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Walker SC, Ransom M, Sood S, Andrews J, Smith CM. Respiratory failure and shock in an infant with severe anemia. Clin Case Rep 2021; 9:e04852. [PMID: 34584715 PMCID: PMC8455968 DOI: 10.1002/ccr3.4852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 08/17/2021] [Accepted: 09/06/2021] [Indexed: 11/29/2022] Open
Abstract
Patients with severe anemia can present with non-specific symptoms, including shock and respiratory distress. Ensuring a rapid, targeted workup is initiated and providing prompt transfusions as necessary are critical for both diagnostic success and clinical improvement.
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Affiliation(s)
- Shannon C. Walker
- Division of Pediatric Hematology/OncologyDepartment of PediatricsVanderbilt University Medical CenterNashvilleTennesseeUSA
- Division of Transfusion MedicineDepartment of Pathology, Microbiology, and ImmunologyVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Meaghan Ransom
- Division of NeonatologyDepartment of PediatricsVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Shawn Sood
- Division of Pediatric Critical Care MedicineDepartment of PediatricsUniversity of Kansas Medical CenterKansas CityMissouriUSA
| | - Jennifer Andrews
- Division of Pediatric Hematology/OncologyDepartment of PediatricsVanderbilt University Medical CenterNashvilleTennesseeUSA
- Division of Transfusion MedicineDepartment of Pathology, Microbiology, and ImmunologyVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Christine M. Smith
- Division of Pediatric Hematology/OncologyDepartment of PediatricsVanderbilt University Medical CenterNashvilleTennesseeUSA
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Amaro-Hosey K, Danés I, Vendrell L, Alonso L, Renedo B, Gros L, Vidal X, Cereza G, Agustí A. Adverse Reactions to Drugs of Special Interest in a Pediatric Oncohematology Service. Front Pharmacol 2021; 12:670945. [PMID: 34025429 PMCID: PMC8131830 DOI: 10.3389/fphar.2021.670945] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 04/22/2021] [Indexed: 01/02/2023] Open
Abstract
Introduction: Drugs used in oncological diseases are frequently related to adverse drug reactions (ADR). Few studies have analyzed the toxicity of cancer treatments in children in real practice. Methods: An observational, longitudinal and prospective study has been carried out in an Oncohematology Service of a tertiary hospital. During 2017, patients exposed to one or more drugs of a previously agreed list were identified and followed-up for at least 6 months each. Characteristics of ADR, incidence, causality and possible preventability, have been evaluated. Results: 72 patients have been treated with at least one study drug, and 159 ADR episodes involving at least one of these drugs have been identified, with a total of 293 ADR. Most episodes required hospital admission (35.2%) or happened during the hospital stay (33%), and 91.2% were severe. Blood disorders were the most frequent ADR (96; 32.8%), related to thioguanine (42) and pegaspargase (39) mainly, followed by infections (86; 29.4%) related to thioguanine (32), pegaspargase (27), Erwinia asparaginase (14) and rituximab (13). Two ADR were unknown. Most ADR were dose-dependent or expectable (>90%). The