promover desenvolvimento social e econômico para a região, pela utilização industrial de tintas, vernizes, sabão, lonas e esmaltes finos. Portanto, objetiva-se no presente estudo determinar a biometria, parâmetros físicos e rendimento lipídico do fruto da oiticica. Os frutos foram colhidos, selecionados, sanitizados. Em seguida, utilizou-se um paquímetro para a realização da biometria dos frutos e então sofreram separação em exocarpo-mesocarpo, endocarpo e amêndoas. As amostras foram trituradas e armazenadas ate procedidas as análises. Para a determinação do pH e condutividade, utilizou-se cerca de 5g de cada amostra, acrescidos de 50mL de água destilada e homogeneização, por conseguintemente foi utilizado o peagâmetro digital e condutivímetro, respectivamente. Para a acidez total titulável (ATT, utilizou-se as amostras anteriores e titulou-se com NaOH 0,1N, usando fenolftaleína como indicador, até as amostras alcançarem pH de 8,1. Procedeu-se a determinação do teor lipídico pelo método de Sohlext, com 2 a 5 g das amostras e hexano como solvente. Os frutos apresentaram peso médio de 9g. A variação do pH para as diferentes amostra foi irrelevante, enquanto o exocarpo-mesocarpo apresentou maior condutividade, com 308,6 mScm-1, e o endocarpo foi evidenciado por apresentar maior ATT, com 16,8%. Obteve-se na amêndoa maior percentual lipídico, com rendimento médio de 43,0%. Diante da importância e alta rentabilidade lipídica do fruto, faz-se necessário desenvolvimento de metodologias para utilização dessa matéria-prima.Biometrics, physical characteristics and yield fruit of lipid Licania rigid Benth purchased in the municipality of Pombal-PBAbstract: Licania rigid Benth, popularly oiticica, is typical vegetation in the northeastern hinterland. It contains high oil content in its fruits and good productivity even in times of drought; promote social and economic development for the region, the industrial use of paints, varnishes, soap, tarpaulins and thin glazes. Therefore, this study aims determine biometrics, physical parameters and lipid yield the fruit of the myrtle. The fruits were harvested, sorted, sanitized. Then, a caliper was used to carry out the biometrics fruit and then underwent separation exocarp-mesocarp and endocarp almonds. The samples were ground and stored until analysis proceeded. For the determination of pH and conductivity was used about 5g of each sample plus 50ml of distilled water and homogenizing for then digital pH meter was used and conductivity, respectively. For titratable acidity (TA was used earlier samples, and titrated with 0.1N NaOH, using phenolphthalein as an indicator until the samples reach a pH of 8.1. The procedure was the determination of the lipid content by Sohlext method, of 2 to 5 g of sample and hexane as solvent. The fruits showed an average weight of 9g. The pH changes for the various samples were irrelevant, while the exocarp-mesocarp showed higher conductivity, with 308.6 MSCM-1, and the endocarp was evidenced by higher ATT present with 16.8%. It was obtained in the almond lipid largest percentage, with average yield of 43.0%. Given the importance and high lipid profitability of the fruit, it is necessary to develop methodologies for use of this raw material.

  1. Un Enquiridion de Erasmo desconocido y un raro ejemplar del Libro de Albeytería de Francisco de la Reyna adquiridos por la Biblioteca Universitaria de Zaragoza, nuevas adiciones a la tipobibliografía aragonesa del siglo XVI

    Directory of Open Access Journals (Sweden)

    Moralejo Álvarez, María Remedios

    2011-07-01

    Full Text Available El artículo da cuenta de la adquisición, por la Biblioteca Universitaria de Zaragoza, de dos raros impresos aragoneses del siglo XVI: un Enquiridion de Erasmo, de Jorge Coci, 1529, hasta ahora absolutamente desconocido, y el ejemplar del Tratado de Albeytería de Francisco de la Reina, que con toda probabilidad perteneció al "Bibliófilo Aragonés", Juan M. Sánchez. Incluye el estudio y la descripción bibliográfica de ambos para incorporar a la tipobibliografía aragonesa del siglo XVI.The paper is about the acquisition, by the University Library of Saragossa, of two rare 16th Century Aragonese prints: An Enchiridion of Erasmus by Jorge Coci, 1529, to date completely unknown, and the copy of the 'Tratado de Albeytería' by Francisco de la Reyna, which, in all likelihood, belonged to the 'Aragonese Bibliophile', Juan M. Sánchez. It includes the bibliographic study and description of both so as to form part of 16th Century Aragonese typo bibliography.

  2. Permanencia del conocimiento adquirido en los dos primeros años de la Licenciatura de Médico Cirujano.: ¿Persiste al evaluarlo en el cuarto año?

    Directory of Open Access Journals (Sweden)

    M. Eugenia Ponce de León-Castañeda

    Full Text Available Introducción. Los alumnos generalmente profundizan en el conocimiento de acuerdo al tipo de preguntas con que son evaluados: si evalúan memoria se favorece un aprendizaje mecánico y repetitivo que permanece poco tiempo en la memoria; si son de comprensión o aplicación favorecerán aprendizajes significativos. Materiales y métodos. Estudio analítico, observacional transversal. Por jueces se seleccionaron preguntas obtenidas de exámenes de anatomía, psicología, fisiología y cirugía de los tres niveles de conocimiento. El mismo examen se aplicó al azar a 13 grupos de segundo año y a 13 grupos de cuarto. La calificación y el análisis se realizaron de manera electrónica. Se aplicó la U de Mann-Whitney para identificar diferencias y percentiles con rango intercuartílico para la dispersión. Resultados. Se contestaron 310 exámenes de segundo año y 247 de cuarto. La fiabilidad del examen fue de 0,9009 y 0,9102, respectivamente. Se identificaron diferencias significativas (p = 0,000 en el examen global y en las respuestas de cirugía y psicología, considerando aciertos y nivel de conocimiento (memoria y comprensión. No se encontraron diferencias en anatomía (p = 0,527 y fisiología (p = 0,203. La mediana de aciertos fue de 39 y 43, respectivamente. La dispersión de reactivos en el análisis global y por asignatura mantuvo un rango intercuartílico de 3-4. Conclusiones. Al ser evaluado, el alumno con conocimientos memorísticos pierde interés al no encontrar la aplicación y la integración del conocimiento básicos en la clínica.

  3. Disease: H00106 [KEGG MEDICUS

    Lifescience Database Archive (English)

    Full Text Available : C1 inhibitor deficiency (hereditary angioedema); C4 binding protein alpha deficiency; C4 binding protein b... subcutaneous and submucosal layers, identified as angioedema (hereditary or acquired). Genetic deficiency o

  4. International consensus and practical guidelines on the gynecologic and obstetric management of female patients with hereditary angioedema caused by C1 inhibitor deficiency

    DEFF Research Database (Denmark)

    Caballero, Teresa; Farkas, Henriette; Bouillet, Laurence

    2012-01-01

    devices, and progestins can be used. Pregnancy: Attenuated androgens are contraindicated and should be discontinued before attempting conception. Plasma-derived human C1 inhibitor concentrate (pdhC1INH) is preferred for acute treatment, short-term prophylaxis, or long-term prophylaxis. Tranexamic acid...

  5. Carcinoma papilífero de tireóide associado à tireoidite de hashimoto: relato de caso

    Directory of Open Access Journals (Sweden)

    Inês Maria Crespo Gutierres Pardo

    2016-10-01

    Full Text Available Introdução: A tireoidite de Hashimoto é o tipo de hipotireoidismo primário adquirido de causa auto-imune mais comum em região não-carente de iodo. Já o carcinoma papilífero de tireóide é o tipo mais comum de câncer de tireóide diferenciado na infância. Embora exista controvérsia na literatura quanto à associação entre Carcinoma Papilífero de Tireoide (CPT e Tireoidite de Hashimoto (TH, vários estudos detectaram incidência aumentada deste tipo de câncer em pacientes com TH. Objetivos: relatar o caso de uma paciente pediátrica com TH que desenvolveu CPT. Metodologia: revisão de dados obtidos e analisados do prontuário médico e pesquisa bibliográfica. Relato de caso: L. P, nascida em 25/07/1999, sexo feminino, foi encaminhada ao ambulatório de endocrinologia infantil da Policlínica Municipal de Sorocaba aos 9 anos de idade, devido ao desenvolvimento precoce de características sexuais secundárias, com aparecimento de pelos pubianos e de telarca há 1 ano. Ao exame físico, constatou-se desenvolvimento puberal segundo a classificação de Tanner, M3 P3 e tireóide palpável. Através de exames laboratoriais, foi diagnosticada com tireoidite de Hashimoto. Após 2 anos de tratamento, constatou-se aumento de tireóide em USG, diagnosticado como nódulo benigno em PAAF. No entanto, após 5 anos de seguimento, foi observada a presença de nódulo maligno, identificado como carcinoma papilífero da tireóide. Paciente foi submetida à tireoidectomia total com esvaziamento paratraqueal, devido as metástases em linfonodos. Após a cirurgia a paciente evoluiu bem, sem intercorrências e sem evidências de metástases funcionantes de carcinoma diferenciado de tireóide. Conclusão: É importante que os profissionais de saúde fiquem atentos à possibilidade de associação do CPT com a TH, quando houver mudança no padrão ultrassonográfico com a presença de linfoadenopatia cervical significativa.

  6. CARACTERIZAÇÃO MICROBIOLÓGICA POR METODOLOGIA CLÁSSICA DE DOCE DE LEITE, LEITE CONDENSADO E QUEIJO MINAS PADRÃO ADQUIRIDOS NO MERCADO DE JUIZ DE FORA (MG E PADRONIZAÇÃO DE MULTIPLEX PARA DETECÇÃO DE PATÓGENOS POR PCR EM TEMPO REAL

    Directory of Open Access Journals (Sweden)

    Jaqueline Flaviana Oliveira de Sá

    2012-10-01

    Full Text Available Os derivados lácteos são alimentos com excepcional valor nutritivo e amplamente consumido pela população mundial. Entretanto, são também excelentes meios de cultura para muitos micro-organismos, sendo, portanto, passíveis de contaminação por diferentes agentes microbiológicos, podendo levar a doenças manifestadas por ação de patógenos ou por suas toxinas. A obtenção de alimentos seguros depende dentre outros fatores, dos métodos de análises utilizados, os quais devem fornecer resultados rápidos e confiáveis que permitam o monitoramento da segurança microbiológica de alimentos, seja pela indústria ou pelos órgãos de fiscalização e para isso, diversos métodos alternativos têm sido desenvolvidos para a detecção e quantificação de patógenos. O primeiro objetivo do presente estudo foi caracterizar microbiologicamente, por metodologia clássica, amostras de doce de leite, leite condensado e queijo Minas Padrão com SIF, produzidos em vários estados do Brasil ecomercializados em supermercados de Juiz de Fora (MG. Foram feitas análises de contagem padrão em placas de mesófilos, bolores e leveduras, coliformes a 30ºC e a 45ºC, Staphylococcus spp. coagulase positiva e negativa, além da pesquisa de Salmonella sp. e Listeria monocytogenes. Altas contagens padrão em placas de mesófilos, leveduras e Staphylococcus spp.coagulase negativa foram encontradas nos três produtos. O segundo objetivo foi desenvolver uma metodologia alternativa à clássica, que apresentasse resultados mais rápidos e de alta especificidade para a detecção dos principais patógenos contaminantes de produtos lácteos e transmissores de doenças de origem alimentar, utilizando a técnica de PCR em tempo real. Foi padronizada uma reação multiplex para detecção de Salmonella entérica var thyphimurium e Staphylococcus aureus. O presente trabalho contribuirá com a rara literatura mundial sobre a microbiota contaminante do doce de leite, leite condensado e queijo Minas Padrão, fornecendo dados científicos à academia, autoridades regulamentadoras e indústria, vislumbrando a possibilidade da utilização de métodos de diagnóstico microbiológico alternativos aos clássicos, que forneçam resultados cada vez mais rápidos e mais sensíveis.

  7. Permanencia del conocimiento adquirido en los dos primeros años de la Licenciatura de Médico Cirujano.: ¿Persiste al evaluarlo en el cuarto año? Retention of knowledge acquired in the first two years of Medical School.: Does it persist when tested it in the fourth year students?

    Directory of Open Access Journals (Sweden)

    M. Eugenia Ponce de León-Castañeda

    2012-09-01

    Full Text Available Introducción. Los alumnos generalmente profundizan en el conocimiento de acuerdo al tipo de preguntas con que son evaluados: si evalúan memoria se favorece un aprendizaje mecánico y repetitivo que permanece poco tiempo en la memoria; si son de comprensión o aplicación favorecerán aprendizajes significativos. Materiales y métodos. Estudio analítico, observacional transversal. Por jueces se seleccionaron preguntas obtenidas de exámenes de anatomía, psicología, fisiología y cirugía de los tres niveles de conocimiento. El mismo examen se aplicó al azar a 13 grupos de segundo año y a 13 grupos de cuarto. La calificación y el análisis se realizaron de manera electrónica. Se aplicó la U de Mann-Whitney para identificar diferencias y percentiles con rango intercuartílico para la dispersión. Resultados. Se contestaron 310 exámenes de segundo año y 247 de cuarto. La fiabilidad del examen fue de 0,9009 y 0,9102, respectivamente. Se identificaron diferencias significativas (p = 0,000 en el examen global y en las respuestas de cirugía y psicología, considerando aciertos y nivel de conocimiento (memoria y comprensión. No se encontraron diferencias en anatomía (p = 0,527 y fisiología (p = 0,203. La mediana de aciertos fue de 39 y 43, respectivamente. La dispersión de reactivos en el análisis global y por asignatura mantuvo un rango intercuartílico de 3-4. Conclusiones. Al ser evaluado, el alumno con conocimientos memorísticos pierde interés al no encontrar la aplicación y la integración del conocimiento básicos en la clínica.Introduction. Students generally go deep into the knowledge according to the type of questions they are evaluated with, if they only will support mechanical and repetitive learning that remains just a short time in the memory, if they understand and apply their learning then these supports significant learning. Materials and methods. Analytical observational study by the method of judges there were selected 88 questions of the three levels of knowledge from tests of Anatomy, Psychology, Physiology and Surgery. The same test was randomized and applied to 13 groups of second and fourth grade. The evaluation and the analysis were performed with an electronic system. The U of Mann-Whitney was applied to identify differences and percentiles with inter-quartiles rank for the dispersion. Results. 310 students of second grade and 247 of fourth grade were answered and analyses. The reliability of the test was of 0.9009 and 0.9102, respectively. Significant differences were identified (p = 0.000 in the global examination and the answers of Surgery and Psychology, considering right answers and level of knowledge and Psychology. Considering right answers and level of knowledge (memory and understanding. There were no differences in Anatomy (p = 0.527 and Physiology (p = 0.203. There median of right answers was 39 and 43, respectively. The dispersion of items in the global analysis and by subject maintained an inter-quartiles rank between 3 and 4. Conclusions. It is important to include as many items of high cognitive levels in assessments to facilitate meaningful learning.

  8. Atividade simpática, parassimpática e metabólica influenciadas pelo comportamento da distribuição do suporte de peso em pé adquirido na condição de hemiparesia crônica

    OpenAIRE

    Ramos, Gabrielly Craveiro

    2016-01-01

    Introdução: O acidente vascular cerebral (AVC) é a causa mais frequente de incapacidade neurológica crônica da população adulta. Esta afecção cerebrovascular pode gerar alterações tanto no controle postural, observada por assimetria na distribuição do suporte de peso em pé, quanto no controle autonômico, verificadas por meio das respostas simpática e parassimpática na variabilidade da frequência cardíaca (VFC). Assim, a modificação combinada dos controles promovida pelo dano encefálico poderi...

  9. The resources allocated to investments in the next few years will focus on increased production cost savings, plant modernization and maintaining acquired know-how; Los recursos destinados a inversiones en los proximos anos se centraran en el aumento de la proudccion el ahorro en costes, la modernizacion de la plant y el mantenimiento de conocimientos adquiridos

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2002-07-01

    Now that Cofrentes NPP has reached operating maturity after eighteen years of operation, it faces a series of challenges in the upcoming period of 2003-2007 to be able to achieve the ultimate objective of producing a safe, reliable, Environmentally-friendly kilowatt as economically as possible. With this purpose in mind, a detailed Investment Plan has been designed, the most relevant aspects of which are described in this article. (Author)

  10. Life After Project Effort: Appying Values Acquired in a Responsibility-based Physical Activity Program. [Vida después del “Proyecto Esfuerzo”: Aplicación de los valores adquiridos en un programa de actividad física basado en la responsabilidad].

    Directory of Open Access Journals (Sweden)

    Anthony Meléndez

    2015-07-01

    Full Text Available Among physical activity curricular models used in the youth development field, the Teaching Personal and Social Responsibility (TPSR model has been widely incorporated in many underserved youth community and school physical education programs around the United States and the world (Hellison, 2011. Project Effort is an extended day program that uses the TPSR model as a framework. Literature has shown that TPSR programs and Project Effort have had a positive impact on the life of the participants. The purpose of this study was to investigate what TPSR values former participants’ have acquired in Project Effort and through other sources, and how they have guided their lives. A multiple-case design was implemented to understand this phenomenon. The findings showed that former participants considered that four TPSR values (i.e. respect, effort, self-direction, helping others were really important to their lives. Participants reported that they learned the TPSR values of helping others and leadership in Project Effort. Also they mentioned that they acquired the TPSR life skills of being reflective, teamwork, and goal setting in Project Effort. The TPSR value of helping others, and the TPSR life skill of being reflective acquired in Project Effort were most useful to the participants. Participants learned the TPSR value of self-direction and the TPSR values of respect and caring. Resumen Entre los modelos curriculares de actividad física utilizados para el desarrollo de la juventud, la enseñanza personalizada y el modelo de Enseñanza de la Responsabilidad Personal y Social (TPSR han sido ampliamente incorporados en muchas comunidades los jóvenes marginados y en programas de educación física escolares en Estados Unidos y en el mundo (Hellison, 2011. El proyecto esfuerzo es un programa de día extendido que utiliza el modelo TPSR como fundamento. La literatura ha demostrado que los programas TPSR y el Proyecto Esfuerzo han tenido un impacto positivo en la vida de los participantes. El propósito de este estudio fue investigar qué valores promocionados por el modelo TPSR habían aprendido los que fueron participantes a través del Proyecto Esfuerzo y a través de otras vías, y cómo estos valores habían guiado su vida. Se diseñó un estudio de caso múltiple para entender este fenómeno. Los resultados mostraron que los antiguos participantes consideraron que cuatro valores TPRS (esto es, respeto, esfuerzo, auto-dirección, ayudar a los demás eran realmente importante para sus vidas. También indicaron que aprendieron en el proyecto esfuerzo valores del TPRS como ayudar a los demás y de liderazgo. Estos participantes indicaron que en el Proyecto Esfuerzo habían aprendido habilidades del TPRS para la vida tales como ser reflexivos, trabajar en equipo y el establecimiento de objetivos. Los valores del TPSR ayudar a los demás y ser reflexivo que aprendieron en el Proyecto Esfuerzo fueron las más útiles para los participantes. Los participantes aprendieron valores del TPSR como la autodirección, el respeto de respeto y cariño hacia los demás.

  11. Program analysis and presentation of results of the profiles and depth dose rates obtained with the PTW software MC{sub 2} MEPHYSTO; Programa de analisis y presentacion de resultados de los perfiles y porcentajes de dosis en profundidad adquiridos con el software MEPHYSTO MC2 de PTW

    Energy Technology Data Exchange (ETDEWEB)

    Tato de la Cuevas, F.

    2011-07-01

    In the periodic quality control of linear accelerators is usually included acquisition and analysis of profiles and PDDs (percentage depth dose). In the protocol of Quality Control of electron accelerators for clinical use of the proposed analysis SEFM 4 Profiles for each of the energies used clinically. This involves a large number of curves to be analyzed and the subsequent introduction of the parameters in a spreadsheet or similar for your assessment as to the reference state. We have developed a program that analyzes the curves acquired by mcc Mephysto PTW software and presents the results of that analysis in a spreadsheet.

  12. Anaphylaxis Due to Head Injury

    Directory of Open Access Journals (Sweden)

    Bruner, Heather C.

    2015-05-01

    Full Text Available Both anaphylaxis and head injury are often seen in the emergency department, but they are rarely seen in combination. We present a case of a 30-year-old woman who presented with anaphylaxis with urticaria and angioedema following a minor head injury. The patient responded well to intramuscular epinephrine without further complications or airway compromise. Prior case reports have reported angioedema from hereditary angioedema during dental procedures and maxillofacial surgery, but there have not been any cases of first-time angioedema or anaphylaxis due to head injury. [West J Emerg Med. 2015;16(3:435–437.

  13. Anaphylaxis due to head injury.

    Science.gov (United States)

    Bruner, Heather C; Bruner, David I

    2015-05-01

    Both anaphylaxis and head injury are often seen in the emergency department, but they are rarely seen in combination. We present a case of a 30-year-old woman who presented with anaphylaxis with urticaria and angioedema following a minor head injury. The patient responded well to intramuscular epinephrine without further complications or airway compromise. Prior case reports have reported angioedema from hereditary angioedema during dental procedures and maxillofacial surgery, but there have not been any cases of first-time angioedema or anaphylaxis due to head injury.

  14. Disease: H01799 [KEGG MEDICUS

    Lifescience Database Archive (English)

    Full Text Available H01799 Vibratory urticaria; Vibratory angioedema Vibratory urticaria is a rare typ...e of physical skin reactivity characterized by the occurrence of local erythematous, edematous, cutaneous an...enship ML, Pruzansky JJ ... TITLE ... Vibratory angioedema: a hereditary type of ph

  15. Concomitância da tireoidite de Hashimoto e o carcinoma diferenciado da tireóide

    Directory of Open Access Journals (Sweden)

    Alexandre Roberti

    Full Text Available OBJETIVO: Avaliar a associação da tireoidite auto-imune e o carcinoma diferenciado da tireóide na Santa Casa de Misericórdia de Goiânia-Goiás. MÉTODO: De 1395 tireoidectomias realizadas de 1994 a 2003, foram selecionadas 120 carcinomas diferenciados (27 foliculares e 93 papilíferos. Foram avaliadas as variáveis clínicas (idade e sexo com apresentação de freqüências e de sumários de medidas-resumo na descrição estatística. Para aferir a associação de tireoidite auto-imune e carcinoma diferenciado da tireóide em função dos achados histopatológicos, utilizou-se tabelas de contingência e análise pelo teste não paramétrico do quiquadrado de Pearson. Em todos os testes estatísticos foi adotado um nível de significância de 5% (p<0,05. RESULTADOS: 11,1% dos carcinomas foliculares e 18,3% dos carcinomas papilíferos estão associados à tireoidite auto-imune. Existe uma relação de freqüências quatro vezes maior da tireoidite auto-imune com o carcinoma diferenciado da tireóide em comparação com outras doenças tireoideanas (16,7% X 3,6%. CONCLUSÕES: Tais resultados permitem inferir que a associação entre a tireoidite auto-imune e o carcinoma diferenciado da tireóide é mais que casual, exigindo uma observação clínico-laboratorial cuidadosa nos portadores da doença auto-imune.

  16. Anaphylaxis in children

    African Journals Online (AJOL)

    EL-HAKIM

    radiocontrast dyes and dialysis membranes).4 ... proteins, affects as many as 6% of young children and 3% to 4% of adults and ... angioedema) caused by eating certain plant-derived foods. This is ... plasma histamine levels and non-allergic.

  17. Gene : CBRC-OANA-01-1559 [SEVENS

    Lifescience Database Archive (English)

    Full Text Available |Oan#S38831641 PREDICTED: Ornithorhynchus anatinus similar to serpin peptidase inhibitor, clade G (C1 inhibitor), member 1, (angioede...ma, hereditary), (LOC100079402), partial mRNA /cds=p(1,9

  18. Gene : CBRC-OANA-01-0477 [SEVENS

    Lifescience Database Archive (English)

    Full Text Available |Oan#S38831641 PREDICTED: Ornithorhynchus anatinus similar to serpin peptidase inhibitor, clade G (C1 inhibitor), member 1, (angioede...ma, hereditary), (LOC100079402), partial mRNA /cds=p(1,9

  19. Formaldehyd i tekstil som mulig årsag til arthritis og angioødem

    DEFF Research Database (Denmark)

    Jensen, O C; Bach, B

    1992-01-01

    A case of arthritis and angioedema which developed on occupational exposure to formaldehyde in textiles is described. Possible pathological mechanisms are discussed. The suspicion that an unknown immunological reaction may be the cause is raised....

  20. Safety of Oral Paracetamol – Analysis of Data from a Spontaneous ...

    African Journals Online (AJOL)

    (DOAJ), African Journal Online, Bioline International, Open-J-Gate and Pharmacy Abstracts ... pharmaceutical market in 1950 under the name .... reported 25 cases of hypersensitivity in children ... food allergy, idiopathic angioedema, acquired.

  1. Revisión general de compromiso renal en enfermedades autoinmunes

    Directory of Open Access Journals (Sweden)

    G. Eduardo Wainstein, Dr.

    2010-07-01

    Se revisaran las manifestaciones clínicas y anatomapatologicas más comunes de algunas de las enfermedades autoimunes sistémicas. El tratamiento solo se esboza, ya que una discusión en detalles de este sobrepasa la intención de esta revisión.

  2. Graves disease and IgA deficiency as manifestations of 22q11.2 deletion syndrome:

    OpenAIRE

    Silva, João Miguel de Almeida; Silva, Cecília Pereira; Melo, Flavio Fernando Nogueira de; Silva, Luis Alberto A.; Utagawa, Claudia Yamada

    2010-01-01

    A síndrome de deleção 22q11.2 (SD22q11.2) está associada à alta variabilidade fenotípica, abrangendo o espectro velocardiofacial/síndrome de DiGeorge. Manifestações autoimunes, endocrinológicas e de imunodeficiência vêm sendo relatadas associadas à síndrome. O objetivo deste estudo foi relatar um caso de SD22q11.2 associado à deficiência de IgA e à doença de Graves e rever a literatura visando verificar a frequência dessas alterações na SD22q11.2. Os distúrbios autoimunes, cada vez mais relac...

  3. Tireoidite de Hashimoto pode estar associada a um subgrupo de pacientes de esclerose sistêmica com hipertensão pulmonar

    OpenAIRE

    Costa, Ciliana Cardoso B.; Medeiros, Morgana; Watanabe, Karen; Martin, Patricia; Skare, Thelma L.

    2014-01-01

    Introdução: Estudos recentes mostram associação entre tireoidites autoimunes e esclerose sistêmica (ES), e sugerem que essa condição pode interferir no fenótipo da ES. Entretanto, esses estudos avaliam as tireoidites autoimunes como um todo e nenhum deles aborda especificamente a tireoidite de Hashimoto (TH) na ES. Objetivo: Investigar a presença de TH em pacientes com ES e sua possível associação com as manifestações da doença. Casuística e métodos: Manifestações clínicas de hipotireoidi...

  4. Concomitância da tireoidite de Hashimoto e o carcinoma diferenciado da tireóide

    OpenAIRE

    Roberti, Alexandre; Andrade Sobrinho, Josias de; Denardin, Odilon Victor Porto; Rapoport, Abrão

    2006-01-01

    OBJETIVO: Avaliar a associação da tireoidite auto-imune e o carcinoma diferenciado da tireóide na Santa Casa de Misericórdia de Goiânia-Goiás. MÉTODO: De 1395 tireoidectomias realizadas de 1994 a 2003, foram selecionadas 120 carcinomas diferenciados (27 foliculares e 93 papilíferos). Foram avaliadas as variáveis clínicas (idade e sexo) com apresentação de freqüências e de sumários de medidas-resumo na descrição estatística. Para aferir a associação de tireoidite auto-imune e carcinoma diferen...

  5. Odynophagia following retained bee stinger

    Directory of Open Access Journals (Sweden)

    S Viswanathan

    2012-01-01

    Full Text Available Nearly half of Hymenoptera stings affect the head and neck region of victims, but reports on oropharyngeal bee stings are very few. We describe the case of a patient with odynophagia and suffocation in mass envenomation. He had a retained bee stinger whose removal was delayed for more than 24 hours following the sting, due to persisting angioedema. Odynophagia receded after removal of the stinger and treatment with paracetamol, steroids and metronidazole. The patient also developed rhabdomyolysis, renal failure and hepatitis that were treated with conservative therapy. Oropharyngeal stings can simulate symptoms of persisting angioedema in victims of mass envenomation.

  6. Cutaneous findings in five cases of malaria

    Directory of Open Access Journals (Sweden)

    Jignesh B Vaishnani

    2011-01-01

    Full Text Available Malaria is an infectious disease caused by protozoa of the genus Plasmodium. Cutaneous lesions in malaria are rarely reported and include urticaria, angioedema, petechiae, purpura, and disseminated intravascular coagulation (DIC. Here, five malaria cases associated with cutaneous lesions have been described. Out of the five cases of malaria, two were associated with urticaria and angioedema, one case was associated with urticaria, and other two were associated with reticulated blotchy erythema with petechiae. Most of the cutaneous lesions in malaria were nonspecific and reflected the different immunopathological mechanism in malarial infection.

  7. Autoimmune progesterone dermatitis in a patient with endometriosis: case report and review of the literature

    OpenAIRE

    Baptist, Alan P; Baldwin, James L

    2004-01-01

    Abstract Autoimmune progesterone dermatitis (APD) is a condition in which the menstrual cycle is associated with a number of skin findings such as urticaria, eczema, angioedema, and others. In affected women, it occurs 3–10 days prior to the onset of menstrual flow, and resolves 2 days into menses. Women with irregular menses may not have this clear correlation, and therefore may be missed. We present a case of APD in a woman with irregular menses and urticaria/angioedema for over 20 years, w...

  8. Da esclerodermia ao síndrome de poems

    Directory of Open Access Journals (Sweden)

    Ana Sofia Montez

    2015-12-01

    Full Text Available Homem, 84 anos, com antecedentes de hipotiroidismo e alterações cutâneas recentes compatíveis com esclerodermia, confirmadas em biópsia cutânea, mas com estudo auto-imune negativo. Foi internado por queixas constitucionais. Ao exame objetivo, apresentava-se emagrecido, com lesões de vitiligo nas mãos além das de esclerodermia (figura 1 e distensão abdominal com ascite

  9. Da esclerodermia ao síndrome de poems

    OpenAIRE

    Ana Sofia Montez; Elsa Rocha

    2015-01-01

    Homem, 84 anos, com antecedentes de hipotiroidismo e alterações cutâneas recentes compatíveis com esclerodermia, confirmadas em biópsia cutânea, mas com estudo auto-imune negativo. Foi internado por queixas constitucionais. Ao exame objetivo, apresentava-se emagrecido, com lesões de vitiligo nas mãos além das de esclerodermia (figura 1) e distensão abdominal com ascite

  10. A literatura é um arquivo (Os fantasmas de Link

    Directory of Open Access Journals (Sweden)

    Raul Antelo

    2010-12-01

    Full Text Available Admitamos que, se a literatura é imune, é porque ela é igualmente autoimune. A literatura é não-literária. Ela é extremamente voraz ou, como diria Link, “la literatura tiene cierta capacidad de incorporarlo todo”. Mas aí se coloca um problema interessante, ao menos para os estudiosos de cinema, aos quais me dirijo, que é a relação entre crítica e montagem.

  11. HAE international home therapy consensus document

    DEFF Research Database (Denmark)

    Longhurst, Hilary J; Farkas, Henriette; Craig, Timothy

    2010-01-01

    ABSTRACT: Hereditary angioedema (C1 inhibitor deficiency, HAE) is associated with intermittent swellings which are disabling and may be fatal. Effective treatments are available and these are most useful when given early in the course of the swelling. The requirement to attend a medical facility ...

  12. HAE international home therapy consensus document

    NARCIS (Netherlands)

    Longhurst, Hilary J.; Farkas, Henriette; Craig, Timothy; Aygoren-Pursun, Emel; Bethune, Claire; Bjorkander, Janne; Bork, Konrad; Bouillet, Laurence; Boysen, Henrik; Bygum, Anette; Caballero, Teresa; Cicardi, Marco; Dempster, John; Gompels, Mark; Gooi, Jimmy; Grigoriadou, Sofia; Huffer, Ursula; Kreuz, Wolfhart; Levi, Marcel M.; Long, Janet; Martinez-Saguer, Inmaculada; Raguet, Michel; Reshef, Avner; Bowen, Tom; Zuraw, Bruce

    2010-01-01

    ABSTRACT: Hereditary angioedema (C1 inhibitor deficiency, HAE) is associated with intermittent swellings which are disabling and may be fatal. Effective treatments are available and these are most useful when given early in the course of the swelling. The requirement to attend a medical facility for

  13. Analysis of characteristics associated with reinjection of icatibant

    DEFF Research Database (Denmark)

    Longhurst, Hilary J; Aberer, Werner; Bouillet, Laurence

    2015-01-01

    PURPOSE: Phase 3 icatibant trials showed that most hereditary angioedema (HAE) (C1 inhibitor deficiency) acute attacks were treated successfully with one injection of icatibant, a selective bradykinin B2 receptor antagonist. We conducted a post hoc analysis of icatibant reinjection for HAE type I...

  14. Angiotensin-converting enzyme insertion/deletion polymorphism ...

    African Journals Online (AJOL)

    The clinical manifestations of KD include per- sistent fever, non-purulent conjunctivitis, diffuse muco- sal inflammation, polymorphous skin rashes, indurative angioedema of the hands and feet, and non-suppurative cervical lymphadenopathy3. In about 20% of patients vasculitis will lead to coronary artery lesions as detect-.

  15. Efficacy and safety of the angiotensin II receptor blocker losartan for hypertrophic cardiomyopathy

    DEFF Research Database (Denmark)

    Axelsson, Anna; Iversen, Kasper; Vejlstrup, Niels

    2015-01-01

    ·0001) confirmed drug compliance; blood pressure did not decrease in the placebo group. Two (2%) patients, both in the placebo group, died from sudden cardiac death during follow-up. In the losartan group, one (1%) patient had angioedema, one (1%) had deterioration of renal function, and one (1%) had hyperkalaemia...

  16. Quincke's oedema of the uvula associated with mucous retention cyst-a case report.

    Science.gov (United States)

    Arunachalam, P S; Ramachandra, C R

    2000-04-01

    We report a rare case of recurrent angioedema of uvula (Quincke's Oedema), causing air way obstruction. A brief review of literature and treatment options are alto included. The histoloigical specimen showed an associated mucous retention eyst, which in conjunction with Quinckc's oedema has not been previously reported.

  17. Quincke’s oedema of the uvula associated with mucous retention cyst-a case report

    OpenAIRE

    Arunachalam, P. S.; Ramachandra, C. R. S.

    2000-01-01

    We report a rare case of recurrent angioedema of uvula (Quincke’s Oedema), causing air way obstruction. A brief review of literature and treatment options are alto included. The histoloigical specimen showed an associated mucous retention eyst, which in conjunction with Quinckc’s oedema has not been previously reported.

  18. Early health technology assessments in pharmacogenomics: a case example in cardiovascular drugs

    NARCIS (Netherlands)

    Geenen, Joost W.; Baranova, Ekaterina V.; Asselbergs, Folkert W.; de Boer, Anthonius; Vreman, Rick A.; Palmer, Colin Na; Maitland-van der Zee, Anke H.; Hövels, Anke M.

    2017-01-01

    Aim: To assess the required characteristics (cost, sensitivity and specificity) of a pharmacogenomic test for being a cost-effective prevention of angiotensin-converting enzyme inhibitors induced angioedema. Furthermore, we assessed the influence of only testing high-risk populations. Materials &

  19. Omalizumab for Chronic Urticaria:

    DEFF Research Database (Denmark)

    Ghazanfar, Misbah Nasheela; Thomsen, Simon Francis

    2017-01-01

    Purpose of Review The purpose of this study was to review real-life studies on effectiveness and safety of omalizumab in chronic urticaria (CU). Recent Findings CU is an itching skin disease characterized by wheals, angioedema, or both (present >6 weeks). Omalizumab is a humanized anti...

  20. Role of tropomyosin as a cross-reacting allergen in sensitization to cockroach in patients from Martinique (French Caribbean island) with a respiratory allergy to mite and a food allergy to crab and shrimp

    NARCIS (Netherlands)

    Purohit, A.; Shao, J.; Degreef, J. M.; van Leeuwen, A.; van Ree, R.; Pauli, G.; de Blay, F.

    2007-01-01

    BACKGROUND: Tropomyosin has been described as cross-reacting allergen between mite, cockroach and shrimp. METHODS: In 13 patients with asthma and/or rhinitis sensitized to mite and/or German cockroach and presenting urticaria, oral allergy syndrome or angio-edema upon eating shrimp and/or crab, we

  1. The Sport’s Bar Grandpa: an unusual left temporo-mandibular and tongue pain

    Directory of Open Access Journals (Sweden)

    Paolo Leandri

    2014-09-01

    Full Text Available This case report describes the condition of an elderly patient admitted to hospital for a new onset headache and pain in the left temporo-mandibular joint, initially incorrectly interpreted as an angioedema, but that evolved into a tongue infarction.

  2. Anaphylaxis to Moringa oleifera: First description

    OpenAIRE

    Lucinda J. Berglund

    2018-01-01

    We describe the first reported case of repeated anaphylaxis after ingestion of Moringa oleifera, causing significant hypotension, angioedema and elevation of serum tryptase. Moringa oleifera seedpod was confirmed as the causative allergen by skin testing with the fresh pod. Moringa oleifera is widely consumed, both as a vegetable and in herbal medicines.

  3. Cold urticaria patients exhibit normal skin levels of functional mast cells and histamine after tolerance induction

    DEFF Research Database (Denmark)

    Kring Tannert, Line; Stahl Skov, Per; Bjerremann Jensen, Louise

    2012-01-01

    Cold urticaria is a skin condition characterized by rapid appearance of itchy wheals and occasionally angioedema in response to cold stimulation. Antihistamines do not sufficiently protect all patients from symptoms, even when used in higher than standard doses. In these patients, desensitization...

  4. Relatório de Estágio Curricular – Centro Hospitalar de Trás-os-Montes e Alto Douro (Vila Real)

    OpenAIRE

    Borges, Vanessa

    2012-01-01

    Durante o período de estágio pude colocar em prática os conhecimentos teóricos que foram adquiridos ao longo do percurso académico. Sem dúvida que é muito importante colocar em prática o conhecimento adquirido e, ao mesmo tempo, trabalhase com um público-alvo, bastante diferenciado, (crianças, jovens, adultos e idosos), e põe-se em prática, acima de tudo, a missão do Animador Sociocultural. Este profissional tem como objetivo promover o desenvolvimento sociocultural de grupos e comunidades, c...

  5. Gestión del conocimiento tácito en el Instituto Nacional de Salud

    OpenAIRE

    Huaillani Chavez, Silvia del Rosario

    2014-01-01

    El presente trabajo aborda la influencia de la cultura organizacional en la transferencia de los conocimientos adquiridos en la institución. En este sentido, tiene como objetivo aplicar un modelo de gestión del conocimiento que permita fortalecer la cultura organizacional y difundir el conocimiento tácito adquirido a través de una plataforma de gestión del conocimiento, a fin de fomentar la interacción y comunicación entre los miembros de la institución. Este modelo de gestión del conocim...

  6. Visión panorámica del sistema inmune

    OpenAIRE

    Paola, Toche P.

    2012-01-01

    El sistema inmune media numerosas patologías, por lo que es importante conocer su estructura y funcionamiento. Se clasifica en innato y adquirido. El sistema inmune innato brinda una temprana e inespecífica respuesta contra los microorganismos. El sistema inmune adquirido humoral y celular nos brinda una respuesta específica para diferentes moléculas, posee memoria frente a los antígenos y diversidad para reaccionar a una gran variedad de antígenos.

  7. Visión panorámica del sistema inmune

    Directory of Open Access Journals (Sweden)

    Toche P. Paola, Dra.

    2012-07-01

    Full Text Available El sistema inmune media numerosas patologías, por lo que es importante conocer su estructura y funcionamiento. Se clasifica en innato y adquirido. El sistema inmune innato brinda una temprana e inespecífica respuesta contra los microorganismos. El sistema inmune adquirido humoral y celular nos brinda una respuesta específica para diferentes moléculas, posee memoria frente a los antígenos y diversidad para reaccionar a una gran variedad de antígenos.

  8. Comunidades virtuales de práctica y aprendizaje

    OpenAIRE

    Rodríguez Illera, José Luis

    2007-01-01

    Las comunidades virtuales, sean de práctica o de aprendizaje según una distinción habitual, han adquirido un lugar central en la sociedad actual, especialmente por los avancestecnológicos y la denominada web social.

  9. Homo modulans (III: de la naturaleza de la música

    Directory of Open Access Journals (Sweden)

    Modesto García Jiménez

    2013-01-01

    Full Text Available Partiendo de lo que pudiéramos llamar extraña universalidad de la música, pueden esgrimirse una serie de consideraciones sobre si la música es un don inherente o por el contrario un lenguaje adquirido, una casualidad sonora externa absolutamente al alma.

  10. Estudio normativo y diseño de un Laboratorio de Ensayos de Materiales Explosivos

    OpenAIRE

    Hernández Rodríguez, José Luis

    2017-01-01

    Se pretende que el alumno utilice los conocimientos adquiridos durante sus estudios de grado para diseñar un Laboratorio en el que poder realizar los ensayos normalizados de las características de los productos explosivos de utilización industrial. Escuela de Ingeniería de Caminos y Minas Universidad Politécnica de Cartagena

  11. Comparative dermatology: acquired digital fibrokeratoma

    OpenAIRE

    Cunha Filho, Roberto Rheingantz da

    2008-01-01

    Demonstra-se quadro característico de fibroqueratoma digital adquirido em trabalhadora rural de 42 anos de idade, que se compara a corno de rinoceronte.It is presented a case of a 42 year-old white female farmer with the classical feature of acquired digital fibrokeratoma, which is compared to rhinoceros horn.

  12. Colonización por Staphylococcus aureus resistente a la meticilina en una unidad de cuidados intensivos de adultos de un hospital colombiano: caracterización fenotípica y molecular con detección de un clon de circulación en la comunidad

    Directory of Open Access Journals (Sweden)

    Narda María Olarte

    2010-09-01

    Conclusiones. El 7,2% de los pacientes que ingresaron a la unidad de cuidados intensivos estaban colonizados con SARM. Éste es el primer reporte de colonización por aislamientos de SARM-ST8-SCCmec IVc adquirido en la comunidad y relacionado genéticamente con el clon pandémico USA300-0114 en Colombia.

  13. Eficácia, uso de medicamentos e gastos no tratamento da artrite reumatoide no sistema único de saúde, 2003 a 2006

    OpenAIRE

    Juliana de Oliveira Costa

    2012-01-01

    A artrite reumatoide (AR) é uma doença autoimune crônica incapacitante, que acarreta perda da qualidade de vida e elevado impacto econômico para os pacientes e para a sociedade. O tratamento medicamentoso inclui utilização de agentes biológicos, como o infliximabe (IFX), que são indicados para pacientes que apresentaram falha terapêutica ao tratamento com Medicamentos Modificadores do Curso da Doença (MMCD). No Sistema Único de Saúde (SUS) estes medicamentos são disponibilizados por meio do C...

  14. Significado do epitope spreading na patogênese dos pênfigos vulgar e foliáceo Significance of epitope spreading in the pathogenesis of pemphigus vulgaris and foliaceus

    Directory of Open Access Journals (Sweden)

    Valéria Aoki

    2008-04-01

    Full Text Available Os pênfigos são dermatoses bolhosas auto-imunes, em que há a produção de auto-anticorpos direcionados contra moléculas de adesão dos epitélios, levando à perda da coesão celular. A produção de auto-anticorpos ocorre quando os pacientes desenvolvem um desequilíbrio da resposta imune (quebra da tolerância imunológica, passando a reconhecer antígenos próprios. A resposta é geralmente direcionada contra um único epítopo alvo; entretanto, como conseqüência da resposta inflamatória do processo primário e do extenso dano tecidual ocasionado, pode haver exposição de componentes protéicos ocultos, levando à produção de diferentes auto-anticorpos. Assim, é possível que surja uma nova doença cutânea auto-imune, em decorrência do fenômeno intra ou intermolecular de epitope spreading. São revistos os principais conceitos desse fenômeno e sua ocorrência nas dermatoses bolhosas auto-imunes, com ênfase nos pênfigos, grupo de dermatoses bolhosas autoimunes mais prevalente no Brasil.Pemphigus comprises autoimmune blistering skin diseases in which autoantibodies directed against antigens (epithelial adhesion molecules are found, leading to loss of cell cohesion. The production of autoantibodies occurs due to an immune imbalance (break of immune tolerance driving to recognition of self- antigens. The response is usually directed against an exclusive target epitope; however, due to the inflammatory response and to the extensive tissue damage, it is possible that the exposure of hidden protein components leads to distinct autoantibody production. Hence, a new autoimmune disease may occur in consequence of an intra- or intermolecular epitope spreading phenomenon. The authors review the main concepts of this phenomenon, and its occurrence in autoimmune blistering diseases, with emphasis on pemphigus, the most prevalent disease of this group in our country.

  15. The need for direct immunofluorescence in the diagnosis of IgA bullous dermatosis

    OpenAIRE

    Chang, Daniel

    2012-01-01

    A dermatose bolhosa por imunoglobulina da classe A linear (DbIgA) do adulto é uma doença autoimune rara caracterizada por formação de bolhas subepidérmicas e depósito linear de imunoglobulina da classe A (IgA) na zona da membrana basal (ZMB). Por possuir aspectos clínicos e histológicos semelhantes a outras dermatoses bolhosas, principalmente a dermatite herpetiforme e o penfigoide bolhoso, faz-se necessária a realização de imunofluorescência direta para confirmação diagnóstica. Apresenta-se ...

  16. Graves Disease And Down Sindrome : Clinical Case

    Directory of Open Access Journals (Sweden)

    Scrinic Olesea

    2015-08-01

    Full Text Available Introduction: Pacients with Down’s syndrome present an increase revalence of autoimune endocrine disorders. We communicate the case of 14 years and 6 months old pacient known with Down syndrome admitted in Endocrinology department with suspicion of hyperthyroidism, the diagnosis being confirmed by hormonal dosage. The particularity of the case consists in: symptomatology onset during puberty, clinical evolution with mild symptoms, without ocular involvement, morphological and functional remission obtained relatively soon after the initiation of antithyroid therapy, lack of posttherapy side effects, favorabile evolution under the “block and replace” therapy

  17. Lúpus eritematoso sistêmico e pancreatite aguda: relato de dois casos

    OpenAIRE

    Azevedo, Ana Beatriz Cordeiro de; Brito, Fabiano Almeida; Santos, Flávia Patrícia Sena Teixeira; Ferreira, Gilda Aparecida; Carvalho, Marco Antônio Parreiras de

    2003-01-01

    A pancreatite aguda é uma manifestação incomum do lúpus eritematoso sistêmico (LES) e a freqüência desta associação não é conhecida. Contudo, a pancreatite aguda é um diagnóstico diferencial importante na avaliação da dor abdominal em pacientes com LES. Os pacientes, normalmente, apresentam dor de intensidade variável, algumas vezes simulando abdome agudo. Vários fatores têm sido implicados na patogênese desta condição, tais como fenômenos autoimunes, vasculite, anticorpos antifosfolípides e ...

  18. A literatura é um arquivo (Os fantasmas de Link

    Directory of Open Access Journals (Sweden)

    Raul Antelo

    2010-05-01

    Full Text Available http://dx.doi.org/10.5007/1984-784X.2010v10n15p34 Admitamos que, se a literatura é imune, é porque ela é igualmente autoimune. A literatura é não-literária. Ela é extremamente voraz ou, como diria Link, “la literatura tiene cierta capacidad de incorporarlo todo”. Mas aí se coloca um problema interessante, ao menos para os estudiosos de cinema, aos quais me dirijo, que é a relação entre crítica e montagem.

  19. Autoimmune progesterone dermatitis in a patient with endometriosis: case report and review of the literature

    Directory of Open Access Journals (Sweden)

    Baldwin James L

    2004-08-01

    Full Text Available Abstract Autoimmune progesterone dermatitis (APD is a condition in which the menstrual cycle is associated with a number of skin findings such as urticaria, eczema, angioedema, and others. In affected women, it occurs 3–10 days prior to the onset of menstrual flow, and resolves 2 days into menses. Women with irregular menses may not have this clear correlation, and therefore may be missed. We present a case of APD in a woman with irregular menses and urticaria/angioedema for over 20 years, who had not been diagnosed or correctly treated due to the variable timing of skin manifestations and menses. In addition, we review the medical literature in regards to clinical features, pathogenesis, diagnosis, and treatment options.

  20. Clinical profile of HIV infection

    Directory of Open Access Journals (Sweden)

    Khopkar Uday

    1992-01-01

    Full Text Available HIV seropositivity rate of 14 percent was observed amongst STD cases. Heterosexual contact with prostitutes was the main risk factor. Fever, anorexia, weight loss, lymphadenopathy and tuberculosis were useful clinical leads. Genital ulcers, especially chancroid, were common in seropositivies. Alopecia of unknown cause, atypical pyoderma, seborrhea, zoster, eruptive mollusca and sulfa-induced erythema multiforme were viewed with suspicion in high risk groups. Purpura fulminans, fulminant chancroid, vegetating pyoderma and angioedema with purpura were unique features noted in this study.

  1. Dermatologic emergencies

    Directory of Open Access Journals (Sweden)

    M.P. Simón Díaz

    2016-01-01

    Full Text Available Dermatologic emergencies represent about 8–20% of the diseases seen in the Emergency Department of hospitals. It is often a challenge for primary care physicians to differentiate mundane skin ailments from more serious, life threatening conditions that require immediate intervention. In this review we included the following conditions: Stevens-Johnson syndrome/toxic epidermal necrosis, pemphigus vulgaris, toxic shock syndrome, fasciitis necrotising, angioedema/urticaria, meningococcemia, Lyme disease and Rocky Mountain spotted fever.

  2. AMINO ACID BLOOD POOL OF CHILDREN WITH ALLERGIC DISEASES

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    Shmulich O. V.

    2014-01-01

    Full Text Available The amino acid blood pool of children with atopic dermatitis, bronchial asthma, urticaria, angioedema was investigated. The variability of blood plasma amino acid content (tryptophan, histidine, tyrosine, cysteine, methionine was observed. The changes of histidine and tryptophan levels might be connected with the formation of biogenic amines, such as histamine, serotonine, with take part in the development of allergic reactions and inflammatory processes in organism.

  3. Hypersensitivity Reactions to Nonsteroidal Anti-Inflammatory Drugs: An Update

    OpenAIRE

    Sánchez-Borges, Mario; Caballero-Fonseca, Fernan; Capriles-Hulett, Arnaldo; González-Aveledo, Luis

    2010-01-01

    After beta lactam antibiotics, hypersensitivity reactions to nonsteroidal antiinflammatory drugs are the second cause of hypersensitivity to drugs. Acute manifestations affect the respiratory tract (aspirin exacerbated respiratory disease), the skin (urticaria and angioedema), or are generalized (anaphylaxis). Correct diagnosis and treatment in order to prevent unnecessary morbidity and the potential risk of death from these severe reactions, and to provide proper medical advice on future dru...

  4. Pattern of drug eruptions in a tertiary care hospital

    International Nuclear Information System (INIS)

    Tahir, Z.; Nadeem, N.; Aman, S.; Kazmi, A.H.

    2013-01-01

    Background: An adverse drug reaction is unintentional which occurs at doses used for prophylaxis, diagnosis or treatment. Objectives: To determine the frequency of various cutaneous drug eruptions that occur in patients in a tertiary care hospital setting. Patients and Methods: All patients with cutaneous drug eruptions seen at the Dermatology Department of Mayo Hospital, Lahore, over 6 months were enrolled and the pattern of drug eruptions like urticaria, angioedema, fixed drug eruption, maculopapular rash, erythema multiforme, Stevens-Johnson syndrome and toxic epidermal necrolysis etc. were recorded, along with drugs that caused it. Results:A total of 160 patients (86 males, 74 females) were included in the study. Mean age of patients was 30.7+-15.4 years. Major eruptions were fixed drug eruption (21.3%) followed by urticaria without angioedema (10%), maculopapular rash (9.3%), lichenoid drug eruption (8.7%), acneiform drug eruption (7.5%), Stevens-Johnson syndrome (6.9%), vesiculobullous eruption (5.6%), erythema multiforme and eczematous eruption (5% each). Common drugs causing eruptions were sulfonamides (16.3%), followed by NSAIDs (14.4%), herbal and homeopathic medications (12.5%), penicillins (9.3%), tetracyclines (8.7%), antituberculous drugs, cephalosporins and antiepileptics (6.3% each). Conclusion: Fixed drug eruption and urticaria without angioedema were commonest eruptions while, sulfonamides and NSAIDs were the major causative drugs. Policy message: Reporting of adverse drug reactions is not done in Pakistan and needs to be done in each hospital. (author)

  5. Determinação de autoanticorpos para antígenos da mielina no soro de pacientes HLA - DQB1*0602 com esclerose múltipla

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    Carvalho Adriana

    2003-01-01

    Full Text Available Esclerose múltipla (EM é doença inflamatória desmielinizante do sistema nervoso central (SNC de natureza autoimune, mediada por linfócitos Th1. A produção de autoanticorpos séricos para proteína básica da mielina (MBP, proteolipídeo PLP e sequência da glicoproteína de oligodendrócito MOG 92-106, foi determinada em 54 indivíduos saudáveis e 26 pacientes com EM expressando ou não o alelo de suscetibilidade HLA-DQB1*0602. Independentemente da expressão do alelo DQB1*0602, todos os pacientes apresentaram produção marcante (p< 0,0001 de autoanticorpos isotipo IgG para MBP e MOG 92-106, e do isotipo IgA para PLP e MOG 92-106. Os resultados sugerem que outros alelos HLA da classe II exerçam influência na suscetibilidade à EM e no reconhecimento imunológico dos antígenos encefalitogênicos, determinando o padrão de resposta autoimune e contribuindo na manutenção e/ou controle da inflamação no SNC.

  6. Doença de Kikuchi-Fujimoto: apresentação de um caso

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    Jailson de Sousa Oliveira

    2017-08-01

    Full Text Available A doença de Kikuchi-Fujimoto (DKF ou linfadenite histiocítica necrotizante é uma doença benigna e auto-limitada, rara, caracterizada por linfadenopatia generalizada, febre e leucopenia. É um importante diagnóstico diferencial com patologias linfoproliferativas, autoimunes, infecciosas, podendo em raros casos estar associada a estas. Relatamos o caso de um paciente de 24 anos, com quadro de febre, linfadenopatia cervical e inguinal e lesões cutaneomucosas. O Fator Anti-Nuclear (FAN foi positivo, hemograma evidenciou pancitopenia, anti-DNA negativo. A biópsia de linfonodo inguinal evidenciou linfadenite histiocítica necrotizante. O paciente evoluiu com piora clínica por atividade de doença associada a sepse, evoluindo com pericardite aguda e tamponamento cardíaco. Realizado pulsoterapia com ciclofosfamida, com melhora substancial das manifestações cutâneas e sistêmicas. O diagnóstico de pacientes com DKF deve implicar necessariamente no seguimento para avaliação do surgimento de doenças autoimunes, assim como doenças infecciosas e linfoproliferativas.

  7. Lupus erythematosus, thyroiditis, alopecia areata and vitiligo – A multiple autoimmune syndrome type 3 case presentation

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    Alin Laurentiu Tatu

    2017-04-01

    Full Text Available The combination of at least three autoimmune diseases in the same patient has defined as multiple autoimmune syndrome (MAS. Abnormalities of T cell-mediated immunity and humoral immunity have been described previously in the literature. Aims of work were to investigate the 22 years old patient with lupus erythematosus for three years and autoimune thyroiditis for one year, regardind other possible autoimmune conditions and to establish a treatment to control the diseases. The clinical exam revealed some circular hairless patches on the beard appeared about three months ago and white depigmented disseminated areas started one month ago and the laboratory investigations were performed. The modified laboratory findings were total IgE 530 UI/mL, Anti-SSA (anti-RO antibodies> 200 IU/mL, SSB negative, Antinuclear antibodies (ANA positive and fine speckled, Lupus anticoagulant testing positive, Anti-thyroid peroxidase antibodies 951 UI/ml, TSH 4,7 µUI/mL. The diagnosis of multiple autoimmune syndrome(MAS type 3 including Lupus erythematosus, autoimune Thyroiditis, Alopecia Areata and Vitiligo was established. Endocrine autoimmunities are associated with autoantibodies that react to specific antigens, whereas patients with collagen diseases synthesize immunoglobulins that recognize nonorgan-specific cellular targets, such as nucleoproteins and nucleic acids. Cellular autoimmunity is important in the pathogenesis MAS. The existence of one autoimmune disorder helps lead to the discovery of other autoimmune conditions.

  8. Demyelinating disease in patients with myasthenia gravis Doenças desmielinizantes em pacientes com miastenia gravis

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    Denis Bernardi Bichuetti

    2008-03-01

    Full Text Available Myasthenia gravis (MG is an autoimmune disease characterized by fluctuating muscle weakness, caused by impaired neuromuscular transmission. Patients with MG can present other autoimmune diseases in association, commonly hypo or hyperthyroidism. The association of MG to demyelinating disease is rare and has been described before. We report on three Brazilian patients with MG that presented distinct demyelinating diseases, two monophasic and one recurrent neuromyelitis optica, several years after the diagnosis of MG, and discuss their clinical courses.Miastenia gravis (MG é doença autoimune caracterizada por episódios de fraqueza muscular alternados com melhora, causada por bloqueio da junção neuromuscular. Pacientes com MG podem apresentar outras doenças autoimunes, comumente hipo ou hipertiroidismo, e a associação de MG com doenças desmielinizantes é raramente descrita. Relatamos três pacientes brasileiros com MG que desenvolveram doenças desmielinizantes, dois monofásicos e um neuromielite óptica recorrente, vários anos após o diagnóstico de MG e discutimos seus cursos clínicos.

  9. Qualidade de vida em urticária crônica: inquérito em ambulatório público universitário, Botucatu (Brasil Quality of life in chronic urticaria: a survey at a public university outpatient clinic, Botucatu (Brazil

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    Maria Regina Cavariani Silvares

    2011-10-01

    Full Text Available OBJETIVO: Avaliar o impacto da urticária crônica na qualidade de vida dos pacientes de ambulatório universitário a partir do questionário DLQI (Dermatology Life Quality Index. MÉTODOS: Inquérito sobre o impacto na qualidade de vida infligido pela urticária crônica a partir do questionário DLQI validado para a língua portuguesa. Pacientes foram entrevistados durante suas consultas em ambulatório especializado, entre maio de 2009 e maio de 2010, em serviço público brasileiro (Botucatu-SP. Os escores do DLQI foram analisados segundo subgrupos: idade, gênero, escolaridade, tempo de doença e presença de angioedema. RESULTADOS: Foram entrevistados 100 pacientes com urticária crônica. Predominou o gênero feminino (86%, a idade média foi de 41,8 anos, duração média da doença foi de seis anos e angioedema ocorreu em 82% dos pacientes. O escore médio do DLQI foi de 13,5, caracterizando grave impacto à qualidade de vida, superior a hanseníase, psoríase, eczema atópico e carcinoma basocelular. Presença de angioedema se associou a maiores escores: 14,5 x 9,9 (p OBJECTIVE: To evaluate the impact of chronic urticaria on quality of life of outpatients through the university questionnaire Dermatology Life Quality Index (DLQI. METHODS: Survey of the impact on quality of life caused by chronic urticaria, using the DLQI questionnaire validated for the Portuguese language. Patients were interviewed during visits to a specialized outpatient clinic between May 2009 and May 2010 at a Brazilian public service (Botucatu-SP. DLQI scores were analyzed according to the following subgroups: age, gender, education, disease duration, and presence of angioedema. RESULTS: We interviewed 100 patients with chronic urticaria. There was a female predominance (86%, mean age 41.8 years, mean disease duration of 6 years, and angioedema occurrence in 82% of patients. The mean DLQI score was 13.5, characterized by serious impact on quality of life, higher

  10. ¿Cuán rentable es la educación superior en Colombia?

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    Gustavo Hernández

    2010-01-01

    Full Text Available En este trabajo se analiza la rentabilidad de la educación superior en Colombia, particularmente, la hipótesis de screening, esto es, la importancia del capital humano adquirido. Se utilizó una nueva base de datos para la educación superior, la cual ha sido construida a partir de los registros administrativos de las instituciones de educación superior, y es cruzada con la base de aportantes de seguridad social. Se encuentra que el mercado laboral colombiano valora mucho la institución de la cual se gradúa el individuo, seguido por la elección de la carrera. Adicionalmente, la experiencia lograda posterior a la graduación tiene una mayor rentabilidad que la experiencia independiente de la clase de capital humano adquirido.

  11. Importancia de la estadística descriptiva en la investigación

    OpenAIRE

    María Elena Delvasto Jaimes

    2006-01-01

    En todo el mundo las empresas cuentan en sus inventarios con recursos de toda índole: talento humano, materias primas, energía y know how, entre otros. A partir de la invención del computador, los datos han adquirido una relevancia inusitada como patrimonio cuyo valor depende directamente del tratamiento que se les dé.

  12. Terapias cognitivo-conductuales en la fobia social, en adultos

    OpenAIRE

    San Vicente Montalbán, Ainara

    2015-01-01

    La fobia social es una enfermedad psiquiátrica que causa costes socioeconómicos significativos y que presenta una alta comorbilidad. Las terapias cognitivo-conductuales (TCC) pueden ser una alternativa de tratamiento efectiva, ya que buscan el cambio de pensamientos y comportamientos adquiridos en una enfermedad con un alto componente de aprendizaje. Objetivo: Verificar la efectividad de las terapias cognitivo-conductuales (TCC) con respecto a otros tratamientos empleados en la fobia soci...

  13. humano en Costa Rica

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    Luis Guillermo Loría

    2007-01-01

    Full Text Available Usando la técnica de espectrometría gamma y protocolos estandarizados, a nivel latinoamericano, se midió la actividad específica en Bq kg-1 de productos alimentarios y agua, ambos productos fueron adquiridos directamente en los supermercados. Los descendientes de uranio y torio, así como isótopos antropogénicos, no fueron encontrados. K 40 es el único isótopo natural presente en los productos.

  14. Comportamiento de bacilos gram negativos hospitalarios frente a germicidas iodóforos

    OpenAIRE

    Penacca, Alejandra C.; Magariños, María del Carmen; Guillén, María G.

    1999-01-01

    Las infecciones hospitalarias han adquirido una relevante importancia debido a la aparición de microorganismos resistentes a numerosos agentes biocidas. La flora residente hospitalaria se encuentra frecuentemente en ropas, alimentos, equipos biomédicos e incluso soluciones de desinfectantes, en un ambiente relativamente pequeño donde conviven los pacientes que en la mayoría de los casos tienen disminuidos sus mecanismos naturales de defensa, quedando fácilmente expuestos a las distintas y num...

  15. El gabinete de Comunicación como impulsor de la gestión comunicativa de los clubes de fútbol / Press Office as a driver of communicative management of football clubs

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    Fernando OLABE-SÁNCHEZ

    2015-01-01

    Full Text Available En este trabajo nos planteamos determinar el concepto y las funciones de los gabinetes de Comunicación, en aras de comprender posteriormente la importancia que han adquirido estos departamentos en un sector como el de los clubes de fútbol profesionales, toda vez que el comportamiento de estas entidades se encuadra más en los modelos empresariales que en los meramente deportivos.

  16. Cambio climático

    OpenAIRE

    Sánchez Campos, L.; Rodríguez, L.M.; Sansón Abascal, C.M.

    2011-01-01

    Para entender esta problemática, en lenguaje ameno y didáctico, profusamente ilustrado se ofrecen conceptos importantes como efecto invernadero, calentamiento global, zonas vulnerables, entre otros. Describe además que han hecho, hacen y harán los niños cubanos para mitigar el cambio climático. Al final, pueden comprobar los conocimientos adquiridos a través de juegos y conocer nuevas palabras en el glosario ofrecido.

  17. Importancia de la estadística descriptiva en la investigación

    Directory of Open Access Journals (Sweden)

    María Elena Delvasto Jaimes

    2006-01-01

    Full Text Available En todo el mundo las empresas cuentan en sus inventarios con recursos de toda índole: talento humano, materias primas, energía y know how, entre otros. A partir de la invención del computador, los datos han adquirido una relevancia inusitada como patrimonio cuyo valor depende directamente del tratamiento que se les dé.

  18. Etiología del colesteatoma ótico

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    Julianis Loraine Quintero Noa

    2011-12-01

    Full Text Available El colesteatoma es una estructura quística caracterizada por la presencia de epitelio escamoso productor de queratina, que sustituye o recubre la mucosa normal en la hendidura del oído medio y ápex petroso, y puede ser causa de hipoacusia irreversible, destrucción ósea y graves complicaciones por su crecimiento expansivo. Clásicamente se describen los colesteatomas en congénitos y adquiridos. La etiología de su formación es multifactorial y continúa siendo poco claro y controversial. Se reportan diferentes teorías que han tratado de explicar el colesteatoma congénito, la transición de un bolsillo de retracción hasta la aparición del colesteatoma adquirido primario, y otras en la génesis del colesteatoma adquirido secundario. Se describe la presencia de algunas citoquinas dentro del colesteatoma que inducen la hiperproliferación e invasión incoordinada de los queratinocitos de la piel del conducto auditivo externo y la pars fláccida, más agresiva en el colesteatoma adquirido pediátrico, y que desempeñan un papel fundamental en la proliferación y en la apoptosis del queratinocito. En cultivo in vitro de una muestra de tejido colesteatomatoso, se ha identificado recientemente que el TNF-a estimula la producción de la IL-8. Se considera de interés ofrecer esta revisión sobre la etiología del colesteatoma, que aún se mantiene en el campo de la investigación y continúa siendo un reto para los otocirujanos por su alta incidencia de recidivas y posibles complicaciones.

  19. Hiperión: sistema personalizado para la recomendación de actividades en base a competencias no adquiridas

    OpenAIRE

    Serrano-Guerrero, Jesús; Cerezo, Andrés; Romero, Francisco P.; Olivas, José A.; Menéndez-Domínguez, Víctor

    2011-01-01

    El presente trabajo muestra una herramienta llamada Hiperión cuyo objetivo es la recomendación de actividades evaluables de forma personalizada, con el fin de que aquellos alumnos que no hayan adquirido una serie de competencias a lo largo del periodo de clases lectivas, las adquieran durante los periodos extraordinarios. Dicha herramienta permite varias funcionalidades que otros sistemas como Moodle no permiten. Entre estas funcionales encontramos la definición ...

  20. Ejecución de créditos derivados de contratos bancarios

    OpenAIRE

    Gómez de Liaño Diego, Rosa

    1998-01-01

    El tráfico mercantil y su desarrollo ha dado lugar a la implantación de relaciones y situaciones contractuales que se han abierto paso muy deprisa, y forman parte de nuestro entorno y dentro de esa corriente los contratos bancarios, que tienen como objeto principal la concesión de crédito , han adquirido una dimensión principal, adoptando formas y peculiaridades derivadas de las exigencias de cada momento.

  1. Análisis, diseño y desarrollo de una plataforma prototipo para el envío de publicidad a través de redes inalámbricas de área personal, entre dispositivos fijos y móviles mediante tecnología bluetooh

    OpenAIRE

    Herrera Calvopiña, Cristian Vinicio; Sanguano Mantilla, David Alejandro

    2013-01-01

    La realización del proyecto esta dado por el anhelo de crear una herramienta informática que facilite el envío de publicidad sin contaminación y desperdicio de recursos naturales de manera sencilla y de menor costo utilizando los conocimientos adquiridos en toda la carrera cursada e implementar dichos conocimientos en las cátedras como proyectos de software, gerencia informática, base de datos y programación.

  2. Retinosquises

    Directory of Open Access Journals (Sweden)

    Manuel A P Vilela

    2011-04-01

    Full Text Available Retinosquise traduz a separação anômala das camadas retinianas, podendo ser congênita, adquirida ou secundária a situações como a miopia, trauma e vasculopatias. Reúne-se as principais características clínicas, recentes opções diagnósticas e as formas de manejo dos quadros ligados ao cromossoma X e aos adquiridos.

  3. Proyecto gestor fiducia - fondos actualización de versión del sistema gestor fiducia - fondos

    OpenAIRE

    González, Evelyn; Triviño, Aracely; Murillo, Ingrid

    2011-01-01

    La empresa de soluciones empresariales Gestor dirige este proyecto al Banco Nacional de Vivienda conocido por sus siglas BNV el cual es una institución con nacionalidad Venezolana. El BNV dentro de sus competencias tiene satisfacer las necesidades de vivienda y hábitat para la familia Venezolana para cumplir con este objetivo gestiona los recursos humanos, financieros y tecnológicos asociados a los planes de vivienda y fideicomiso. BNV ha adquirido el sistema Gestor Fiducia - Fondos de...

  4. Diphyllobothrium latum: relato de caso no Brasil

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    Emmel Vanessa Erichsen

    2006-01-01

    Full Text Available Difilobotriose é causada em humanos pela infecção com vermes adultos do gênero Diphyllobothrium adquiridos pelo consumo de peixe cru ou mal cozido. Diphyllobothrium latum foi confirmado pelo exame dos proglotes grávidos e típicos ovos operculados nas fezes. O paciente havia comido crustáceos e peixes. É o relato do primeiro brasileiro infectado.

  5. Liderazgo y comunicación Interna. Welcome to my reality

    OpenAIRE

    Sánchez Gómez, María

    2015-01-01

    La comunicación interna ha adquirido gran protagonismo en la actualidad y se están imponiendo nuevas formas de liderazgo personal en las empresas. La conferencia analiza los nuevos modelos y la importancia que hoy tiene la comunicación interna, que se ha convertido en imprescindible. Universidad de Málaga. Campus de Excelencia Internacional Andalucía Tech.

  6. Estudo da qualidade de vida nos pacientes com urticária crônica Quality of life assessment in patients with chronic urticaria

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    Ana Paula Fusel de Ue

    2011-10-01

    Full Text Available FUNDAMENTOS: A urticária crônica compromete o doente por interferir nas atividades diárias, prejudicar a autoestima e as relações interpessoais. Os profissionais de saúde subestimam seu impacto na qualidade de vida dos doentes. OBJETIVOS: Avaliar a qualidade de vida com questionário específico e genérico. Compará-la entre os tipos clínicos de urticária crônica e avaliar se o angioedema piora a qualidade de vida. MÉTODOS: Participaram 62 doentes com urticária crônica, com sinais e sintomas da doença até 7 dias da consulta, que foram divididos em urticária crônica comum, urticária crônica física e urticária crônica mista. RESULTADOS: Observou-se predominância de mulheres (72,6%, idade média de 39,8 anos, angioedema associado em 75,8% dos doentes. Apresentaram mais angioedema doentes com urticária crônica comum (p=0,011 e mulheres (p=0,024. Quanto aos tipos clínicos, 32,3% apresentaram urticária crônica comum, 27,4% urticária crônica física e 40,3% urticária crônica mista. O escore médio total do questionário específico foi 10,4. No questionário específico, os domínios mais comprometidos foram "Sintomas e sentimentos" e "Atividades diárias", e, no SF-36, "Aspectos físicos" e "Vitalidade". Houve comprometimento da qualidade de vida nas mulheres, nos doentes com até 30 anos, em primeira consulta, nos mais escolarizados, naqueles com até 1 ano de doença e naqueles com angioedema. CONCLUSÃO: A urticária crônica compromete a qualidade de vida medida pelos questionários específico e genérico. Não houve diferença estatisticamente significante na qualidade de vida entre os tipos clínicos. A presença do angioedema conferiu pior qualidade de vida aos doentes. Houve correlação estatisticamente significante entre os escores do questionário específico e do questionário genérico.BACKGROUND: Chronic urticaria affects patients by interfering with their daily activities, damaging their self-esteem and

  7. Sepse por Staphylococus aureus resistente à meticilina adquirida na comunidade no sul do Brasil Sepsis due to community-acquired methicillin-resistant Staphylococcus aureus in southern Brazil

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    Luciane Cristina Gelatti

    2009-08-01

    Full Text Available Staphylococcus aureus resistente à meticilina foi inicialmente descrito como um típico microrganismo adquirido em infecções nosocomiais. No entanto, nos últimos anos Staphylococcus aureus resistente à meticilina adquirido na comunidade é causa de infecções de pele e tecidos moles, mas infecções graves como pneumonia e sepse podem ocorrer. Este relato descreve um caso de sepse em criança, complicado com pneumonia secundária a lesão em partes moles por Staphylococcus aureus resistente à meticilina adquirido na comunidade no Sul do Brasil. O paciente foi atendido em Unidade de Emergência com história de ferimento provocado por trauma em membro inferior que evoluiu para celulite, pneumonia e sepse.Methicillin-resistant Staphylococcus aureus was initially described as a typical microorganism acquired in nosocomial infections. However, over recent years, community-acquired methicillin-resistant Staphylococcus aureus has been a cause of skin and soft-tissue infections. Serious infections such as pneumonia and sepsis can also occur. This report describes a case of sepsis in a child that was complicated by pneumonia secondary to soft tissue lesions that were due to community-acquired methicillin-resistant Staphylococcus aureus in southern Brazil. The patient was attended at the Emergency Unit with a history of injury caused by lower-limb trauma that evolved to cellulitis, pneumonia and sepsis.

  8. Associação de imunodeficiência primária com lúpus eritematoso sistêmico: revisão da literatura e as lições aprendidas pela Divisão de Reumatologia de um hospital universitário terciário em São Paulo

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    Paolo Ruggero Errante

    2016-02-01

    Full Text Available Resumo As imunodeficiências primárias (IDP representam um grupo heterogêneo de doenças resultantes de defeitos hereditários no desenvolvimento, na maturação e na função normal de células do sistema imunológico; assim, tornam os indivíduos suscetíveis a infecções recorrentes, alergia, autoimunidade e doenças malignas. Neste estudo retrospectivo descrevem-se doenças autoimunes (DAI, em especial o lúpus eritematoso sistêmico (LES, que surgiram associadas ao curso das IDP. Classicamente, a literatura descreve três grupos de IDP associadas ao LES: (1 deficiência de componentes da via do complemento, (2 defeitos na síntese de imunoglobulinas e (3 doença granulomatosa crônica (DGC. Na atualidade, outras IDP têm sido descritas como manifestações clínicas do LES, como a síndrome de Wiskott-Aldrich (WAS, a poliendocrinopatia autoimune-candidíase-distrofia ectodérmica (APECED, a síndrome linfoproliferativa autoimune (ALPS e a linfocitopenia idiopática CD4+. Também são apresentados achados de uma coorte de adultos do ambulatório da Divisão de Reumatologia da Universidade Federal de São Paulo. As manifestações de IDP encontradas pelo nosso grupo de estudo foram consideradas leves em termos de gravidade de infecções e mortalidade no início da vida. Assim, é possível que alguns estados de imunodeficiência sejam compatíveis com a sobrevivência em relação à suscetibilidade infecciosa; no entanto, esses estados podem representar um fator de predisposição forte para o desenvolvimento de doenças imunológicas, como observado no LES.

  9. Effective treatment of different phenotypes of chronic urticaria with omalizumab: Case reports and review of literature.

    Science.gov (United States)

    Kasperska-Zajac, A; Jarząb, J; Żerdzińska, A; Bąk, K; Grzanka, A

    2016-06-01

    Despite the excellent efficacy and safety profile of omalizumab in chronic spontaneous urticaria (CSU), there are scarce data concerning its role in the treatment of refractory cases with different phenotypes of urticaria. We describe our experience with the therapy of nine patients with CSU co-existing with delayed pressure urticaria (DPU) or angioedema or both and refractory to treatment with high-dose antihistamines. The first patient, with severe CSU and recurrent angioedema, did not respond well to cyclosporine A or corticosteroids and suffered from numerous side effects of long-term corticosteroid therapy. The second patient presented with severe symptoms of DPU, which first of all prevented any daily activities of the professional routines. Both patients showed a complete remission of urticaria after the first injection of omalizumab. The third patient with CSU and severe DPU had been ineffectively treated for more than 20 years with various medications. Following the administration of omalizumab, the symptoms of CSU subsided but those of DPU intensified, and the drug was withdrawn after two cycles. In another four patients with refractory CSU and angioedema, the symptoms subsided after the first administration of omalizumab, and the patients have been in remission for about 5 weeks. In the remaining two patients, the symptoms did not resolve despite four 300 mg doses of omalizumab. It is important to establish a therapeutic regimen with omalizumab (150-300 mg; every 4-8 weeks) tailored to individual patient's needs and dependent on the type of urticaria; this may minimize unnecessary the medication exposure, adverse drug effects, and healthcare costs. © The Author(s) 2015.

  10. A case report: Nursing interventions on a patient with anaphylactic shock in ICU.

    Science.gov (United States)

    Zariquiey-Esteva, G; Santa-Candela, P

    The care plan of a 42-year-old woman with anaphylactic shock, secondary to ingestion of amoxicillin/clavulanic acid, with upper airway involvement due to laryngeal angioedema, is presented. Previously she had had two episodes of angioedema of unknown origin. The incidence of this phenomenon is between 3.2 and 10 cases/100,000 people/year. An evaluation was made and three altered necessities stood out: breathing and circulation (she needed mechanical ventilation and noradrenalin perfusion), elimination (she required furosemide to keep an acceptable diuresis time), and hygiene and skin protection (she presented generalised hyperaemia, lip, lingual and oropharyngeal oedema). The hospital's Clinical Research Ethics Committee requested the patient's informed consent to access her clinical history. According to the altered necessities, seven diagnoses were prioritised according to NANDA taxonomy: risk of allergic response, risk of infection, risk of ineffective renal perfusion, decreased cardiac output, impaired spontaneous ventilation, risk of unstable blood glucose level, and risk of dysfunctional gastrointestinal motility. Scores of outcome criteria showed a favourable evolution after 24hours. The development of a standardised NANDA-NOC-NIC language in the clinical case presented allowed us to organise the nursing work, facilitating recording and normalising clinical practice. As a limitation of this case, we didn't have serial plasma levels of histamine and tryptase to assess the evolution of anaphylactic symptoms. Highlight the importance of health education in a patient with a history of angioedema. Copyright © 2016 Sociedad Española de Enfermería Intensiva y Unidades Coronarias (SEEIUC). Publicado por Elsevier España, S.L.U. All rights reserved.

  11. A Study on Brown Seaweed Therapy ( Sargassum sp. toward MDA Levels and Histological Improvement on Rat Foot Suffering Rheumatoid Arthritis

    Directory of Open Access Journals (Sweden)

    Fauziah Fauziah

    2013-07-01

    Full Text Available Rheumatoid arthritis (AR, an autoimun disease, is characterized by the inflammation in the joint area caused an excessive of free radicals. An excessive of free radicals in the body cause oxidative stress, that increasing levels of malondialdehyde (MDA as an indicator of lipid peroxidation and the decreasing levels of anti-oxidants. The treated with extract of brown seaweed (Sargassum sp. intended to find out the MDA levels in serum and the histological of the foot joints rheumatoid arthritis rats. Malondialdehyde levels are determined through a TBA test (Thio Barbituric acid, meanwhile the histological of the rat foot joints was determined by Hematoxylen-Eosin staining (HE. The results showed the brown seaweed extract therapy (Sargassum sp. was significantly (p <0.01 reduce levels of malondialdehyde (MDA in the serum of 21,24% and improving histological foot joints rheumatoid arthritis rats.

  12. Trombose coronariana como primeira complicação da aíndrome antifosfolípide

    Directory of Open Access Journals (Sweden)

    Carlos Henrique Miranda

    2012-04-01

    Full Text Available A síndrome do anticorpo antifosfolípide (SAF é uma trombofilia autoimune, caracterizada pela presença de anticorpos plasmáticos contra fosfolípides, associada a episódios recorrentes de trombose venosa e/ou arterial e morbidade gestacional (especialmente abortamento de repetição. Reportamos o caso de uma paciente feminina, jovem, com diagnóstico de lúpus eritematoso sistêmico (LES, associado à presença de anticorpos antifosfolípide de longa data, com apresentação de infarto agudo do miocárdio (IAM por trombose proximal da artéria descendente anterior como primeira complicação clínica da SAF.

  13. Penfigoide bolhoso no adulto mais jovem: relato de três casos Bullous pemphigoid in younger adults: three case reports

    Directory of Open Access Journals (Sweden)

    Roberta Richter Zanella

    2011-04-01

    Full Text Available O penfigoide bolhoso é uma dermatose bolhosa autoimune subepidérmica, mais comumente observada na população idosa (acima dos 70 anos. Autoanticorpos são formados contra antígenos específicos da zona de membrana basal: BP180 e BP230 (proteínas do hemidesmossomo. Apresentamos três casos de penfigoide bolhoso, em adultos com menos de 50 anos de idade, destacan do as peculiaridades clínicas na faixa etária mais jovem.Bullous pemphigoid is an autoimmune subepidermal bullous dermatosis more commonly observed in the elderly (over 70 years old. Autoantibodies are produced for specific antigens of the epidermal basement membrane zone: BP 180 and BP 230 (hemidesmosome proteins. We report three cases of bullous pemphigoid in adults younger than 50 years old, discussing the clinical characteristics of the disease in younger patients.

  14. Miastenia gravis análise de 90 casos tratados com timectomia myasthenia gravis

    Directory of Open Access Journals (Sweden)

    Almeida Fábio Henrique Souza

    2000-01-01

    Full Text Available A Miastenia Gravis é uma doença auto-imune caracterizada por auto-anticorpos contra receptores nicotínicos de acetilcolina da placa neural. O tratamento clínico básico para as formas generalizadas é feito com drogas anticolenesterásicas, mas em algumas fases podem ser necessários outras modalidades de tratamento, tais como a corticoterapia e a plasmaferese. O tratamento cirúrgico, a timectomia, é uma forma de abordar a causa base da doença e tem resultados bastante encorajadores, visto que é atribuída ao timo a produção dos auto-anticorpos. Apresentamos neste trabalho o quadro clínico, os resultados cirúrgicos e as alteração anátomo-patológicas dos 90 casos estudados.

  15. Febre reumática: um modelo animal para uma vacina humana

    OpenAIRE

    Flavio Ferraz de Paes e Alcantara

    2006-01-01

    A febre reumática é um bom exemplo de uma doença auto-imune deflagrada por um processo infeccioso. Num prazo de uma a quatro semanas após a resolução de uma faringite não tratada por cepas reumatogênicas de S. pyogenes, o organismo de um hospedeiro susceptível desencadeia uma resposta imune contra grandes articulações, coração, tecidos subcutâneos e cérebro. Acredita-se que elementos presentes na bactéria e reconhecidos durante a infecção na orofaringe, sejam confundidos com estruturas própri...

  16. Manifestações bucais em pacientes com hipogamaglobulinemia

    OpenAIRE

    Karin Sá Fernandes

    2010-01-01

    A hipogamaglobulinemia é uma alteração da imunidade humoral caracterizada por baixos níveis séricos de anticorpos podendo ter causas primárias e secundárias. Estes pacientes apresentam uma susceptibilidade a infecções bacterianas de repetição ou crônicas, principalmente do trato respiratório. Além disso, há alta prevalência de doenças gastrointestinais infecciosas e inflamatórias, hepatite C, doenças auto-imunes, doenças linfoproliferativas e granulomatosas. Ainda que a doença seja conhecida ...

  17. Síndrome de Overlap - um caso clínico

    Directory of Open Access Journals (Sweden)

    Denise Lopes

    2014-09-01

    Full Text Available Os autores apresentam um doente de 72 anos com um quadro de alterações cutâneas, dispneia e diminuição de força muscular de agravamento progressivo com cerca de um ano de evolução. Após investigação exaustiva concluiu-se pela presença simultânea de esclerodermia e miopatia inflamatória. As síndromes de overlap caracterizam-se pela presença no mesmo doente de duas ou mais doenças autoimunes. Um dos exemplos desta síndrome é a associação de esclerodermia com polimiosite, de ocorrência pouco frequente

  18. Carcinoma papilífero da tireoide e suas variantes histológicas associados à tireoidite de Hashimoto

    OpenAIRE

    Neves Júnior, Murilo Pedreira; Camandaroba, Marcos Pedro Guedes; Almeida, Marco Antônio Cardoso de; Miranda, Julia Souto

    2009-01-01

    p. 389-393 INTRODUÇÃO E OBJETIVO: A associação entre o carcinoma papilífero da tireoide e suas variantes e a tireoidite de Hashimoto (TH) é bastante questionada no meio científico, pois compartilham diversos aspectos morfológicos, imuno-histoquímicos e biomoleculares. Os tumores da tireoide representam mais de 90% de todos os cânceres endócrinos e são caracterizados por alterações genéticas, entre as quais envolvem RET (rearranjos) e BRAS, RAS, P53 (mutações). Já a TH é uma doença autoimun...

  19. Thyroid papillary carcinoma and histologic variants linked to Hashimoto disease

    OpenAIRE

    Neves Junior, Murilo Pedreira; Camandaroba, Marcos Pedro Guedes; Almeida, Marco Antônio Cardoso de; Miranda, Julia Souto

    2009-01-01

    INTRODUÇÃO E OBJETIVO: A associação entre o carcinoma papilífero da tireoide e suas variantes e a tireoidite de Hashimoto (TH) é bastante questionada no meio científico, pois compartilham diversos aspectos morfológicos, imuno-histoquímicos e biomoleculares. Os tumores da tireoide representam mais de 90% de todos os cânceres endócrinos e são caracterizados por alterações genéticas, entre as quais envolvem RET (rearranjos) e BRAS, RAS, P53 (mutações). Já a TH é uma doença autoimune, caracteriza...

  20. Carcinoma papilífero da tireoide e suas variantes histológicas associados à tireoidite de Hashimoto

    OpenAIRE

    Neves Junior,Murilo Pedreira; Camandaroba,Marcos Pedro Guedes; Almeida,Marco Antônio Cardoso de; Miranda,Julia Souto

    2009-01-01

    INTRODUÇÃO E OBJETIVO: A associação entre o carcinoma papilífero da tireoide e suas variantes e a tireoidite de Hashimoto (TH) é bastante questionada no meio científico, pois compartilham diversos aspectos morfológicos, imuno-histoquímicos e biomoleculares. Os tumores da tireoide representam mais de 90% de todos os cânceres endócrinos e são caracterizados por alterações genéticas, entre as quais envolvem RET (rearranjos) e BRAS, RAS, P53 (mutações). Já a TH é uma doença autoimune, caracteriza...

  1. Púrpura trombocitopênica idiopática e linfoma não-Hodgkin de células T na infância

    OpenAIRE

    Borges,Alessandra C.; Pizza,Maria; Borsato,Maria Luisa; Silva,Helena R. M.; Castro,Helaine C.; Luporini,Silvia M.; Bruniera,Paula

    2006-01-01

    Os linfomas representam 10% de todos os tumores malignos da infância e, destes, os linfomas não-Hodgkin são os mais freqüentes. Crianças com doenças auto-imunes apresentam maior probabilidade de desenvolver doenças linfoproliferativas, podendo ocorrer antes, durante ou após o aparecimento da neoplasia. A associação de púrpura trombocitopênica idiopática e linfomas é infreqüente (3%), principalmente na faixa etária pediátrica. Duas teorias tentam explicar a origem desta associação. Na primeira...

  2. Doença de Graves associada à artrite idiopática juvenil Graves' disease associated with juvenile idiopathic arthritis

    Directory of Open Access Journals (Sweden)

    Vanessa de Matos Santos Mendonça Marques

    2011-04-01

    Full Text Available Os autores relatam o caso de uma menina de 10 anos de idade com diagnóstico de doença de Graves (DG, em tratamento com propiltiouracil, que desenvolveu uveíte e artrite poliarticular e cuja mãe também tem DG e lúpus discoide. São discutidos os diagnósticos diferenciais de artrite inflamatória que surge em uma criança com doença tireoidiana autoimune medicada com drogas antitireóideas.The authors report the case of a 10-year-old girl with Graves' disease (GD, treated with propylthiouracil, who developed uveitis and polyarticular arthritis, and whose mother also had GD and discoid lupus. The differential diagnosis of inflammatory arthritis that appears in a child with autoimmune thyroid disease managed with antithyroid drugs is discussed.

  3. Hepatite aguda colestática pelo propiltiouracil: relato de caso

    Directory of Open Access Journals (Sweden)

    PAROLIN Mônica Beatriz

    2000-01-01

    Full Text Available Propiltiouracil é uma droga amplamente utilizada no tratamento do hipertiroidismo. A hepatotoxicidade é um dos efeitos colaterais mais raros e também mais graves associados a ela. Relata-se um caso de hepatite aguda colestática que acomete um jovem de 15 anos em uso de propiltiouracil para tratamento de hipertiroidismo. Causas virais, metabólicas e autoimunes foram excluídas e a biopsia hepática revelou achados histopatológicos sugestivos de hepatite colestática induzida por droga. Com a suspensão da droga, houve remissão dos sintomas e normalização progressiva das provas de função hepática. Raramente, os pacientes em uso de propiltiouracil podem desenvolver injúria hepática grave.

  4. AUTOIMMUNE HEPATITIS

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    Yusri Dianne Jurnalis

    2010-05-01

    Full Text Available AbstrakHepatitis autoimun merupakan penyakit inflamasi hati yang berat dengan penyebab pasti yang tidak diketahui yang mengakibatkan morbiditas dan mortalitas yang tinggi. Semua usia dan jenis kelamin dapat dikenai dengan insiden tertinggi pada anak perempuan usia prepubertas, meskipun dapat didiagnosis pada usia 6 bulan. Hepatitis autoimun dapat diklasifikasikan menjadi 2 bagian berdasarkan adanya antibodi spesifik: Smooth Muscle Antibody (SMA dengan anti-actin specificity dan/atau Anti Nuclear Antibody (ANA pada tipe 1 dan Liver-Kidney Microsome antibody (LKM1 dan/atau anti-liver cytosol pada tipe 2. Gambaran histologisnya berupa “interface hepatitis”, dengan infiltrasi sel mononuklear pada saluran portal, berbagai tingkat nekrosis, dan fibrosis yang progresf. Penyakit berjalan secara kronik tetapi keadaan yang berat biasanya menjadi sirosis dan gagal hati.Tipe onset yang paling sering sama dengan hepatitis virus akut dengan gagal hati akut pada beberapa pasien; sekitar sepertiga pasien dengan onset tersembunyi dengan kelemahan dan ikterik progresif ketika 10-15% asimptomatik dan mendadak ditemukan hepatomegali dan/atau peningkatan kadar aminotransferase serum. Adanya predominasi perempuan pada kedua tipe. Pasien LKM1 positif menunjukkan keadaan lebih akut, pada usia yang lebih muda, dan biasanya dengan defisiensi Immunoglobulin A (IgA, dengan durasi gejala sebelum diagnosis, tanda klinis, riwayat penyakit autoimun pada keluarga, adanya kaitan dengan gangguan autoimun, respon pengobatan dan prognosis jangka panjang sama pada kedua tipe.Kortikosteroid yang digunakan secara tunggal atau kombinasi azathioprine merupakan terapi pilihan yang dapat menimbulkan remisi pada lebih dari 90% kasus. Strategi terapi alternatif adalah cyclosporine. Penurunan imunosupresi dikaitkan dengan tingginya relap. Transplantasi hati dianjurkan pada penyakit hati dekom-pensata yang tidak respon dengan pengobatan medis lainnya.Kata kunci : hepatitis Autoimmune

  5. Propriedades adesivas e quimiotáticas dos neutrófilos de pacientes com artrite reumatoide e a influência de diferentes medicações

    OpenAIRE

    Venina Marcela Dominical

    2010-01-01

    Resumo: A artrite reumatoide (AR) é uma doença inflamatória crônica, autoimune e sistêmica, caracterizada por ser uma poliartrite simétrica, acometendo preferencialmente os punhos, mãos e pés. O processo patológico que explique a AR ainda permanece desconhecido. A indução da resposta imune, característica da doença, resulta de uma inflamação nas articulações através da infiltração de células inflamatórias que são recrutadas para o tecido sinovial, onde elas aderem às células endoteliais e tra...

  6. Cetirizine-Induced atrial fibrillation

    Directory of Open Access Journals (Sweden)

    Altuğ Osken

    2016-01-01

    Full Text Available Atrial fibrillation (AF is the most common observed arrhythmia in clinical practice. In the literature, AF events associated with drug induction are available. Cetirizine is a second-generation histamine antagonist used in the treatment of allergies, angioedema, and urticaria. We wish to present an atypical case who took cetirizine medication for relieving symptoms of upper tract respiratory system infection, experienced rapid ventricular response AF and treated successfully. To best of our knowledge, this is the first case of cetirizine-induced AF.

  7. Factor XII-independent activation of the bradykinin-forming cascade

    DEFF Research Database (Denmark)

    Joseph, Kusumam; Tholanikunnel, Baby G; Bygum, Anette

    2013-01-01

    and assayed for kallikrein formation. C1-INH was removed from factor XII-deficient plasma by means of immunoadsorption. RESULTS: We demonstrate that prekallikrein-HK will activate to kallikrein in phosphate-containing buffers and that the rate is further accelerated on addition of heat shock protein 90...... the prekallikrein-HK complex to prevent HK cleavage either by prekallikrein or by prekallikrein-HK autoactivation to generate kallikrein. In patients with hereditary angioedema, kallikrein and bradykinin formation can occur without invoking factor XII activation, although the kallikrein formed can rapidly activate...

  8. Urticária e doenças sistêmicas

    Directory of Open Access Journals (Sweden)

    R. F. J. Criado

    1999-12-01

    Full Text Available Chronic urticaria and concurrent angioedema are disappoiting problems for both physicians and patients. The disease can result from multiple causes and probably does not have a single etiology. Several factors have been identified that appear to be important in the pathogenesis of individual cases, some drugs, food additives, physical factors and internal diseases. In some cases no pathogenesis are identified and those cases are classified as idiopathic. In recent years several articles has emphasized autoimmunity and infections due to Helicobacter pylori. Our article reviewed the etiology of chronic urticaria at current concepts.

  9. Successful and Safe Treatment of Chronic Spontaneous Urticaria with Omalizumab in a Woman during Two Consecutive Pregnancies

    DEFF Research Database (Denmark)

    Ghazanfar, Misbah Nasheela; Thomsen, Simon Francis

    2015-01-01

    Chronic spontaneous urticaria is an itching skin disease characterised by wheals, angioedema, or both present for more than six weeks. Omalizumab is a humanized anti-IgE monoclonal antibody recently approved for treatment of chronic urticaria. Several randomised controlled trials have investigated...... the safety, tolerability, and efficacy of omalizumab for chronic urticaria. The safety of omalizumab in pregnancy is not known. We describe a female patient with chronic spontaneous urticaria who was treated with omalizumab continuously through two consecutive pregnancies with convincing results...

  10. Successful and Safe Treatment of Chronic Spontaneous Urticaria with Omalizumab in a Woman during Two Consecutive Pregnancies

    Directory of Open Access Journals (Sweden)

    Misbah Nasheela Ghazanfar

    2015-01-01

    Full Text Available Chronic spontaneous urticaria is an itching skin disease characterised by wheals, angioedema, or both present for more than six weeks. Omalizumab is a humanized anti-IgE monoclonal antibody recently approved for treatment of chronic urticaria. Several randomised controlled trials have investigated the safety, tolerability, and efficacy of omalizumab for chronic urticaria. The safety of omalizumab in pregnancy is not known. We describe a female patient with chronic spontaneous urticaria who was treated with omalizumab continuously through two consecutive pregnancies with convincing results and no apparent toxicity.

  11. Before and after, the impact of available on-demand treatment for HAE

    DEFF Research Database (Denmark)

    Christiansen, Sandra C; Bygum, Anette; Banerji, Aleena

    2015-01-01

    of suffocation, worry about their children inheriting HAE, and medication side effects. Data were analyzed using Wilcoxon signed-rank tests or analysis of variance. Responses were obtained from 134 self-identified HAE subjects: 85 type I, 21 type II, and 28 with normal C1 inhibitor (C1INH). Burden of disease......Availability of effective treatment for acute attacks is expected to transform the care of hereditary angioedema (HAE) patients. We felt that it would be of interest to test these assumptions by examining the perceptions of HAE patients regarding the impact that these therapies have had...

  12. Blepharochalasis

    Directory of Open Access Journals (Sweden)

    Özlem Bilgiç

    2012-12-01

    Full Text Available Blepharochalasis is a disorder characterized by recurrent episodes of painless edema of the eyelid skin, which leads to atrophy and relaxation of the eyelid structures and ptosis. The condition typically manifests itself in childhood or adolescence. The author reported a 16-year-old girl who has been suffered from recurrent painless swelling episodes on the upper eyelids for three years and laxity and wrinkling predominantly on the right upper eyelid for one year. This case was presented for the disorder is a rarely encountered disease and may easily misdiagnosed as recurrent angioedema, especially in its early stage.

  13. Perioperative Management of a Patient with Cold Urticaria

    Directory of Open Access Journals (Sweden)

    Priscilla Agbenyefia

    2017-12-01

    Full Text Available Cold urticaria consists of an allergic immune response to cold temperatures with symptoms ranging from pruritic wheals to life-threatening angioedema, bronchospasm, or anaphylactic shock. Adequate planning to maintain normothermia perioperatively is vital due to impaired hypothalamic thermoregulation and overall depression of sympathetic outflow during deep sedation and general anesthesia. This case report describes the successful perioperative management of a 45-year-old female with a history of cold urticaria undergoing a laparoscopic Nissen fundoplication for refractory gastroesophageal reflux disease and discusses how to appropriately optimize the care of these patients.

  14. Bivirkninger ved N-acetylcystein-behandling af paracetamolforgiftede patienter

    DEFF Research Database (Denmark)

    Schmidt, L E; Dalhoff, K P

    1999-01-01

    number of patients will be treated with NAC than with previous regimens based on plasma concentrations of paracetamol. In this retrospective study we evaluated the incidence of side effects of NAC in 310 patients admitted to the Department of Hepatology, Rigshospitalet, Copenhagen, over a four-year...... period (1.1.1994-31.12.1997). Twenty-six (8.4%) patients developed side effects. Side effects were anaphylactoid, mainly from skin (25 rash, pruritus or flushing), in rare cases more serious (four bronchospasm, three angioedema, one hypotension). None were life-threatening and all patients received...

  15. Clinical Evaluation of Inpatients with Acute Urticaria

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    Ayşe Serap

    2011-12-01

    Full Text Available Background and Design: To determine the clinical and etiological features of inpatients with acute urticaria and angioedema and to assess the need for laboratory tests. Material and Methods: We recruited 105 patients with acute urticaria and angioedema who were admitted to our inpatient unit. The lesions and the characteristics of the patients were analyzed. Routine diagnostic tests including complete blood count, thyroid function tests, hepatitis panel, stool parasite, total IgE levels, cultures, erythrocyte sedimentation rate, C-reactive protein, anti-nuclear antibody, and posterior anterior lung X-ray were ordered. A psychiatric consultation was obtained, when needed. The results were analyzed with SPSS 15.0 statistical software.Results: Among 105 patients, 28 (26.7% had urticaria, 7 (6.7% had angioedema, and 70 (66.7% suffered from both urticaria and angioedema. The most common accompanying symptoms were itching (91.4% and burning (34.3%. The most common systemic symptoms were fatigue (15.2% and headache (12.4%. The lesions usually appeared in the evening hours (24.8%. Twenty-five patients were waking up due to itching during the night. Some lesions were associated with physical activities. Systemic diseases accompanied the lesions in 12 patients (11%. In terms of etiological factors, 33 patients (22.5% had infections. Food- related lesions were encountered in 14 (13% patients. Thirty patients (28.5% had history of medication use. Stress was detected in 37.1% of the patients; anxiety was diagnosed in 3% of patients. The stool was positive for parasites in 10 (9% patients. Conclusion: Acute urticaria is a benign disorder. Although the underlying cause of urticaria can not always be identified, infections and medications are the most common causes. A comprehensive and detailed history is very important to discover the underlying cause. The diagnostic tests should be ordered according to the patient’s history. Conducting diagnostic tests

  16. Osteoporose na artrite reumatoide: papel do sistema vitamina D/hormônio paratireóideo

    Directory of Open Access Journals (Sweden)

    Mattia Bellan

    2015-06-01

    Full Text Available A osteoporose é uma característica extra-articular bem estabelecida da artrite reumatoide (AR. A inflamação sistêmica parece ser essencial para causar uma alteração em múltiplos sistemas homeostáticos implicados na saúde óssea, como as vias RANK/RANKL/osteoprotegerina e Wnt/β catenina; vários outros fatores causais têm sido implicados, como o uso crônico de corticosteroides. Como a vitamina D exerce funções imunorreguladoras importantes, tem-se afirmado que o desarranjo do sistema vitamina D/hormônio paratireóideo (HPT, um determinante bem conhecido da saúde óssea, pode desempenhar um papel patogênico na autoimunidade; estudos com animais e dados clínicos apoiam essa hipótese. Além disso, os pacientes com AR parecem ser relativamente refratários à supressão de HPT induzida pela vitamina D. Portanto, a ligação entre a AR e a osteoporose pode ser em parte causada por alterações no sistema vitamina D/HPT. Uma melhor compreensão da fisiopatologia desse sistema pode ser crucial para prevenir e curar a osteoporose em pacientes com doenças inflamatórias/autoimunes. A maior evidência da correlação clínica de cooperação e interdependência entre a vitamina D e o HPT é que a correção da deficiência de vitamina D, pelo menos nas doenças autoimunes, deve ser orientada para a supressão do HPT.

  17. Provas de atividade inflamatória no pênfigo foliáceo endêmico

    Directory of Open Access Journals (Sweden)

    João Franquini Junior

    1994-03-01

    Full Text Available O pênfigo foliáceo endêmico (PFE é uma afecção onde fenômenos auto-imunes são freqüentemente relacionados com sua patogênese. Abordaram-se neste estudo, alguns testes laboratoriais freqüentemente alterados em outras doenças auto-imunes. Foram estudados em 20 pacientes com PFE a presença ou alterações de fator antinúcleo (FAN, fator reumatóide (FR, proteína C-reativa (PCR, velocidade de hemossedimentação (VHS, eletroforese de proteínas e o número totalde leucócitos. Encontrou-se PCR positiva em mais de 65 % dos casos, leucocitose moderada na maioria dos pacientes, VHS aumentada e alterações discretas da análise de proteínas do sangue. O FAN e o FR apresentaram-se negativos em todos os casos. Embora estes exames sejam considerados inespecíficos, o seu estudo associado ao quadro clínico pode colaborar no acompanhamento do PFE.Endemic pemphigus foliaceus (EPF has its pathogenesis frequently associated to autoimmune phenomena. In this paper, afew routine laboratory tests, usually disturbed in some autoimmune diseases, were taken in 20 patients with EPF, which were screened for antinuclear antibodies (ANA, rheumatoid factor (RF, C-reactive protein (CRP and changes of eritrocyts sedimentation rate (ESR, serologic proteins electrophoresis and total leucocyte count. The CRP was found in 60% of cases, leucocitosis in 85%, high ESR in all of them and mild alterations in serologic proteins analysis. No ANA or RF was found. Although widely accepted as inespeciflc tests, we believe that an association of the laboratory routine tests with clinicalfindings, can prove to be helpful in the follow up care of these patients.

  18. Different clinical allergological features of Taenia solium infestation.

    Science.gov (United States)

    Minciullo, Paola Lucia; Cascio, Antonio; Isola, Stefania; Gangemi, Sebastiano

    2016-01-01

    The tapeworm Taenia ( T. ) solium can be responsible for two different conditions: taeniasis and cysticercosis. Helminth infections in human host cause an immune response associated with elevated levels of IgE, tissue eosinophilia and mastocytosis, and with the presence of CD4+ T cells that preferentially produce IL-4, IL-5, and IL-13. Individuals exposed to helminth infections may have allergic inflammatory responses to parasites and parasite antigens. PubMed search of human cases of allergic reactions occurring during T. solium infestation was performed combining the terms (allergy, urticaria, angioedema, asthma, anaphylaxis) with T. solium . A study was considered eligible for inclusion in the review if it reported data on patients with T. solium infestation who had signs or symptoms of allergy. In literature we found six articles reporting the association between an allergic reaction and T. solium infestation: two cases of urticaria, two cases of relapsing angioedema, one case of asthma and two cases of anaphylaxis. Despite the large diffusion of T. solium infestation, we found only a few cases of concomitant allergic reaction and the presence of Taenia in the host. The association between T. solium infestation and allergic manifestations has never been clearly demonstrated, and in absence of a well-documented causality the hypotheses are merely speculative. Therefore, the association between Taenia infection and allergy needs to be thoroughly studied to better clarify if this association may really exist and which is the pathogenetic mechanism supported.

  19. Omalizumab for treating chronic spontaneous urticaria: an expert review on efficacy and safety.

    Science.gov (United States)

    Giménez-Arnau, Ana M

    2017-03-01

    Chronic spontaneous urticaria (CSU) is characterized by the recurrence of itchy hives and/or angioedema for greater than six weeks, with no known external trigger. Omalizumab, a humanized, recombinant, monoclonal anti-IgE antibody, is the only approved add-on therapy for H1-antihistamine refractory CSU patients. Areas covered: The objective of this article is to discuss the mechanism of action, pharmacokinetics and pharmacodynamics of omalizumab for the treatment of CSU. The review also summarizes efficacy and safety data from proof-of-concept, phase II (X-CUISITE, MYSTIQUE), and pivotal phase III omalizumab studies (ASTERIA I, ASTERIA II, and GLACIAL). Expert opinion: Omalizumab is a clinically effective and safe biological therapy for treating H1-antihistamine refractory CSU patients. It significantly reduces CSU symptoms (hives, itch and angioedema), and improves patient health-related quality of life. While omalizumab is already integral to the treatment of antihistamine refractory CSU, widespread use will depend on legal and economic factors, as well as improvements in the early and accurate diagnosis of CSU patients who would benefit from treatment.

  20. Onset complexo pré e pós-tratamento de desvio fonológico em três modelos de terapia fonológica Complex onset pre and post phonological disorder treatment in three different phonological therapy models

    Directory of Open Access Journals (Sweden)

    Tiago Mendonça Attoni

    2010-01-01

    Full Text Available OBJETIVO: Analisar a ocorrência de onset complexo pré e pós-tratamento em crianças tratadas com três diferentes modelos de terapia fonológica. MÉTODOS: Participaram 21 sujeitos com desvio fonológico, 16 meninos e cinco meninas, com idades entre quatro e sete anos e 11 meses, divididos em grupos de sete sujeitos de acordo com o modelo utilizado para o tratamento: Ciclos Modificado, Oposições Máximas e ABAB-Retirada e Provas Múltiplas. Verificou-se os dados do sistema fonológico inicial e final, referentes à produção total de onsets complexos e dos onsets complexos com /l/ e com /r/. Estes foram classificados em: não adquiridos, de 0 a 39%; parcialmente adquiridos, de 40 a 69% e adquiridos de 70 a 100%. Os dados foram submetidos à análise estatística. RESULTADOS: Quanto ao total de onsets complexos, nos Modelos de Ciclos e Oposições Máximas, houve diferença nas médias dos onsets complexos não adquiridos e dos onsets complexos adquiridos antes e após a terapia e, no Modelo ABAB apenas nos onsets complexos adquiridos (pPURPOSE: To examine the occurrence of complex onset pre- and post-treatment in children treated with three different models of phonological therapy. METHODS: Twenty-one subjects with phonological disorder participated in the study, 16 boys and five girls, with ages varying between four years and seven years and eleven months. The children were divided into three groups of seven subjects, according to the therapy models used: Modified Cycles Model, Maximum Opposition Model and ABAB-Withdrawal and Multiple Probes Model. Data from initial and final evaluations of the phonological system were analyzed, regarding the total production of complex onsets and of production of complex onsets with /l/ and /r/. These were classified as: not acquired, from 0 to 39%; partially acquired, from 40 to 69%; and acquired, from 70 to 100%. Statistical analyses were carried out. RESULTS: Regarding the total number of occurences

  1. Smart Fortwo Electric Drive

    OpenAIRE

    Rebollo Francos, Vanesa

    2017-01-01

    Este TFG se ha realizado con la motivación de conseguir un producto creativo que reuna las técnicas básicas de edición de vídeo y traduzca en contenido creativo todo lo reflejado por el anunciante a través de su briefing. Se pretende mostrar y defender una forma original de realizar piezas creativas cuando no se cuentan con los recursos básicos queriendo a la vez demostrar que se han adquirido las capacidades básicas que debe reunir un creativo publicitario. Grado en Publicidad y Relacione...

  2. Valorización de Cementos Pacasmayo S.A.A.

    OpenAIRE

    Briceño Montalván, Juan Manuel; Joseli Ortiz, William; Linares Céspedes, Gustavo Adolfo

    2017-01-01

    El trabajo de investigación tiene como finalidad realizar la valorización de la empresa Cementos Pacasmayo basándose en el análisis de la situación financiera de la empresa, los supuestos que se proponen acerca de las expectativas futuras de la empresa (expectativas de crecimiento, flujos futuros, etc.) y los conocimientos adquiridos durante nuestros años de estudio. En el Capítulo I se describe la industria cementera, se analiza su desempeño y las características de los actores productivos, ...

  3. Trabajando en crear felicidad en el trabajo

    OpenAIRE

    Rodríguez González, Elena

    2016-01-01

    Treball final de Màster Universitari en Psicologia del Treball, de les Organitzacions i en Recursos Humans. Codi: SBE513. Curs acadèmic 2015-2016 Como su propio nombre indica, el siguiente trabajo es el final del camino recorrido en el Máster en Psicología del Trabajo, de las Organizaciones y en Recursos Humanos. En él resumo los conocimientos adquiridos a lo largo del mismo, así como las competencias conseguidas y el camino realizado para su obtención. Cada aspecto del máster ha ...

  4. Paisajes Agrarios en conflicto. El caso de la floricultura en el Baix Maresme (Barcelona)

    OpenAIRE

    Sancho Reinoso, Alexis; Paül i Carril, Valerià, 1979-; Tort i Donada, Joan, 1958-

    2013-01-01

    Actualmente, la comarca catalana del Maresme combina su carácter agrícola y metropolitano de una manera muy desigual. La expansión de los usos urbanos en el sector meridional de la comarca (conocido comunmente como Baix Maresme) ha relegado a la anécdota a casi todos los usos agrícolas, exceptuando la floricultura, cuya tradición en este ámbito se remonta a los años 1920. La clave de su supervivencia ha sido la competitividad que ha adquirido gracias a su intensificación. Los invernaderos son...

  5. Optimização de sistemas híbridos fotovoltaicos‐eólicos em zonas insulares de diversidade climática‐Arquipélago da Madeira

    OpenAIRE

    Esteves, José Carlos Magro

    2007-01-01

    Nesta tese apresento um estudo detalhado sobre vários aspectos relacionados com a optimização de sistemas híbridos fotovoltaicos-eólicos em zonas insulares de diversidade climática-arquipélago da Madeira que foi desenvolvido no Laboratório Regional de Engenharia Civil e com algumas deslocações no Laboratório de Energia Solar da Universidade de Vigo entre 2002 e 2007. Foi baseado nos conhecimentos adquiridos ao longode 25 anos de prática profissional de estudo, projecto, montagem e monitori...

  6. Perfil dos gerentes de unidades básicas de saúde Perfil de los gerentes de las unidades basicas de la salud Manager's profile of basic unit of health

    Directory of Open Access Journals (Sweden)

    Marilia Alves

    2004-08-01

    Full Text Available Estudo descritivo com objetivo de delimitar o perfil dos gerentes das UBS de Belo Horizonte. Coletaram-se dados a partir de um roteiro básico de uma amostra de 46,45% de gerentes de 127 UBS. O quadro gerencial é composto na maioria por mulheres, enfermeiras, com idade entre 36 e 50 anos, exercendo a gerência há mais de 5 anos, com conhecimento adquirido na graduação. Para o alcance da resolutividade o gerenciamento demanda atributos individuais que extrapolam os conhecimentos adquiridos em programas formais de capacitação. Atenta-se para a necessidade do município assumir o compromisso com a capacitação de seus gerentes, respaldando-os com conhecimentos complementares em face às exigências da política de gestão do SUS.Estudio descriptivo con objetivo de delimitar el perfil de los gerentes de las *UBS de Belo Horizonte. Los datos fueron obtenidos a partir de un guión básico de una muestra del 46,45% de gerentes de 127 UBS. El cuadro gerencial es compuesto en la mayoría por mujeres, enfermeras, con edad entre 36 y 50 años, ejerciendo la gerencia hay más de 5 años, con conocimiento adquirido en la graduación. La administración de los problemas demanda atributos individuales que extrapolan los conocimientos adquiridos en programas formales de capacitación. Se Atenta para la necesidad del municipio asumir el compromiso con la capacitación de sus gerentes, respaldándolos con conocimientos complementes en faz a las exigencias de la política de gestión del SUS.Descriptive study with objective to delimit the profile of the manager of the UBS of Belo Horizonte. They had been collected given from a basic script of a sample of 46,45% of controlling of 127 UBS. The managemental picture is composed in the majority for women, nurses, with age between 36 and 50 years, exerting the management has more than 5 years, with knowledge acquired in the graduation. For the reach of the resolution the management demand individual attributes

  7. Optimización de la calidad y vida comercial del hinojo entero y mínimamente procesado en fresco

    OpenAIRE

    Escalona Contreras, Víctor Hugo; Aguayo Giménez, Encarnación Pilar; Artés Calero, Francisco

    2004-01-01

    El cultivo del hinojo (Foeniculum vulgare Hill. var. dulce D.C.) ha adquirido un creciente interés en las Comunidades de Valencia, Murcia y Cataluña para su exportación a países centroeuropeos. Se conoce muy poco del comportamiento del hinojo recolectado bajo refrigeración, atmósfera controlada (AC) y envasado en atmósfera modificada (EAM), técnicas aplicadas para preservar su calidad y prolongar su vida comercial. Tampoco se disone de información científica sobre el hinojo mínimamente proces...

  8. Procesos de composición de software: identificación de servicios y evaluación de calidad

    OpenAIRE

    Cechich, Alejandra; Buccella, Agustina; Flores, Andrés P.; Aranda, Gabriela N.; Martínez Carod, Nadina; Luzuriaga, Juan Manuel; Martínez, Rodolfo; Moyano, Marcelo; Mazalu, Rafaela; Martín, Adriana Elba

    2010-01-01

    Tomando como base conocimientos adquiridos en investigaciones anteriores, las presentes líneas de investigación abordan distintas temáticas en la mejora de procesos software, centrando el estudio en: (1) mejoras a procesos específicos (Especificación de Requisitos, Desarrollo Global de Software); (2) definición y validación de técnicas para evaluación de composiciones en dominios específicos (Sistemas de Información Geográficos, Gobierno Electrónico); y (3) evaluación de atributos de calidad ...

  9. Digital data filtering in a Hall effect based angular position sensor

    OpenAIRE

    Solana Muñoz, Jorge

    2009-01-01

    Este proyecto empieza con el análisis de un sensor de efecto Hall como los estudiados en la asignatura Instrumentación Electrónica. Durante su estudio se pondrán en práctica algunos de los conocimientos adquiridos en ella. Posteriormente se entra en una fase de diseño de un sistema electrónico digital que procesará la señal procedente del sensor. En esta parte entran en juego conceptos de Sistemas Electrónicos Digitales necesarios para la elección de los bloques y las funciones lógicas oportu...

  10. Educación y videojuegos: un mundo de posibilidades

    OpenAIRE

    León Bedia, Celia

    2015-01-01

    RESUMEN: A día de hoy, las nuevas tecnologías de la información y la comunicación han adquirido un papel muy importante en nuestra sociedad, convirtiendo el jugar a videojuegos en la actividad favorita de los niños/as. Con este trabajo se pretende demostrar que los juegos electrónicos pueden funcionar como un recurso educativo dentro del aula. Para ello haremos un breve repaso por su historia, analizaremos sus beneficios y sus inconvenientes, conoceremos dos experiencias reales en centros ...

  11. La comida local y su significado en la China contemporánea: el caso del suroeste de Hubei

    OpenAIRE

    Wu, Xu; Arriola, Carmen

    2015-01-01

    Resumen Este artículo se enfoca en la comida local y los significados asociados en el área étnica de China central, y está basado en trabajos de campo realizados en la prefectura de Enshi, una prefectura tujia-miao autónoma que se encuentra en el suroeste de la provincia de Hubei. Como muchas otras áreas en China contemporánea, la comida local en el suroeste de Hubei, conocida como comida hezha, ha sido integrada al sistema de restaurantes urbanos y ha adquirido una variedad de significados. ...

  12. Manual de revisoría fiscal con un enfoque de auditoría integral, aplicando estándares internacionales de auditoría (CW)

    OpenAIRE

    Villa-Mesa, Ronald José

    2015-01-01

    Este documento es el resultado del conocimiento adquirido tanto en la Academia como en el  ejercicio como profesional independiente y como docente de Contaduría Pública. Es de vital importancia para el ejercicio profesional del Contador-Auditor, reconocer la Revisoría Fiscal como una actividad propia de nuestra profesión, con funciones de fiscalización enmarcadas dentro de la legislación mercantil y la Ley 43 de 1990, Estatuto Orgánico de la Profesión Contable en Colombia. El Revisor Fiscal, ...

  13. Cuantificación del Error en las Mediciones Debido a la Frecuencia de Muestreo

    OpenAIRE

    Sánchez F., Luis Pastor; Díaz de León, Juan Luis; Yáñez M., Cornelio; Herrera Charles, Roberto

    2004-01-01

    En los sistemas de medición digital es relevante la frecuencia de muestreo por su influencia en la exactitud de las mediciones. Su efecto es determinante cuando resulta necesario obtener los valores pico de la señal. Los métodos para mejorar la calidad del registro de datos adquiridos están relacionados con la operación del sistema en tiempo real o si es admitido realizar una toma de muestras y luego realizar su procesamiento. En el artículo se obtiene la relación entre la frecuencia de muest...

  14. Juventude e tecnologia: conscientização sobre aspectos jurídicos

    OpenAIRE

    Arantes, Álisson Rabelo; PUC Minas; Campos, Bruno César de Souza; PUC Minas; Silva, Mariana Aparecida da; PUC Minas

    2016-01-01

    A extensão é uma das ferramentas fundamentais para a formação humanística do profissional que a universidade forma, uma maneira de introduzir na sociedade uma porção do conhecimento adquirido ao longo do curso, uma relação em que ambas as partes saem ganhando. Um dos projetos presentes no campus da PUC Minas em Arcos é denominado Inclusão Digital para Jovens e Adolescentes, que consiste em proporcionar uma maior inserção da comunidade jovem da cidade no mundo digital. As escolas enfrentam atu...

  15. Plan de negocio de una residencia geriátrica

    OpenAIRE

    García Sanz, Federico

    2015-01-01

    El proyecto fin de carrera que a continuación se desarrolla denominado “Plan de Negocio de una Residencia Geriátrica” tiene como objetivo la realización de un Plan de Negocio como aplicación práctica de los conocimientos adquiridos durante los cinco cursos que componen la carrera de Ingeniería Industrial en su especialidad de Organización Industrial. En primer lugar se presenta una visión teórica de todos aquellos aspectos relacionados con el concepto “idea”. La intención es dejar const...

  16. Propuesta de mejora de la cadena de abastecimiento en la etapa de recepción de materiales del proceso productivo de una empresa minera de la zona norte del país

    OpenAIRE

    Cajas Zúñiga, Jonathan Román; Cruzado Novoa, Humberto Pablo; Vera Gutiérrez, Carlos Enrique

    2016-01-01

    El presente estudio se desarrolla debido a las constantes demoras en la entrega de los productos adquiridos por la Empresa Minera, esto en razón a los tiempos entre los procesos internos del área logística. Uno de los cuales se refiere a la trazabilidad casi nula que se tiene de los embarques desde el momento que son despachados por el proveedor hasta el momento en que llegan a los almacenes de la empresa y están listos para ser entregados. Bajo este escenario queremos hacer uso de las TIC, c...

  17. Desarrollo de una aplicación para el diseño de hornos de proceso

    OpenAIRE

    Cortés Roblas, Miguel Ángel

    2014-01-01

    El presente proyecto fin de carrera se basa en los conocimientos adquiridos durante el desarrollo de mis estudios universitarios y las prácticas que realicé en la empresa Foster Wheeler Iberia, en la división de hornos. Allí descubrí un equipo, los hornos de proceso, en cuyo diseño intervenían gran parte de las disciplinas que me habían interesado durante la carrera, transferencia de calor en todas sus formas (conducción, convección y radiación), mecánica de fluidos tanto para ...

  18. Educación para la salud renal en personas mayores desde un centro de atención primaria Renal health education older people from a center primary care

    OpenAIRE

    Pilar Peña Amaro; Juan García López; Yolanda Lupiáñez López; Encarna Figueroa Magaña; María Gámiz Magaña; Ana Trujillo Abad

    2011-01-01

    Realizamos un programa de educación para la salud enfocado a la prevención primaria y secundaria de la enfermedad renal en personas mayores desde un centro de atención primaria. Ponemos un póster en la sala de espera del centro con los contenidos sobre los que queremos incidir (hábitos de vida renosaludables). Cuando el paciente acude a consulta evaluamos los conocimientos que tenía y los que ha adquirido y los comentamos por si hay preguntas o dudas. Las personas mayores asocian la ingesta d...

  19. ¡Véngase que esto es la maravilla!: redes e imaginarios de la migración colombiana en Chile.

    OpenAIRE

    Gordillo Sánchez, Daniel

    2015-01-01

    Trabalho de conclusão de curso apresentado ao Instituto Latino-Americano de Arte, Cultura e História da Universidade Federal da Integração Latino-Americana (UNILA), como requisito parcial à obtenção do título de Bacharel em Antropologia – Diversidade Cultural Latino-Americana. Orientador: Prof. Doctor Antonio de la Peña García. Durante os últimos anos, a população de imigrantes colombianos no Chile tem se incrementado consideravelmente e atualmente, esta corrente migratória tem adquirido u...

  20. Formas de la conciencia de clase en la Nueva Granada : (1848-1854

    Directory of Open Access Journals (Sweden)

    Germán Colmenares

    1966-11-01

    Full Text Available Capítulo VII. El socialismo granadino El empleo de la palabra socialismo se ha restringido considerable- mente a partir de los escritos de Marx y con el marxismo ha adquirido un sentido muy preciso que ya no cobija la vaga oposición que se establecía entre el individualismo (de raíz liberal y una preocupación más amplia, puede decirse que más generosa, que apuntaba a los intereses de toda la sociedad.

  1. Diseño de sistema de gestión de seguridad de información para ecuacolor

    OpenAIRE

    Lara Muñoz, Hernán; Reyes Reina, José Humberto; Navarrete Mera, Washington

    2006-01-01

    Diseño De Sistema De Gestión De Seguridad De Información Para Ecuacolor El objetivo de nuestra tesis es el Diseño de un Sistema de Gestión de Seguridad de la Información para la empresa ECUACOLOR, basado en el análisis de la empresa y el conocimiento adquirido durante el Diplomado de Auditoría Informática Un segundo objetivo es contribuir para que las empresas ecuatorianas tomen conciencia de la necesidad de implementar Sistemas de Seguridad, como una herramienta que ayudará a cumpli...

  2. Riesgos a la salud humana e impactos ambientales derivados del manejo integral de residuos hospitalarios en el hospital infantil Napoleón Franco Pareja

    OpenAIRE

    Lugo Silva, Kelly Beth de Jesús; SENA

    2016-01-01

    Desde el año 2000, el manejo adecuado de residuos hospitalarios ha adquirido una notable importancia en Cartagena, dado que solo el 9 % de los centros médicos y hospitalarios de la ciudad les da un tratamiento correcto. Los residuos hospitalarios representan un riesgo para la salud del personal médico, paramédico y de enfermería, así como de pacientes, visitantes, personal de recolección de residuos y comunidad en general, además del riesgo ambiental que de ellos se deriva. Este artículo es u...

  3. Desarrollo competencial en educación infantil a través del aprendizaje basado en proyectos en centros educativos de jaén

    OpenAIRE

    Palomares Ruiz, Pedro

    2017-01-01

    Esta tesis surge derivada de la incertidumbre generada acerca de la idoneidad de la implementación de la práctica pedagógica, aprendizaje basado en proyectos. Tras constatar que a pesar de ser una práctica muy conocida no era proporcional a su grado de implementación suscita el interés por conocer el grado competencial adquirido por el alumnado en el tercer nivel de educación infantil, de los centros de la provincia de Jaén, en los que se ha implementado la práctica pedagógica objeto de estud...

  4. Análisis del aprendizaje usando el nivel de la incertidumbre en la adquisición de conocimiento

    OpenAIRE

    Huapaya, Constanza Raquel; Lizarralde, Francisco Ángel José; Arona, Graciela; Vivas, Jorge

    2013-01-01

    Como continuación de la investigación sobre el uso de la Minería de Datos Educacional (MDE) para descubrir nuevo conocimiento basado en datos de la actividad del estudiante se ha elegido estudiar la incertidumbre en la medición de la adquisición de conocimiento a fin de mejorar la estimación de perfiles cognitivos del estudiante sobre los cuales se está investigando desde hace dos años. El conocimiento adquirido por los estudiantes es, en general, imperfecto. El grado de profundidad en la ...

  5. El proceso educativo en la recuperación nutricional de los niños y las niñas

    OpenAIRE

    Arboleda Noreña, Luis Guillermo; Gutiérrez Hernández, Dora Cecilia

    2014-01-01

    Tesis (Maestría en Educación y Desarrollo Humano). Universidad de Manizales. Facultad de Ciencias Sociales y Humanas. CINDE, 2014 Este estudio nace de la necesidad de mayores investigaciones de corte comprensivo sobre los Centros de Recuperación Nutricional—CRN— y los procesos subyacentes en ellos, especialmente educativos, de acuerdo con la superior relevancia que han adquirido estos espacios en el país como estrategia efectiva en la lucha contra la desnutrición infantil, no sólo por su c...

  6. Examen de auditoría integral a las contribuciones de mejoras por el período comprendido entre el 1 de Enero y el 31 de diciembre del 2012, en el Gobierno Municipal del Cantón Morona

    OpenAIRE

    Valencia Zabala, Liliam Margot

    2014-01-01

    En el presente trabajo de investigación trata sobre una auditoría integral al Gobierno Municipal del Cantón Morona, se han diseñado capítulos que se relacionan con el desarrollo de una auditoría integral a las contribuciones de mejoras, que ha sido desarrollado con el aporte de los funcionarios auditados y se ha evaluado con los conocimientos adquiridos en esta maestría. Se han utilizado conceptos claves, que son parte fundamental de la auditoría integral como son: auditoría de gesti...

  7. ENSAYOS DE CREEP POR TORSIÓN Y TRACCIÓN

    OpenAIRE

    Daniela Alessio; Sandra Robles; Lilian Moro; René Molina

    2017-01-01

    En este estudio se efectúa el análisis de dos metodologías de ensayo para evaluar el comportamiento de un material al creep o fluencia por activación térmica o termofluencia. Se realizaron en laboratorio dos tipos de ensayos, por torsión y por tracción, bajo combinaciones de temperatura y tensión comparables, de un acero austenítico, de uso habitual en los equipos de la industria petroquímica de la región. Con los registros adquiridos, se graficaron las diferentes curvas deformación-tiempo de...

  8. EL LENGUAJE PERIODÍSTICO CULTURAL: NUEVAS PLATAFORMAS, NUEVOS PARADIGMAS RESUMEN / Cultural journalistic language: new media, new paradigms

    Directory of Open Access Journals (Sweden)

    Eva Álvarez Ramos

    2015-01-01

    Full Text Available Los cambios producidos en el periodismo por el nacimiento y el rápido desarrollo de los medios digitales y el protagonismo adquirido por los lectores, han llevado a modificar los parámetros tradicionales de la redacción periodística. En este artículo analizamos cuáles son esas mudanzas, qué causas las han provocado y cómo se han adaptado los medios culturales a su existencia digital.

  9. Análisis de modos de falla, efectos y criticidad (AMFEC) del sistema de inyección de un motor de encendido provocado Corsa Evolution 1.4L empleando herramientas de aprendizaje y clasificación para la programación del mantenimiento

    OpenAIRE

    Aguilar Romero, Angel Yasmany; Tandazo Flores, Luis Fernando

    2017-01-01

    En este proyecto se desarrolla la técnica de análisis de modos de falla, efectos y criticidad (AMFEC) en el sistema de inyección del motor de un vehículo a raíz de la información obtenida sobre su comportamiento en diferentes estados de funcionamiento, los datos adquiridos son analizados mediante herramientas de aprendizaje y clasificación para la programación del mantenimiento. This project develops the technique of analysis of modes of failure, effects and criticality (AMFEC) in the syst...

  10. Lamarck necesita a Darwin: la búsqueda de intención en el estudio de la evolución y de la historia

    OpenAIRE

    Moreno, Juan

    2009-01-01

    a teoría de Lamarck sobre herencia de caracteres adquiridos y sobre respuestas inmediatas a retos ambientales ha ofrecido una promesa de intencionalidad y protagonismo en el proceso evolutivo al ser humano y a los restantes organismos. La teoría de Darwin sobre evolución por selección natural no ofrece este consuelo y no presupone nada más que procesos de recambio gradual en poblaciones naturales. El estudio de la ecología, la etología, la neurobiología, la cultura animal, la psicología y la ...

  11. Manual de procesos de gestión financiera aplicado al Hospital Provincial General Docente Vicente Corral Moscoso

    OpenAIRE

    Rojas Ortega, Angélica Magdalena; Trelles Torres, Silvia América

    2007-01-01

    La motivación de esta tesis fue el emplear conocimientos adquiridos en el transcurso de nuestros estudios académicos e investigaciones, en una Institución Pública como es el Hospital "Vicente Corral Moscoso". Nuestro estudio consta de seis capítulos en los cuales describimos varios conceptos y elementos importantes para la comprensión de este manual, en una Institución del Sector Público no Financiero, donde intervienen leyes, disposiciones legales y acuerdos vigentes emitidos por el Minis...

  12. Inteligencias múltiples: el arte de las matemáticas en educación infantil

    OpenAIRE

    Díaz Molinero, Marta

    2014-01-01

    En mi Trabajo Fin de Grado presento una propuesta donde el arte y las matemáticas se unen de forma atractiva. Se trata de una visión sobre el desarrollo de la mente basada principalmente en la Teoría de las Inteligencias Múltiples de Gardner (2013). Esta teoría respalda las diferentes actividades que propongo para llevar al aula con alumnos de 4 años de edad. Todo ello para afianzar los conocimientos sobre figuras geométricas que han adquirido los niños a lo largo del curso. Desarrollo la pr...

  13. El grupo de discusión como situación social

    Directory of Open Access Journals (Sweden)

    ENRIQUE MARTÍN CRIADO

    1997-01-01

    Full Text Available se propone una fundamentacion metodologica del grupo de discusion que sustituya el enfoque psicoanalitico -que supone una esencia intemporal de "grupo"- por un enfoque que contempla la produccion de discurso como un acto que pone en relacion agentes dotados de unos esquemas de produccion de sentido -adquiridos en su trayectoria social e incorporados mediante familiarizacion inconscinete- con una serie de "situaciones sociales" que introducen una serie de reglas y constricciones sobre lo decible. el manejo de esta tecnica tendra que tener en cuenta, asi, la estructuracion del "orden publico interaccional" del medio social en que se pretende investigar.

  14. Autógrafos de Cristobal Colón: Ensayo de Análisis Grafológico de su Escritura

    Directory of Open Access Journals (Sweden)

    Boletín Cultural y Bibliográfico Banco de la República

    1968-02-01

    Full Text Available Absolutamente el único mapa o dibujo topográfico que resta de Colón. De este marino, que toda su vida confeccionó mapas, que de modo seguro tuvo que haber dibujado las derrotas de sus viajes, que se sabe que regaló un gran mapa a Isabel, solo queda este pedazo de papel (hoy en el Archivo de la Casa de Alba, en Madrid, "misteriosamente adquirido por la Duquesa de Alba", según Thacher (I, p. 477, quien lo reproduce en (III, p. 8 9 y dice : "Evidentemente dibujado en enero de 1493.

  15. Los pueblos originarios y la práctica del derecho internacional en Chile: nuevos horizontes ante el debilitamiento de los legados del autoritarismo

    OpenAIRE

    Álvez Marín, Amaya; Becker Lorca, Arnulf

    2017-01-01

    Resumen A partir de los años 1990 el derecho internacional ha comenzado a reconocer las demandas de los pueblos originarios. Desde entonces, los pueblos originarios han adquirido progresivamente el carácter de sujeto de derecho internacional. Para Chile este cambio debería haber sido significativo. Los años noventa no solo marcaron el fin de la Guerra Fría y la consiguiente renovada relevancia del derecho internacional; también fueron los años en que Chile recuperó su democracia. Mientras el ...

  16. Sensado de variables mediante terminal Android

    OpenAIRE

    Altaba Rosas, Mar

    2017-01-01

    El presente documento describe los procesos de diseño y desarrollo de un sistema que, a través de una aplicación móvil, sirve como dispositivo para el registro de la actividad cardíaca del paciente, mediante la obtención del electrocardiograma (ECG), y que permite detectar irregularidades para posteriormente, en caso que fuera necesario, poder enviar los datos adquiridos al profesional sanitario pertinente para que éste los analice. El sistema tiene dos componentes diferenciados, por un lado,...

  17. Responsabilidad civil contractual por fraudes con tarjeta de crédito en Colombia

    OpenAIRE

    Rendón Vera, José Santiago

    2007-01-01

    La presente monografía de grado es el fruto de la convergencia de los diferentes conocimientos adquiridos en el pregrado de Derecho aplicados a una problemática especial: la responsabilidad civil por los fraudes cometidos con tarjetas de crédito en Colombia. En efecto, el sistema de tarjeta de crédito se inserta dentro de las nuevas formas de contratación que ha traído consigo la modernidad, su uso es relativamente reciente y siempre objeto de constante desarrollo.

  18. La institucionalización de la lucha contra el terrorismo transnacional a través del derecho internacional

    OpenAIRE

    Seña Salcedo, Cristian Andrés

    2016-01-01

    Hasta hace casi una década, la guerra contra el terrorismo fue una lucha solitaria de los Estados. Actualmente y debido a las implicaciones globales de este fenómeno, las acciones contra este flagelo han adquirido connotación internacional. Gran parte de los países miembros de las Naciones Unidas han acogido esta guerra –contra un enemigo común, pero indefinido- como un compromiso político en favor de la paz y seguridad internacional. La producción constante de instrumentos int...

  19. Diseño y construcción de un banco de simulaciones, para operación y maniobras de las etapas que comprenden un sistema eléctrico de potencia

    OpenAIRE

    Matamoros Rugel, Christian Humberto; Morán Salcán, Pablo, Julio

    2015-01-01

    En la actualidad la industria farmacéutica ha crecido considerablemente tomando en cuenta que las personas son propensas a un sinnúmero de enfermedades, a consecuencia de diversos factores como cambios climáticos, contaminación, mala alimentación, poca prevención de enfermedades, entre otros. El mercado farmacéutico comercializa alrededor de 10.000 diferentes medicamentos distribuidos entre productos de marca y genéricos, los mismos que son adquiridos para su posterior distribución por distri...

  20. O Goodwill e o seu tratamento contabilístico pós adoção das IFRS: uma análise nas empresas da Euronext Lisbon

    OpenAIRE

    Carvalho, Carla

    2015-01-01

    Esta tese tem como objetivo geral a análise do tratamento contabilístico do goodwill adquirido no âmbito das Concentrações de Atividades Empresariais (CAE). Para o efeito, adotamos uma trilogia de estudos acerca do goodwill: seu reconhecimento inicial, sua mensuração subsequente e seus requisitos de divulgação. Cada um deles deu origem a um ensaio. Para a realização dos estudos empíricos incluídos em cada um dos ensaios, foram utilizadas as informações das entidades com valores...

  1. Caracterización de clases de ocupación de suelo y usos agrícolas en un área de la provincia de Toledo (Talavera de la Reina) a partir de imágenes de satélite de media resolución.

    OpenAIRE

    Cuadrado Bernardo, Sara

    2014-01-01

    Con el presente proyecto se ha pretendido realizar una clasificación de los distintos usos del suelo en la provincia de Toledo y de forma más precisa en el municipio de Talavera de la Reina. Se ha profundizado en los conocimientos sobre teledetección adquiridos durante los años de estudio de la titulación de Ingeniero Técnico en Topografía, cubriendo las aplicaciones más importantes. Para ello, en primer lugar se debe recopilar la información, en este caso se han utilizado dos imágenes Lan...

  2. Compromiso ambiental de las organizaciones ¿Responsabilidad social empresaria o filantropía estratégica?

    OpenAIRE

    Carro, Roberto

    2014-01-01

    El tema de la Responsabilidad Social Empresaria ha adquirido un nuevo protagonismo en lo que se refiere a la gestión de las organizaciones. Tanto así que la Organización Internacional de Standards (ISO) ha publicado una norma al respecto. Esto nos lleva a que reflexionemos sobre los fundamentos de esa responsabilidad tanto más que a tomar una serie de parámetros como dados a los cuales se deben ajustar las organizaciones como un nuevo paradigma de gestión. En este artículo nos propo...

  3. Sociedad civil: democracia monitorizada y medios de comunicación en John Keane

    OpenAIRE

    Feenstra, Ramón Andrés

    2010-01-01

    El objetivo de esta tesis doctoral consiste en analizar de manera exhaustiva el concepto de sociedad civil en la obra de Keane. Un estudio que pretende mostrar la potencialidad de la propuesta de sociedad civil de este autor que, ampliamente entendida en la definición de su espacio y de sus actores, ha destacado el papel central de los medios de comunicación en el modelo de democracia monitorizada. Un modelo democrático que se constituye fruto del creciente contrapoder adquirido por una socie...

  4. Relación entre factores académicos y consumo de videojuegos en universitarios. Un modelo de regresión

    OpenAIRE

    Chacón Cubero, Ramón; Zurita Ortega, Félix; Martínez Martínez, Asunción; Castro Sánchez, Manuel; Espejo Garcés, Tamara; Pinel Martínez, Cristina

    2017-01-01

    Las Tecnologías de la Información y Comunicación (TIC) han adquirido una fuerte presencia en la vida cotidiana, constituyendo un factor modulador de los logros académicos y profesionales en la etapa universitaria. Este estudio de diseño descriptivo y corte transversal, realizado sobre 490 estudiantes de la Universidad de Granada, pretende determinar patrones de relación entre el rendimiento académico y los hábitos de consumo de videojuegos, utilizando como principales instrumentos un cuest...

  5. Colombia y el transpacific partnership agreement

    OpenAIRE

    Navarro León, Karen Sofía

    2015-01-01

    Colombia, a partir de 1990, inicia un plan de gobierno enfocado en la apertura económica, con estrategias que propugnaban por un cambio en el modelo económico a través de políticas como la reducción de aranceles a las importaciones y otra serie de medidas proteccionistas, flexibilización laboral, la reducción del papel del Estado para darle protagonismo al sector privado y procesos de privatización de empresas públicas En este entorno internacional se ha adquirido conciencia de que, en un...

  6. Calidad de vida de niños y niñas de sectores medios de la sociedad: estudio de caso en Santa Marta, distrito turístico cultural e histórico, Colombia

    OpenAIRE

    Mieles Barrera, María Dilia

    2013-01-01

    Tesis (Doctorado en Ciencias Sociales, Niñez y Juventud). Universidad de Manizales. Facultad de Ciencias Sociales y Humanas. CINDE, 2013 La investigación denominada CALIDAD DE VIDA DE NIÑOS Y NIÑAS DE SECTORES MEDIOS DE LA SOCIEDAD: ESTUDIO DE CASO EN SANTA MARTA, DISTRITO TURÍSTICO CULTURAL E HISTÓRICO, COLOMBIA, se desarrolla en el marco de la complejidad y vigencia que ha adquirido el concepto calidad de vida, responde a la necesidad de investigar a niños y niñas de sectores medios de ...

  7. Pensamiento del profesorado y alumnado sobre la integración de las TIC y su uso en los centros de adultos de Canarias

    OpenAIRE

    Morales Almeida, Paula

    2014-01-01

    Programa de doctorado: Formación del profesorado [ES] La educación de adultos ha ido adquiriendo una gran importancia en los últimos años como resultado de la educación permanente desarrollada por la sociedad de la información y la comunicación pero para que la educación de adultos tenga éxito debe contar con profesores formados en diversas áreas y que conozcan sus características de aprendizaje. Además, en esta nueva sociedad, las TIC han adquirido una vital importancia, ya que se encuent...

  8. Planificación estratégica para la compañia de Transportes Conocoto Azblan S.A

    OpenAIRE

    Velasquez Espín, Andrea

    2011-01-01

    La presente tesis, desarrollada para la carrera de Ingeniería en Administración de empresas, tiene como tema principal realizar la formulación de una Planificación Estratégica para la compañía de Transportes Conocoto Azblán S.A. La propuesta nace de la necesidad de mejorar el nivel de competitividad de la Compañía de Transportes Conocoto Azblán, logrando un aporte positivo mediante la aplicación de los conocimientos adquiridos durante la carrera. Se establece desarrollar el proyec...

  9. Selección de la financiación óptima para el desarrollo de una idea innovadora en una PYME

    OpenAIRE

    Pignatelli Figueiras, Fernando Luis

    2014-01-01

    El presente proyecto tiene como finalidad poner en práctica los conocimientos en materia de competitividad, innovación y economía de la empresa adquiridos en la titulación de Ingeniería en Organización Industrial. El objetivo es plasmar de una manera clara la metodología a seguir para detectar que es un proyecto innovador y cuáles son los mecanismos de financiación existentes, tanto privados como públicos, en función de las características del proyecto y de la empresa. Para ello se desa...

  10. Mantenimiento de Sistemas de Gestión Integrados

    OpenAIRE

    Rodríguez Rodríguez, Irene

    2013-01-01

    El Trabajo de Fin de Master permite aplicar de forma práctica los conocimientos adquiridos durante el curso del Master Oficial de la Prevención de Riesgos Laborales, Calidad y Medio Ambiente, impartido en la Universidad de Valladolid. La presente memoria técnica resume los requisitos mínimos para realizar un adecuado mantenimiento de un sistema de gestión integrado; para ello, se citan los distintos puntos a tener en cuenta (recursos humanos, formación,requisitos legales...), acompañados de e...

  11. Perfil y representatividad de la alta función pública del gobierno central de Colombia

    OpenAIRE

    André-Noël Roth Deubel; Fredy Alejandro Robayo Corredor

    2015-01-01

    Desde el punto de vista de la teoría de la burocracia representativa, la administración pública no se limita a la función clásica de ejecución neutral de las decisiones. Los individuos son portadores de valores, adquiridos a través de un proceso de socialización, que se expresan en una cierta preferencia en sus decisiones. Así, la influencia ejercida en las decisiones políticas y administrativas por los funcionarios públicos, y en particular por los que ocupan los cargos más altos en la jerar...

  12. El teatro “de niños” como vehículo de aprendizaje multidisciplinar: La historia de la esclava Tawaddud, una versión escolar para títeres

    OpenAIRE

    Fuente Gómez, Daniel de la

    2016-01-01

    El presente Trabajo de Fin de Grado (en adelante, TFG) pretende reivindicar el Teatro como genero literario idóneo para la animación a lectura, así como la practica del arte dramático en el aula de Primaria, ya que se trata de una herramienta tremendamente util para desarrollar competencias en materia de educación literaria, en expresión lingüística, corporal y artística, así como para aplicar habilidades y conocimientos adquiridos en otras disciplinas. En este TFG se aborda...

  13. Analizar los factores de riesgos en los que incurre un banco al otorgar microcréditos en el Ecuador.

    OpenAIRE

    Gómez Piedrahita, Roxana María

    2015-01-01

    En la actualidad el otorgamiento de microcréditos por parte de las instituciones financieras de los países emergentes ha adquirido un mayor grado de importancia debido a que estas economías se dinamizan a través de las pequeñas y medianas empresas (PYMES), a más de impulsar el desarrollo y la productividad de sus clientes se genera un ingreso significativo debido a que estos créditos son de corto plazo y su rotación es rápida. Las instituciones financieras que se especializan en el o...

  14. Aplicación de sistemas de gestión energética sector comercio, caso hoteles

    OpenAIRE

    Auladell Roig, Marc

    2012-01-01

    El presente proyecto se centra en la realización de auditorías energéticas aplicadas en el sector terciario, más concretamente, en los establecimientos hoteleros. La primera parte consiste en la compilación de una base teórica sobre el tema con especial atención a las guías de ahorro publicadas por los entes públicos con competencia en medidas de eficiencia energética. Con posterioridad, se traslada la gestión de los conceptos teóricos adquiridos mediante una metodología ...

  15. Estudio de técnicas de análisis y clasificación de señales EEG en el contexto de sistemas BCI (Brain Computer Interface)

    OpenAIRE

    Henríquez Muñoz, Claudia Nureibis

    2014-01-01

    Máster universitario en Investigación e Innovación en TIC. Las Interfaces Cerebro Computador (BCI) son una tecnología basada en la adquisición y procesamiento de señales cerebrales para el control de diversos dispositivos. Su objetivo principal es proporcionar un nuevo canal de salida al cerebro del usuario que requiere un control adaptativo voluntario. Usualmente los BCI se enfocan en reconocer eventos que son adquiridos por métodos como el Electroencefalograma (EEG). Dicho...

  16. Tratamiento Odontopediatrico de un paciente Vih (+)bajo anestesia general: Primer caso en el Postgrado de Odontología infantil en la Facultad de Odontología Universidad Central de Venezuela

    OpenAIRE

    GUERRA, MARIA E; CASANOVA, MARIA E.; SUÁREZ, JOSÉ A.; SALAZAR, ALEJANDRO

    2003-01-01

    Resumen El Síndrome de Inmunodeficiencia Adquirida, es una enfermedad de alta mortalidad causada por el Virus de Inmunodeficiencia Humana (VIH), el cual se caracteriza por un defecto adquirido aparentemente irreversible, en la inmunidad celular, que predispone al huésped a infecciones oportunistas severas y /o neoplásicas inusuales. Se estima que el Virus de Inmunodeficiencia Humana infecta a 1.000 niños cada día en el mundo, el 90% de éstos se han contaminado durante el embarazo, parto o lac...

  17. Reflexos de sangue: Dracula como espelho da era vitoriana tardia

    OpenAIRE

    Marques, Cátia Sofia Guedes

    2010-01-01

    Tese de mestrado, Ciências da Cultura, Universidade de Lisboa, Faculdade de Letras, 2011 Partindo dos conhecimentos adquiridos no curso de Ciências da Cultura, esta dissertação é produto da articulação entre um documento cultural importante, como um grande clássico da literatura inglesa, Dracula, e o respectivo estudo segundo a perspectiva sociológica das Ciências Sociais. Utilizando os conceitos de género, status, classe social e representação, é possível analisar se as quatro personag...

  18. Violência institucional obstétrica no Brasil: revisão sistemática

    OpenAIRE

    Rafael Cleison Silva dos Santos; UNIFAP; Nádia Ferreira de Souza; Hospital da Mulher Mãe Luzia

    2015-01-01

    Este artigo tem como objetivo realizar revisão sistemática da literatura sobre a violência institucional obstétrica, no Brasil, e apresentar as principais evidências encontradas nos artigos selecionados. Os dados foram adquiridos através da seleção de artigos na Biblioteca Virtual de Saúde (BVS) e a amostra final foi composta por 07 artigos publicados entre os anos 2006 a 2014. A negligência foi a violência institucional obstétrica mais frequente, seguida pela violência verbal, e violência fí...

  19. Contabilidad de gestión y procesos de concentración empresarial : Repercusiones organizativas y sociales de las fusiones y adquisiciones

    OpenAIRE

    Lobo Gallardo, Antonio; Escobar Pérez, Bernabé; González González, José María

    2003-01-01

    El fenómeno de las fusiones y adquisiciones ha adquirido una gran importancia debido al gran número de operaciones y el elevado volumen de recursos implicados en éstas. En este trabajo analizamos el impacto del proceso de cambio organizativo inducido por las operaciones de fusiones y adquisiciones sobre la organización en general y los sistemas de información en particular, entre los que se encuentra la Contabilidad de Gestión. Para alcanzar este objetivo desarrollamos un estudio de caso long...

  20. Ajuste psicosocial y vivencia de la adopción en niños/as adoptados/as internacionalmente

    OpenAIRE

    Reinoso Bernuz, Marta

    2013-01-01

    [esp] La adopción internacional ha adquirido en España unas muy notables dimensiones y el desarrollo y la adaptación de estos niños se ha convertido en un asunto de gran importancia. La presente tesis doctoral pretende contribuir al conocimiento en esta área y tiene por objetivo analizar el nivel de ajuste psicosocial, la vivencia de la adopción y el afrontamiento del estrés en la mediana infancia (8-12 años) de los niños adoptados internacionalmente en nuestro país. Esta tesis se con...

  1. Geogebra, una herramienta para la enseñanza de las matemáticas y simulación de fenómenos

    OpenAIRE

    Camacho, Noé; Godínez, Margarito; Velázquez, Santiago

    2014-01-01

    Hoy en día es de suma importancia relacionar los conocimientos adquiridos en el aula con la sociedad, el entorno, los fenómenos que observamos y los que acontecen en nuestra sociedad, esta labor es principalmente de los docentes, no obstante, en la mayoría de las veces no se dispone de ofertas de capacitado para construir las referidas herramientas y de esta manera llevar acabo esta relación, el objetivo del taller propuesto fue precisamente capacitar a estudiantes y profesores en la modelaci...

  2. Tecnología móvil y aprendizaje: una experiencia en la Universidad Veracruzana

    OpenAIRE

    Méndez Casanova, Elba María; Vázquez Vincent, Marisol; Mastachi Pérez, Marcela; Arciga Solorio, Irene; Pacheco Tlalmis, Luis Felipe

    2013-01-01

    A partir del siglo XXI, los teléfonos móviles han adquirido funcionalidades que van más allá de llamar o enviar mensajes de texto, estos se han unificado con distintos dispositivos lo cual permite realizar una multitud de acciones, a este tipo de evolución del teléfono móvil se le conoce como Smartphone. Este estudio se desarrolla en la en la Facultad de Pedagogía de la Universidad Veracruzana campus Poza Rica, dentro de la cual se propone el uso de la telefonía celular como herramienta didác...

  3. Elementos para una política exterior ambiental (Tema Central)

    OpenAIRE

    Salvador, Íñigo

    2002-01-01

    La necesidad de una política exterior ecuatoriana en lo ambiental surge de la naturaleza global del medio ambiente, de la responsabilidad del Ecuador como país privilegiado por su megadiversidad, de la vinculación inevitable entre la pobreza que le aqueja y la degradación del ambiente y de los compromisos internacionales por él adquiridos. Una política exterior ambiental debe resultar de un proceso de diseño en que participen todos los actores de la temática ambiental, aunque su ejecución deb...

  4. Modelo de administración de recursos humanos basados en la gestión por competencias para las distribuidoras de energía eléctrica

    OpenAIRE

    López Villalba, Tonny Mauricio

    2014-01-01

    146 páginas : ilustraciones, 29 x 21 cm + CD-ROM 2239 Esta tesis propone crear una herramienta administrativa por competencias capaz de facilitar y mejorar la gestión de las personas que trabajan en las distribuidoras eléctricas del país, donde ellos son los protagonistas por su conocimiento y experiencias. Es necesario y oportuno el mejoramiento por las exigencias del cliente, los compromisos adquiridos por sus representantes y la política actual de cambios. Se presenta el tema en cuatro ...

  5. Análisis técnico, económico y ambiental de tecnologías de saneamiento sostenible: Aplicación a una casa rural

    OpenAIRE

    Martínez Royuela, Anna

    2011-01-01

    El presente trabajo tiene como objetivo principal evaluar desde un punto de vista técnico, económico y ambiental las diferentes tecnologías de Saneamiento Sostenible para aplicar el conocimiento adquirido en el caso práctico de una casa rural en el sur de España. Primero se han analizado de manera teórica las tecnologías de Saneamiento Sostenible más importantes actualmente clasificadas según el tipo de residuo que recolectan y tratan. Se han estudiado las tecnologías pro-pias de los sist...

  6. Inmunidad de grupo. Significado e importancia

    OpenAIRE

    Vaqué Rafart, Josep

    2005-01-01

    En los últimos veinte años el concepto de “inmunidad de grupo” ha adquirido gran relevancia debido a su utilidad para definir los objetivos y estrategias de los programas de vacunación, pues permite determinar la intensidad de las actuaciones a aplicar para impedir brotes epidémicos y para controlar y eliminar enfermedades infecciosas. Su definición clásica, establecida por Fox en 1971, dice: "Es la resistencia de un grupo a una infección ante la que una amplia proporción de individuos posee ...

  7. Fundamento y límites de la potestad sancionadora administrativa en materia ambiental

    OpenAIRE

    Bermúdez Soto,Jorge

    2013-01-01

    El ejercicio de la potestad sancionadora de la Administración del Estado en el ámbito ambiental es manifestación de la importancia que la protección del medio ambiente ha adquirido en la sociedad y de la asunción de la misma como función pública. El ejercicio de este poder se encuentra limitado tanto por los principios generales aplicables, pero además se somete a límites específicos al ámbito ambiental. Dichos límites pueden ser categorizados en tres clases: orgánicos, procedimentales y sust...

  8. Evolución de la obesidad en una muestra de origen poblacional española. Valor pronóstico en la mortalidad

    OpenAIRE

    Ponce García, Isabel

    2013-01-01

    1. MAGNITUD DEL PROBLEMA DE LA OBESIDAD La consideración social de la obesidad ha sufrido cambios a lo largo de la historia. En época de carencia nutricional, la obesidad era un objetivo a alcanzar y un signo de pertenecer a una clase pudiente. En la actualidad, los países desarrollados y en vías de desarrollo que han adquirido la forma de vida de aquéllos, han aumentando su prevalencia considerablemente, probablemente como consecuencia de una mala adaptación de nuestra especie, que vive h...

  9. Agricultura urbana: un aporte a la rehabilitación integral

    OpenAIRE

    Moran Alonso, Nerea

    2010-01-01

    El artículo repasa los antecedentes históricos de la agricultura urbana, práctica a la cual en determinados momentos han recurrido diferentes Administra - ciones. Estas prácticas son un ejemplo de cómo actuar en una situación de crisis y de la potencialidad social que tiene la producción de alimentos en un contexto urbano. En países del Sur, han adquirido importancia como estrategia de desarrollo e incluido programas liderados por organismos internacionales. Los huertos urbanos, un modo de in...

  10. Procesamiento de imágenes médicas en odontología como ayuda al diagnóstico

    OpenAIRE

    Sánchez-Barriga Pons, Jorge; Rebollo Fernández, Marcos

    2017-01-01

    En el campo de la odontología es necesario e importante tener una herramienta que permita realizar distintos tipos de cálculos sobre una imagen dada, en este caso, sobre una radiografía mandibular. Con este fin, hemos aplicado los conocimientos adquiridos en procesamiento de imágenes y programación para crear una aplicación que permita obtener resultados para los objetivos requeridos. Uno de tales objetivos que a su vez constituye el fundamental de la aplicación es obtener el Índice Cortic...

  11. Modulación del sistema radicular en condiciones de estrés

    OpenAIRE

    Silva Navas, Javier

    2016-01-01

    Durante su evolución, las plantas han adquirido un desarrollo post-embrionario que juega un papel esencial en su adaptación al ambiente. Durante dicha adaptación, la modulación del crecimiento y desarrollo del sistema radicular juegan un papel clave en el éxito reproductivo, o en otras palabras, la productividad agrícola. Por lo tanto, la obtención de sistemas radiculares más eficientes, es considerada como una de las mejores opciones biotecnológicas para incrementar la producción agrícola. E...

  12. Oleohidráulica : problemas resueltos

    OpenAIRE

    Valencia Leonardo, Eugenio; Bergadà Granyó, Josep Maria; Ripoll, Míriam

    2006-01-01

    La oleohidráulica ha adquirido durante los últimos 50 años una posición de preferencia en el ámbito general de máquinas debido a sus innumerables aplicaciones y ventajas, especialmente en máquinas de obras públicas y máquinas herramientas. Los componentes que en número y variedad se han desarrollado de forma espectacular son los elementos de las centrales hidráulicas (bombas, válvulas y actuadotes tanto lineales como rotativos). En definitiva se trata de optimizar la transmisión de energía...

  13. Planificación estratégica de la empresa Aqualogy Aqua Ambiente Servicios Integrados, S.A.

    OpenAIRE

    Martínez Zafra, María Teresa

    2015-01-01

    El Objetivo de este Proyecto Final de Carrera (de aquí en adelante PFC) es el de desarrollar, gracias a los conocimientos adquiridos en el ciclo superior de Ingeniería de Organización Industrial, una estrategia que permita a la empresa objeto de estudio, mejorar su gestión, así como el de analizar y planificar una estrategia en las políticas empresariales del sector del ciclo del agua en el cual desarrolla sus actividades, de modo que se posicione como una empresa de referencia...

  14. Medicina regenerativa y células madre. Mecanismos de acción de las células madre adultas

    OpenAIRE

    Hernández Ramírez, Porfirio

    2009-01-01

    La medicina regenerativa es una rama de la medicina que se ha desarrollado considerablemente en los últimos años. Los avances en este campo se han vinculado estrechamente con los nuevos conocimientos adquiridos sobre las células madre y su capacidad de convertirse en células de diferentes tejidos. Esta medicina se sustenta en conductas adoptadas por el organismo para remplazar por células sanas a las dañadas por diversos procesos en determinados tejidos. Las medidas terapéuticas empleadas pue...

  15. Desarrollo de procesos de separación y recuperación del boro de aguas contaminadas mediante el uso de biopolímeros

    OpenAIRE

    Demey Cedeño, Hary

    2010-01-01

    El agua es un recurso fundamental para todos los seres vivientes y es un recurso indispensable para el desarrollo industrial. La creciente presión que genera el crecimiento poblacional y el aumento de las necesidades de la civilización moderna, tiene como consecuencia la búsqueda de métodos que hagan posible la reutilización del agua de desecho, separando los contaminantes presentes en la misma. Uno de los elementos que ha adquirido relevancia a nivel mundial es el boro, ya que una contami...

  16. Tratados de libre comercio, Plan Nacional de Desarrollo y Clusters ¿Cambio de ruta o más de lo mismo?

    Directory of Open Access Journals (Sweden)

    René Mendoza

    2004-06-01

    Full Text Available El concepto cluster (aglomerado, conglomerado, núcleo o enjambre es la palabra más popular de nuestros días en toda América Latina. Lo es también Michael Porter, el economista de la Universidad de Harvardl que ganó renombre en la administración de Reagan, en los Estados Unidos, cuando fue llamado a integrar la comisión del Presidente sobre Competitividad Industrial de los Estados Unidos (Porter, 1990: xii. ¿Cómo es que ese concepto ha adquirido tal notoriedad?

  17. “Los cinco reinos”. Diseño de materiales usando las nuevas tecnologías y evaluación de aprendizajes

    OpenAIRE

    Pérez Buendía, Carmen

    2014-01-01

    La tesis realizada ha tenido como objetivo estudiar la eficacia del proceso de aprendizaje experimentado en un grupo de estudiantes mediante una metodología que utiliza como recurso básico las Tecnologías de la información y la comunicación, TIC, desarrollada en grupos cooperativos. En concreto, se ha investigado el nivel adquirido en las competencias científica y digital a partir de la unidad didáctica Los Cinco Reinos organizada en cinco bloques (Ser vivo, Reino Monera, Reino Protista y Vir...

  18. PRONAF A SALVAÇÃO DA LAVOURA OU PROBLEMA? UMA ANÁLISE DO NÍVEL DE SATISFAÇÃO DOS PRODUTORES

    OpenAIRE

    Coronel, Daniel Arruda; Sonaglio, Claudia Maria; Angelo, Helena Dezordi; Zamberlan, Carlos Otavio; Silva, Angelita Freitas Da

    2008-01-01

    Este artigo demonstra conceitos e modelos relacionados à mensuração da satisfação de clientes, focando a satisfação dos agricultores do Assentamento Itamarati I, com relação aos financiamentos do Pronaf (Programa de fortalecimento da agricultura familiar) adquiridos no Banco do Brasil de Ponta Porã-MS. Para isso foram entrevistados 179 assentados. A metodologia utilizada envolveu uma fundamentação teórica embasada em pesquisa bibliográfica, que abordou os principais conceitos relacionados ao ...

  19. Elaboração de planos de transporte de pessoas

    OpenAIRE

    Correia, Marisol B.

    1996-01-01

    Dissertação mest., Engenharia Electrotécnica e de Computadores, Universidade Técnica de Lisboa, Instituto Superior Técnico, 1996 O objectivo deste estudo é definir e apresentar as etapas necessárias para elaborar planos de transporte de pessoas e, de entre estes, escolher os melhores em função dos critérios indicados pelo utilizador. Este estudo apresenta, em primeiro lugar, o conhecimento adquirido sobre os transportes e uma possível representação deste utilizando os enquadramentos co...

  20. La relevancia de la deliberación del consumidor en el ecosistema digital previa a la decisión de compra

    OpenAIRE

    Zevallos Miranda, Fernando R.

    2014-01-01

    Este estudio analiza el rol y la importancia que ha adquirido la búsqueda de información, conversación en foros y redes sociales y deliberación previa a la toma decisiones en el proceso de compra. Partiendo de la hipótesis de que el fácil acceso de los usuarios de Internet a reseñas y prescripciones sobre productos y marcas es uno de los principales detonantes de este fenómeno, se presentan los antecedentes y las opiniones de expertos en relación a la relevancia que ha cobrado la información ...

  1. Estudio de viabilidad para la ejecución de un aparcamiento subterráneo entre las calles Ciudad de Granada, Bolivia y Badajoz de Barcelona

    OpenAIRE

    Domínguez Quinoya, Inmaculada

    2014-01-01

    Este trabajo, punto final a los estudios de Ciencias y Tecnología de Edificación, pretende aplicar todos los conocimientos adquiridos en estos cuatro años en un proyecto concreto y real. Se trata de confirmar o negar la viabilidad de la construcción de un aparcamiento subterráneo en un solar situado entre las calles Ciudad de Granada, Bolivia y Badajoz de Barcelona. 1.- VIABILIDAD EN EL TERRITORIO: Empezamos conociendo la zona donde se ubica el aparcamiento, estudiando si ex...

  2. Utilización de una página web para la enseñanza del Método Pilates

    OpenAIRE

    Camblor, Ezequiel; Jócano, Érica

    2011-01-01

    En el presente trabajo se describe la utilización de una página web cómo herramienta que pretende emular los procesos involucrados en las decisiones de construcción de una clase de Pilates y que tiene como objetivos proporcionar: instancias prácticas de toma de decisiones y herramientas de nivelación de conocimientos, además de evaluar conocimientos adquiridos. La navegación por la página permite: contribuir al aprendizaje por descubrimiento, poner en juego la intuición, el pensamiento imagin...

  3. Prospectiva del sector de calzado de cuero en Colombia, caso Calzado Yullyan

    OpenAIRE

    Alarcón López, Laura Victoria; Caro Sánchez, Jully Alexandra; González Urrea, Laura Catalina

    2016-01-01

    Este trabajo busca aplicar los conocimientos adquiridos para identificar los problemas que se presentan en la empresa “Calzado Yullyan” y obtener posibles soluciones para lograr un mejor desempeño de la organización en el sector. Se pretende determinar los posibles escenarios en los que la empresa se puede ver involucrada, de manera que se planteen soluciones que mejoren las actividades desarrolladas y permitan el crecimiento y fortalecimiento de la misma. Para este trabajo se realizó un anál...

  4. Propuesta de un modelo para mejorar la eficiencia en el control de gestión de los servicios públicos municipales en México

    OpenAIRE

    Israel Patiño Galvan; Concepción Herrera Alcázar; J. Jesús Ceja Pizano

    2013-01-01

    El control de gestión de los servicios públicos municipales en México, se ha desarrollado bajo esquemas normativos que regulan y limitan su funcionamiento y cobertura, los cuales últimamente se han visto superados por el aumento en el número de habitantes, en la cobertura, y finalmente en el volumen de información que es almacenada en documentos. Otro factor que ha adquirido importancia ha sido el auge de la tecnología que presiona de sobre manera su utilización, y la administración publica...

  5. Consenso chileno de prevención, diagnóstico y tratamiento de la diarrea asociada a Clostridium difficile

    OpenAIRE

    Hernández-Rocha, Cristian; Pidal, Paola; Ajenjo, M. Cristina; Quera, Rodrigo; Quintanilla, Marcela; Lubascher, Jaime; Jemenao, M. Irene; Ibáñez, Patricio; Álvarez-Lobos, Manuel; Diomedi, Alexis; Marcotti, Alejandra; Acuña, Mirta; Arab, Juan P; Riquelme, Arnoldo; Candía, Roberto

    2016-01-01

    Introducción: La diarrea asociada a Clostridium difficile (DACD) ha adquirido gran relevancia debido al aumento en su incidencia, gravedad, capacidad de recurrencia y carga económica asociada. Contar con una guía de consenso local es fundamental para mejorar su manejo. Objetivo: Elaborar un consenso multidisciplinara y basado en la evidencia en la prevención, diagnóstico y tratamiento de la DACD. Métodos: Se convocó a un panel de expertos en el área de enfermedades infecciosas, gastroenterolo...

  6. Terapia asistida con animales y cuidados de enfermería : una revisión de la literatura más reciente

    OpenAIRE

    Salazar Calleja, Alma

    2016-01-01

    Introducción. La terapia asistida con animales en el ámbito sanitario se remonta al siglo XI. Con el paso del tiempo y la aparición de nueva evidencia científica que avala el gran número de beneficios derivados de sus efectos terapéuticos, dichas terapias han adquirido cierta popularidad. Objetivos.El objetivo principal de este trabajo es conocer los resultados de la terapia asistida con animales; y como objetivo secundario determinar cuál es el papel de la enfermería. Métodos. Para analizar ...

  7. Conceção e produção de placas de gesso laminado

    OpenAIRE

    Lopes, Susana Maria de Oliveira

    2012-01-01

    O presente relatório tem como objetivo descrever o trabalho desenvolvido durante o período de estágio realizado na Fibroplac que tem como atividade a produção de placas de gesso laminado. As placas de gesso laminado têm-se destacado na indústria da construção civil por serem um produto leve e de rápida instalação, atendendo à atual procura de racionalizar a construção, evitando desperdícios e otimizando etapas. O relatório descreve de forma sucinta os conhecimentos adquirido...

  8. Monitorización y optimización de terapias de tele-neurorrehabilitación cognitiva

    OpenAIRE

    Solana Sánchez, Javier

    2014-01-01

    El Daño Cerebral Adquirido (DCA) se define como una lesión cerebral que ocurre después del nacimiento y que no guarda relación con defectos congénitos o enfermedades degenerativas. En el cerebro, se llevan a cabo las funciones mentales superiores como la atención, la memoria, las funciones ejecutivas y el lenguaje, consideradas pre-requisitos básicos de la inteligencia. Sea cual sea su causa, todo daño cerebral puede afectar a una o varias de estas funciones, de ahí la gravedad del problema. ...

  9. Simulador cardiaco digital

    OpenAIRE

    Plaza Guingla, Vicente; Santin Loayza, Manuel; Yapur Auad, Miguel Eduardo

    2009-01-01

    presente trabajo ha sido diseñado con la finalidad de proporcionar al estudiante un dispositivo que permita simular un patrón de onda cardíaca normal y además que permita variar la frecuencia cardíaca, de manera que se ponga en práctica los conocimientos adquiridos al estudiar esta señal, y las alteraciones que se pueden presentar. Este dispositivo podrá ser utilizado para diagnóstico, ya que permite determinar si la señal cardíaca simulada de la persona, tiene un ritmo cardíaco norm...

  10. Territorio virtual: arquitectrónica

    Directory of Open Access Journals (Sweden)

    Marta Borbonet

    2002-08-01

    Desde el nacimiento en 1989 del lenguaje HTML para el intercambio de datos entre científicos, de la mano de Tim Berners-Lee la densificación de la información en Internet ha adquirido proporciones colosales hasta hoy en día. Paralelamente al ingente volcado de información en la Red han ido creciendo lógicamente nodos de conexión, servidores, routers, etc. o sea, mecanismos de distribución y acceso a este flujo informacional.

  11. Inmunidad e Inmunosenescencia

    OpenAIRE

    Piscoya Arbañil, José; Rodríguez Tafúr, Juan

    2014-01-01

    En el presente trabajo revisamos los últimos avances en la comprensión de la inmunosenescencia o envejecimiento del sistema inmunitario. Este proceso es producto de la interacción de factores innatos (genéticos) y, adquiridos (nutrición, estilos de vida e interacción huésped-parásito). Entre los factores genéticos destacan la expresión controlada genéticamentede las moléculas del sistenia HLA en las células inmunesy como la expresión de determinados alelos puede estar ligada a una mayor l...

  12. Sobrepeso, obesidad y hábitos de vida saludables en estudiantes universitarios de Enfermería de Palencia

    OpenAIRE

    Díez Polo, Teresa

    2015-01-01

    INTRODUCCIÓN: La obesidad ha sido declarada la gran epidemia del siglo XXI, afectando tanto a niños como adultos. Debemos concienciarnos de que los hábitos adquiridos durante la infancia perduran durante la edad adulta. Es necesario promover desde la escuela y la universidad, los hábitos de vida sana y la adherencia a la dieta mediterránea ya que es un aliado en la lucha contra la obesidad. OBJETIVO: Analizar la prevalencia de sobrepeso, obesidad y hábitos de vida saludab...

  13. Golte Jürgen y Doris León Gabriel, Alasitas: discursos, prácticas y símbolos de un « liberalismo aymara altiplánico » entre la población de origen mi

    OpenAIRE

    Sendón, Pablo F.

    2016-01-01

    Las alasitas son pequeños objetos que adoptan una asombrosa variedad de formas y son adquiridos en ferias o mercados de origen altiplánico por personas deseosas de incrementar sus bienes y patrimonio. Es decir, si un individuo busca conseguir un medio de transporte, aumentar su riqueza o ascender en la pirámide social puede comprar alasitas con la forma de automóviles, billetes y títulos universitarios para hacer realidad sus deseos. En cierta manera este tipo de práctica parecería estar rela...

  14. Estudio de la intersección de acceso al barrio La Enea de la ciudad de Manizales.

    OpenAIRE

    Granada Gómez, Hernando; Henao Burgos, Armando

    2001-01-01

    Con el presente trabajo final del Programa de Especialización en Vías y Transporte, se pretende: Analizar la Intersección de Acceso al Barrio la Enea de la Ciudad de Manizales. Aplicar los conocimientos adquiridos sobre ingeniería de tránsito durante el desarrollo del Postgrado, teniendo en cuenta las técnicas relativas al diseño de intersecciones. Analizar si es factible hacer el proyecto desde el punto de vista económico y ambiental, para poder escoger la mejor alternativa, qu...

  15. Problemática contable de las provisiones para impuestos

    OpenAIRE

    Rodríguez García, Ferran

    2014-01-01

    Como sabemos la contabilidad es una disciplina económica, motivo por el cual las valoraciones realizadas en su ámbito precisan de un cierto grado de homogeneización convencional proporcionada ésta, de manera significativa, por el denominado marco conceptual de la contabilidad (MCC) que ha adquirido un amplio consenso internacional en las últimas décadas, como punto de referencia. Dicho marco conceptual recoge toda una serie de principios y criterios fundamentales y básicos para un adecuado tr...

  16. Nuevas tecnologías para la atención a personas con discapacidad de origen neurológico

    OpenAIRE

    Fernández Nistal, Francisco

    2014-01-01

    Según la Encuesta de Discapacidad, Autonomía Personal y Situaciones de Dependencia (INE, EDAD- 2008), residen en España 420.064 personas con daño cerebral adquirido. Un alto porcentaje de las personas con DCA sufren serias dificultades cognitivas que afectan las funciones psíquicas que permiten analizar lo que nos rodea, aprender, reflexionar y tomar decisiones basadas en un razonamiento. Algunos de estos problemas cognitivos son transitorios y reversibles pero otros pueden condicionar la au...

  17. “VALORACIÓN DE PLACA BACTERIANA Y GINGIVITIS, MEDIANTE EL ÍNDICE DE PLACA DE O ́LEARY E ÍNDICE GINGIVAL DE LOE-SILNESS, POSTERIOR AL USO DE CLORHEXIDINA AL 0.12%, EN PACIENTES CON APARATOLOGIA FIJA”

    OpenAIRE

    Bucio Hernández, María Sugey

    2012-01-01

    Antecedentes: La búsqueda de agentes para el control de la placa bacteriana ha sido amplia, más teniendo en cuenta la importancia que ha adquirido la enfermedad periodontal en los últimos años; esto ha llevado a diversas industrias farmaceuticas a investigar en este campo. En el presente estudio se utilizo el índice Gingival de Löe y Silness (1963), por ser sencillo y valorar todas las áreas del diente, el más utilizado actualmente para medir el estado de inflamación y de salud...

  18. Influencia de la movilización rítmica del plexo sacro sin componentes adicionales en la velocidad de la marcha en pacientes neurológicos con capacidad de deambular

    OpenAIRE

    Marañón Jiménez-Arellano, Haizea Alaia

    2013-01-01

    RESUMEN: Introducción: debido a la necesidad de los pacientes con daño cerebral adquirido de un tratamiento para normalizar la marcha y a la creciente línea de investigación estudios sobre la movilización nerviosa, se plantea el siguiente objetivo en el ensayo clínico planteado y el estudio piloto realizado para este trabajo: determinar si la movilización rítmica del plexo sacro mejora la marcha del paciente neurológico. Método: se plantea un proyecto de ensayo clínico randomizado con dos ...

  19. AVALIAÇÃO DAS CONDIÇÕES DE TRABALHO NO SETOR INDUSTRIAL: UMA ABORDAGEM CENTRADA NA ERGONOMIA FÍSICA E ORGANIZACIONAL

    OpenAIRE

    SANTOS, Isaac José Antonio Luquetti dos; MOREIRA, Maria de Lourdes

    2014-01-01

    As empresas estão sendo chamadas a atuar dentro de um novo contexto tecnológico empresarial a fim de proporcionar maior condição de conforto aos seus funcionários e procuram adaptar dentro do perfil econômico atual às mudanças, à competitividade do setor e às incertezas do mercado. Neste processo de mudança, tentam definir estratégias de diferentes níveis e necessita de um apoio efetivo para realizar suas intervenções com segurança compartilhando conhecimentos adquiridos através de uma ...

  20. Resultados del coaching aplicado a ejecutivos

    OpenAIRE

    Vásquez Garzón, William Alonso

    2012-01-01

    El coaching como herramienta para la vida diaria de las empresas ha adquirido en la última década una fuerza considerable en los ámbitos más competitivos de las empresas, como por ejemplo la fuerza comercial y la definición de estrategias para conquistar mercados y alcanzar las metas, que cada vez son más altas. Esto motivo al análisis del coaching ejecutivo de un grupo de ejecutivos pertenecientes al alta y media gerencia, los cuales se capacitaron en técnicas de coaching y ejecutaron los mi...

  1. Estudio de patrones de interacción entre los estudiantes y la Plataforma de Tele-Enseñanza en la UPM

    OpenAIRE

    Moya Pérez, Carlos

    2015-01-01

    Vivimos en una sociedad en la que la información ha adquirido una vital importancia. El uso de Internet y el desarrollo de nuevos sistemas de la información han generado un ferviente interés tanto de empresas como de instituciones en la búsqueda de nuevos patrones que les proporcione la clave del éxito. La Analítica de Negocio reúne un conjunto de herramientas, estrategias y técnicas orientadas a la explotación de la información con el objetivo de crear conocimiento útil dentro de un marco...

  2. Diseño y fabricación de un vehículo aéreo no tripulado

    OpenAIRE

    Cantero Guerrero, Jorge

    2015-01-01

    Este proyecto describe el proceso seguido por dos estudiantes de ingeniería para diseñar y fabricar un prototipo de un cuadricóptero dron de uso civil. Se pasa por diferentes etapas y fases por las que debería pasar cualquiera para poder llevar a cabo lo anteriormente mencionado. También, en cada etapa, se intenta dejar muestras de los conocimientos adquiridos durante el Grado en Ingeniería en Tecnologías Industriales. Se aplican conocimientos de cálculo, geometría, mecánica del sólido ríg...

  3. Estudio de los factores socioeconómicos y culturales y su relación con las actitudes y prácticas de las madres en la nutrición de niños menores de dos años que acuden al puesto salud Atumpampa – distrito de Tarapoto, Agosto - Diciembre 2008

    OpenAIRE

    Ríos Sánchez, Luisa Isabel

    2012-01-01

    Una alimentación saludable requiere, en muchos casos, de una educación nutricional que debe promoverse desde la infancia en el núcleo familiar, ya que los hábitos adquiridos en esa etapa son fundamentales para una correcta alimentación en la adolescencia y una prevención de las enfermedades vinculadas a los trastornos alimenticios. Los efectos positivos o negativos de la alimentación tendrán repercusión, tarde o temprano, en la salud. Planteándome como objetivo central el determinar la relaci...

  4. Diseño de una metodología para diagnosticar la situación actual de las Pymes en el Ecuador

    OpenAIRE

    Alomoto, Nelson

    2010-01-01

    La situación actual de nuestro país, a la luz de diversos indicadores internacionales es una de las peores, a nivel latinoamericano y mundial. Para los gobernantes de turno, políticos, empresarios, y en general para quienes están encargados de la toma de decisiones se ha tornado de vital importancia indicadores tales como los de: desarrollo humano, clima de negocios, competitividad, etc. Precisamente este ´ último ha adquirido una importancia capital, de tal forma que la mayoría de las nacion...

  5. Do peixe com farinha à macarronada com frango: uma análise das transformações na rede urbana no Alto Solimões pela perspectiva dos padrões alimentares.

    OpenAIRE

    Schor, Tatiana; Tavares-Pinto, Moisés Augusto; Avelino, Francisco Carlos da Costa; Ribeiro, Marina Lelis

    2015-01-01

    As transformações e permanências nos padrões alimentares são indicativos de mudanças sociais e ambientais complexas. A passagem de uma dieta tradicional, fortemente baseada em produtos coletados, pescados, caçados, plantados ou mesmo adquiridos localmente para uma dieta de supermercado, isto é oriunda da agroindústria é um interessante indicativo do processo de modernização. A análise dessas mudanças permite entender processos diversificados tais como a urbanização. Os hábitos alimentares no ...

  6. Estudo demográfico de espécies arbóreas de diferentes grupos ecológicos em um fragmento de floresta estacional semidecidual do sul do Brasil

    OpenAIRE

    Yves Rafael Bovolenta

    2016-01-01

    Estudos populacionais permitem entender a história de vida das espécies e sua estabilidade no espaço e tempo. A compreensão da dinâmica populacional requer a quantificação das taxas vitais básicas (crescimento, sobrevivência, decrescimento e fecundidade) e os conhecimentos adquiridos podem ser aplicados à conservação, prevendo trajetórias da população e para entender processos de regulação dos sistemas naturais, principalmente em habitats modificados pelo homem. Nesse sentido, o objetivo foi ...

  7. Desajuste educativo y competencias cognitivas: efectos sobre los salarios

    OpenAIRE

    Lucia Mateos; Ines Murillo; Maria del Mar Salinas

    2014-01-01

    Este trabajo analiza los rendimientos de la educación y del desajuste educativo en España teniendo en cuenta no solo los años de educación recibida por los trabajadores sino también las competencias básicas que estos han adquirido realmente. Utilizando la base de datos PIAAC, los resultados obtenidos indican que tanto los años de educación como las competencias adquiridas contribuyen a determinarlos salarios, siendo mayor el rendimiento asociado a los años de educación cuanto mayor es el nive...

  8. Damiia: Proceso de producción para animación 3D.

    OpenAIRE

    HERNÁNDEZ FERRÉ, GERMÁN

    2018-01-01

    Damiia es una producción personal en animación 3D pensada para plasmar mi interés por la animación profesional a través de un entendimiento de todas sus fases y procesos. Nace con la intención de desarrollar cierta destreza multidisciplinar en el arte digital 3D y demostrar los conocimientos adquiridos durante estos 4 años de carrera. Damiia is a personal production in 3D animation designed to capture my interest in professional animation through an understanding of all its phases and proc...

  9. Humedal urbano en Punta Arenas: Sustentabilidad del Proyecto Parque Ecológico Humedal Tres Puentes

    OpenAIRE

    Luis Inostroza Pino

    2009-01-01

    El Humedal Tres Puentes, ubicado en la entrada norte de Punta Arenas, es un espacio relevante desde el punto de vista ecológico y hábitat de una numerosa avifauna, uno de los más importantes de la ciudad. Sin embargo el Humedal está seriamente amenazado, dado su ubicación sobre uno de los principales vectores de crecimiento de la ciudad de Punta Arenas, en terrenos que han adquirido plusvalía paulatinamente, bien por efecto de la obra pública del Estado o por el simple crecimiento vegetativo ...

  10. Tempo de jejuar e resistir: a presença do kung-fu no treinamento do ator : a experiência extracotidiana no teatro vocacional em proposição épica

    OpenAIRE

    Oliveira, Juliana Rocha de [UNESP

    2010-01-01

    Esta pesquisa surgiu da necessidade de registrar, organizar, sistematizar e relacionar os conhecimentos adquiridos em minha formação de atriz, professora de teatro e artista marcial, no intuito de melhor explorar o processo de criação teatral, utilizando técnicas marciais orientais. Aproximando as duas artes: teatral e marcial – kung fu, termo que além de designar uma arte marcial de origem chinesa possui outros significados como, por exemplo, capacidade de aguentar jejum e resistir, vislumbr...

  11. Modelo de la geometría sol-sensor en la reflectancia de la vegetación: validación a nivel satelital.

    OpenAIRE

    Medrano Ruedaflores, Edgardo Rafael

    2013-01-01

    Las observaciones de la superficie terrestre realizadas por sensores remotos a bordo de plataformas satelitales, pueden ser utilizadas para caracterizar los procesos que ocurren en el sistema suelo-vegetación-atmósfera. Los datos adquiridos desde distintos ángulos de observación son una fuente de información adicional a la ofrecida por las variaciones espectrales, espaciales y temporales detectadas por estos instrumentos. Una de las aplicaciones donde ha cobrado relevancia el uso de esta cuar...

  12. Eficacia de la Terapia Manual para las lesiones de hombro en crossfit

    OpenAIRE

    Pérez Gil, Lauro

    2015-01-01

    La elevada difusión que ha adquirido la práctica de crossfit en la actualidad entre la población como método de mantenerse en forma conlleva la aparición de múltiples lesiones debido a la excesiva intensidad y nivel habilidad que algunos de los ejercicios presentan y que hacen aparecer compensaciones lesivas. Una de las articulaciones más afectadas es el hombro debido a que es sometido a cargas excesivas o en ángulos incorrectos que hacen aparecer lesiones tales como sobrecargas musculares, c...

  13. La campaña electoral, vista desde la perspectiva de la propaganda de ataque y el rumor

    Directory of Open Access Journals (Sweden)

    Dr. Iván Abreu Sojo

    1998-01-01

    Full Text Available En el presente artículo el autor pasa revista a algunos elementos presentes en las campañas electorales, no correspondientes a la promoción de las virtudes de los candidatos o a la oferta electoral. Se trata más bien de analizar el papel relevante que en el contexto venezolano han adquirido la propaganda de ataque, la contrapropaganda y la propaganda negra, la llamada "guerra sucia", los rumores y comentarios, esfuerzos para desacreditar al adversario.

  14. Herramienta para la gestión de convenios de docencia-servicio en Instituciones Prestadoras de Servicios de Salud

    OpenAIRE

    Ortiz Garcia, Yurani Andrea; Restrepo Varela, Juan Guillermo; Velez Velez, Andres

    2014-01-01

    Los procesos de formación de profesionales de salud idóneos en el mundo, complementan su conocimiento entre dos componentes fundamentales, un componente teórico y el otro componente práctico. La formación que recibe en las aulas y la realización de las prácticas académicas a las cuales pueda acceder, le permite al estudiante trasformar el conocimiento académico adquirido en conocimiento cercano a la realidad y con fundamento profesional, razón por la cual las Instituciones Educativas tienen l...

  15. Dor neuropática em paciente com porfiria: relato de caso

    OpenAIRE

    Santos, Alysson B O; Gozzani, Judymara L; Groke, Daniela F

    2010-01-01

    JUSTIFICATIVA E OBJETIVOS: As porfirias são um grupo de distúrbios herdados ou adquiridos que envolvem enzimas participantes do processo de síntese do heme. As manifestações agudas afetam o sistema nervoso, resultando em dor abdominal, vômitos, neuropatia aguda, convulsões e distúrbios mentais. A fisiopatogenia resulta do efeito tóxico dos precursores de porfirina, podendo ser desencadeada por fármacos usados de rotina na prática médica, restrição intensa de carboidratos e estresse metabólico...

  16. Estudio de alternativas para la construcción de sistemas de drenaje urbano sostenible (SUDS) en el campus de las Llamas de la Universidad de Cantabria

    OpenAIRE

    Zorrilla Martínez, Gema

    2015-01-01

    RESUMEN: Este Trabajo Fin de Grado (TFG) tiene como objetivo el estudio de la posible aplicación de Sistemas Urbanos de Drenaje Sostenible (SUDS) en el campus de la Universidad de Cantabria. Para lo cual se han empleado conocimientos adquiridos en las asignaturas del grado como: Construcción de Obras Públicas, Hidráulica e Hidrología, Obras Hidráulicas, Geotecnia, Impacto Ambiental, Edificación, Caminos (especialmente en lo referente a la utilización de firmes permeables), Proyectos y Sosteni...

  17. La tradición del trabajo de campo en Geografía

    Directory of Open Access Journals (Sweden)

    Perla Zusman

    2011-01-01

    Full Text Available El trabajo de campo ha adquirido distintas significaciones a lo largo de la historia de la Geografía. Los cambios en la concepción de la Geografía han derivado en redefiniciones de la contribución del trabajo de campo al proceso de producción de conocimiento. El objetivo de este texto es aproximarse a los aspectos epistemológicos y políticos presentes en las distintas formas de entender el trabajo de campo. A su vez, se busca mostrar que las diversas maneras de concebir y hacer el trabajo de campo conviven en la actualidad

  18. Estudio de la mujer emprendedora: El medio rural como oportunidad

    OpenAIRE

    Pérez Cabrera, Alejandra; Tallón Fernández, María Dolores

    2017-01-01

    La mujer constituye un sujeto especialmente relevante para el desarrollo, no sólo económico, sino también social y cultural de las zonas rurales. Y, en este sentido, el emprendimiento rural en los últimos años ha adquirido un papel cada vez más protagonista, ya que contribuye a la modernización y sostenibilidad de estos entornos gracias a la creación de nuevas empresas que, en muchas ocasiones, implementan nuevos modelos de negocio distintos de los tradicionales. En este trabajo se examinan a...

  19. La crisis migratoria en el Mediterráneo y la Unión Europea: principales políticas y medidas antinmigrantes

    OpenAIRE

    Rebeca Oroza Busutil; Yoannis Puente Márquez

    2017-01-01

    La crisis migratoria que desde hace varias décadas afecta a Europa, con la llegada de inmigrantes y refugiados provenientes de África y del Oriente Medio, ha adquirido en los últimos años dimensiones de una verdadera tragedia humanitaria. Este fenómeno, unido a las consecuencias negativas de la crisis económica, ha provocado el reforzamiento de las ideas racistas, xenófobas e intolerantes, enarboladas por los partidos de la extrema derecha europea, que han encontrad...

  20. Conexión social. Programa de ayuda a niños y jóvenes en riesgo de adicción a las nuevas tecnologías

    OpenAIRE

    Sanz Martín, Ainhoa

    2014-01-01

    Con el paso de los años las nuevas tecnologías (telefonía móvil, videojuegos, redes de televisión…) han adquirido un valor en la forma de vida de las personas muy importante, sobre todo en menores y jóvenes, quienes hacen un uso excesivo de las mismas. Este hecho es muy preocupante ya que nos podemos encontrar en la sociedad con adolescentes con patrones concretos vinculados a las nuevas tecnologías y que carecen de habilidades sociales suficientes para comunicarse y con dificultades en el de...

  1. Formación de robots móviles mediante el uso de controladores

    Directory of Open Access Journals (Sweden)

    Adriana Riveros Guevara

    2013-12-01

    Full Text Available El manejo de sistemas multi-robots, ha adquirido gran atención en las últimas décadas, destacándose en aplicaciones tales como la elaboración de mapas, el transporte de objetos e incluso el rescate de personas. Teniendo en cuenta esta motivación, se realizó la búsqueda de trabajos que abordaron el tema, encontrando diferentes tipos de controladores aplicados a estos sistemas manteniendo la configuración líder-seguidor.

  2. Rediseño de una lavadora de bidones para envasado de agua tratada

    OpenAIRE

    Martinez Lozano, Ernesto Rolando

    2009-01-01

    El objetivo de esta tesis es aplicar los conocimientos adquiridos, para realizar el rediseño de una lavadora manual para bidones de una empresa de tratamiento de agua, se establecerán las condiciones de diseño optimo para disminuir el tiempo en el proceso de lavado de los bidones que son utilizados en el proceso de envasado del agua tratada el cual es realizado manualmente, en donde los tiempos de lavado varían entre 40 y 60 botellas por hora; queriendo llegar a obtener un tiempo estándar de ...

  3. Mejora en los procesos de identificación de servicios, obtención de requisitos, integración de información y desarrollo de software

    OpenAIRE

    Cechich, Alejandra; Aranda, Gabriela N.; Buccella, Agustina; Flores, Andrés P.; Luzuriaga, Juan Manuel; Martín, Adriana Elba; Martínez, Rodolfo; Martínez Carod, Nadina; Moyano, Marcelo; Mazalu, Rafaela; Garriga, Martín

    2009-01-01

    Tomando como base conocimientos adquiridos en investigaciones anteriores, el presente proyecto aborda distintas temáticas en la mejora de procesos software, centrando el estudio en (1) mejoras a procesos específicos – ej.especificación de requisitos; (2) definición y validación de técnicas para evaluación de composiciones en dominios específicos (Sistemas de Información Geográficos, Requisitos en Desarrollos Globales); (3) evaluación de atributos de calidad específicos (integrabilidad y acces...

  4. Centros de datos avanzados – estructura, análisis y diseño

    OpenAIRE

    Calabresi, Franco Gonzalo

    2017-01-01

    125 p. il. El siguiente proyecto de grado fue llevado a cabo mediante la aplicación de una serie de aprendizajes y conocimientos adquiridos a lo largo de la carrera de Ingeniería en Telecomunicaciones. El enfoque principal se centra en la implementación de conceptos referidos a sistemas de entornos, redes, gestión y liderazgo de proyectos, tendencias eco-amigables y cálculo de necesidades de DC, entre otras. En este documento se analiza el Data Center de Banco Masventas antes y desp...

  5. EVALUACION ERGONOMICA Y PSICOSOCIAL DE PUESTOS DE TRABAJO CON PANTALLA DE VISUALIZACION DE DATOS

    OpenAIRE

    Rosique-Molina, Vicente

    2012-01-01

    El presente trabajo se realiza como Trabajo Fin del Máster (TFM) de Prevención de Riesgos Laborales, Especialidad de Ergonomía y Psicosociología, y pretende plasmar los conocimientos teóricos adquiridos durante el curso realizando una Evaluación Ergonómica y Psicosocial de puestos de trabajo con Pantallas de Visualización de Datos (PVD), y demostrar que los métodos utilizados, el del Instituto Nacional de Seguridad e Higiene en el Trabajo (INSHT) para la evaluación ergonómica y el CoPsoQ I...

  6. Tendências de pesquisas brasileiras sobre mulheres mastectomizadas

    OpenAIRE

    Azevedo, Elisângela Braga de; Bezerra, Pollyana Amorim Ponce de Leon; Neto, José Melquiades Ramalho; Bustorff, Leila Alcina Correia Vaz; Souto, Cláudia Maria Ramos Medeiros

    2012-01-01

    Objetivou-se analisar as tendências das pesquisas realizadas no Brasil sobre mulheres mastectomizadas. Trata-se de um estudo bibliográfico de abordagem quantitativa, realizado de 15 de junho a 31 de julho de 2009. Para coleta dos dados empíricos utilizou-se um instrumento estruturado, posteriormente os dados foram tabulados, analisados, transformados em porcentagens e agrupados em uma tabela para facilitar a visualização das informações. A amostra foi constituída por resumos adquiridos atravé...

  7. Tendências de pesquisas brasileiras sobre mulheres mastectomizadas Tendencias en la investigación sobre la mujer brasileña sometida a mastectomía Trends in research with Brazilian women after mastectomy

    OpenAIRE

    Elisângela Braga de Azevedo; Pollyana Amorim Ponce de Leon Bezerra; José Melquiades Ramalho Neto; Leila Alcina Correia Vaz Bustorff; Cláudia Maria Ramos Medeiros Souto

    2012-01-01

    Objetivou-se analisar as tendências das pesquisas realizadas no Brasil sobre mulheres mastectomizadas. Trata-se de um estudo bibliográfico de abordagem quantitativa, realizado de 15 de junho a 31 de julho de 2009. Para coleta dos dados empíricos utilizou-se um instrumento estruturado, posteriormente os dados foram tabulados, analisados, transformados em porcentagens e agrupados em uma tabela para facilitar a visualização das informações. A amostra foi constituída por resumos adquiridos atravé...

  8. Plan de empresa para un project manager de construcción

    OpenAIRE

    Sánchez Rincón, José Antonio

    2012-01-01

    Objetivos que se pretenden: Estudiar los entresijos para crear una nueva empresa de servicios en lo que se conoce como Project Manager en Construcción, estudiando de antemano las oportunidades y riesgos que se pueden correr, poniéndonos como objetivo además, incluir en el trayecto del trabajo a desarrollar el máximo de conocimientos adquiridos en los estudios de la presente carrera. En resumen, hacer un Plan de empresa para producir bienes inmobiliarios con la gestión del...

  9. INFLUENCIA DE LA MOTRICIDAD FINA EN LA ES-CRITURA DE ALUMNOS CON DIFICULTADES DE APRENDIZAJE DE LA E.S.O.

    OpenAIRE

    Salgado-García, María Isabel

    2013-01-01

    La escritura es una actividad compleja que implica un entrenamiento previo para su adecuada consecución. En ocasiones, ese trabajo o entrenamiento previo no ha sido eficaz y se adquiere la escritura, pero sin un desarrollo adecuado de la motricidad dina con la consecuencia de no haber adquirido un trazo, legibilidad y limpieza adecuada. Es por ello, que hemos planteado una investigación con un alumnado de secundaria, que pese a haber recibido educación en su infancia para desarrollar unas hab...

  10. Taller de Química experimental: una mirada más allá del tubo de ensayo

    OpenAIRE

    Kozubsky, L.; Canestro, E.; Aloy, Mabel Rosa

    2009-01-01

    El taller consiste en una propuesta de trabajo grupal entre los alumnos y el coordinador docente en el que se emplean las metodologías que ayuden a aprender a pensar, aplicar conocimientos previamente adquiridos y descubrir nuevos. Es una propuesta abierta que conjuga trabajo con creatividad y cierta dosis lúdica, haciendo de la clase una experiencia activa donde se construye, intercambia y recrea con espacio para imaginar, equivocarse, ensayar, reflexionar. Así se desarrolló un taller optati...

  11. Seguridad de la terapia de interferón alfa 2b recombinante más ribavirina en la hepatitis crónica C Safety of recombinant interferon alpha 2b plus ribavirin in chronic hepatitis C

    OpenAIRE

    Yoan Antonio Sánchez Rodríguez; Enrique Arús Soler; Pedro López Saura; Hugo Nodarse Cuní

    2011-01-01

    INTRODUCCIÓN: la hepatitis crónica C ha adquirido rango de pandemia. El virus de la hepatitis C se ha convertido en la causa principal de hepatitis crónica, cirrosis hepática, hepatocarcinoma, y trasplante de hígado a nivel mundial. OBJETIVO: identificar los efectos adversos asociados a la terapia combinada interferón alfa 2b recombinante más ribavirina durante la evolución del tratamiento y hasta 8 semanas después de finalizado, así como los principales efectos asociados a salidas temporales...

  12. Seguridad de la terapia de interferón alfa 2b recombinante más ribavirina en la hepatitis crónica C

    OpenAIRE

    Sánchez Rodríguez, Yoan Antonio; Arús Soler, Enrique; López Saura, Pedro; Nodarse Cuní, Hugo

    2011-01-01

    INTRODUCCIÓN: la hepatitis crónica C ha adquirido rango de pandemia. El virus de la hepatitis C se ha convertido en la causa principal de hepatitis crónica, cirrosis hepática, hepatocarcinoma, y trasplante de hígado a nivel mundial. OBJETIVO: identificar los efectos adversos asociados a la terapia combinada interferón alfa 2b recombinante más ribavirina durante la evolución del tratamiento y hasta 8 semanas después de finalizado, así como los principales efectos asociados a salidas temporales...

  13. El Niño 1997-98 en los medios de comunicación: realidades, deformaciones y exageraciones de un evento climático

    Directory of Open Access Journals (Sweden)

    Óscar Marcos Valiente

    2000-01-01

    Full Text Available El fenómeno El Niño de 1997-98 ha sobrepasado su dimensión climática y ha adquirido una repercusión mediática sin precedentes, tomando temporalmente el relevo a otras preocupaciones medioambientales como el cambio climático o el agujero de la capa de ozono. Este artículo revisa el tratamiento informativo del evento, y ofrece una recopilación de curiosidades y equívocos relacionados con El Niño aparecidos en medios de comunicación

  14. Proyecto de viabilidad: creación de una empresa de mantenimiento industrial y gestión energética

    OpenAIRE

    Morán Rodríguez, Cristian

    2012-01-01

    El autor de este Proyecto Final de Carrera ha cursado los estudios de Ingeniería en Organización Industrial, es por eso que se plantea un proyecto que englobe los conocimientos adquiridos en esta especialidad. Para la selección de este proyecto, se tuvieron en cuenta diferentes alternativas. Entre todas ellas se optó por un Proyecto de viabilidad para la Creación de una empresa dedicada al mantenimiento industrial y la gestión energética, ya que, teniendo presente el momento so...

  15. Plan maestro de mantenimiento en una empresa de distribución

    OpenAIRE

    Julve Rodríguez, Roberto

    2014-01-01

    El propósito de este proyecto es realizar un plan maestro de mantenimiento en las instalaciones que Avon Cosmetics posee en Alcalá de Henares. Para ello, y cumpliendo las normativas y requisitos necesarios, se llevará éste a cabo de la manera más satisfactoria posible. Los objetivos del proyecto son: Aplicar los conocimientos adquiridos durante los años de estudio de una forma práctica. Comprender el mantenimiento que se utilizaba y ser capaz de detectar que elementos son...

  16. Concentração de fluoreto em arroz, feijão e alimentos infantis industrializados

    OpenAIRE

    Casarin,Renato C V; Fernandes,Daniel R M; Lima-Arsati,Ynara B O; Cury,Jaime A

    2007-01-01

    OBJETIVO: Determinar a concentração de fluoreto na refeição brasileira típica (arroz e feijão) e em alimentos infantis industrializados e estimar suas contribuições para fluorose dental. MÉTODOS: Os alimentos foram adquiridos de supermercados das cidades de Piracicaba e Campinas, SP, Brasil. Os alimentos infantis industrializados foram comprados em 2001 e o arroz e feijão em 2003, e imediatamente analisados. Foram analisadas três marcas de arroz, três de feijão e 36 amostras de alimentos infa...

  17. La economía colaborativa : factores desencadenantes y comparación con la economía de mercado

    OpenAIRE

    Salinas Lozano, Noelia María

    2016-01-01

    El objetivo de este trabajo es hacer un estudio de la economía colaborativa centrado en las ventajas e inconvenientes que presenta dicho modelo en la economía actual. Se describen las principales plataformas de economía colaborativa existentes en España, basadas en el intercambio de bienes y servicios sin la necesidad de ser adquiridos, y que comienzan a surgir coincidiendo con el inicio de la recesión económica del año 2007 qu...

  18. "El sol no siempre brilla para todos": estrategias de inserción de los jóvenes afrocolombianos a la ciudad de Pereira

    OpenAIRE

    Basallo, Sandra Patricia Martínez

    2014-01-01

    El acelerado proceso de urbanización de la población afrocolombiana puede explicarse a partir de los crecientes flujos migratorios desde la región Pacífica hacia las ciudades, entre las cuales, Pereira ha adquirido una relativa importancia en los últimos años como polo de atracción de esta población. No obstante, el fenómeno migratorio hacia esta ciudad así como los procesos de integración de los migrantes a la sociedad receptora, han recibido una escasa atención por parte de los analistas so...

  19. Donatella Gagliardi. Urdiendo Ficciones. Beatr

    OpenAIRE

    Trujillo Maza, María Cecilia

    2016-01-01

    Hace algunas décadas la exclusión de la mujer de la cultura impresa en el Siglo de Oro se presentaba como una cuestión irrefutable, tanto en la crítica literaria como en la historiografía del libro y de la lectura. Sin embargo, la merecida atención que este aspecto ha adquirido en los últimos años ha puesto en entredicho las conclusiones de aquellos especialistas que habían negado la participación de la mujer en el panorama literario del Quinientos. Las publicaciones de Mª Carmen Marín Pina, ...

  20. El derecho humano a la educación: proyección en el libre desarrollo de la personalidad

    Directory of Open Access Journals (Sweden)

    María Candelaria del Pino Padrón

    2018-04-01

    Full Text Available La educación se constituye en parte fundamental de esa esencia interna del individuo que conforma su personalidad. Así, el libre desarrollo de la personalidad del sujeto se instituye en derecho inalienable vinculado a conocimientos adquiridos y vivencias asimiladas. El ejercicio del derecho a la educación alcanza un indudable valor como coadyuvante del crecimiento intelectual y personal del individuo. Una educación en valores no solamente promueve el libre desarrollo de la personalidad, sino también la autonomía de individuo.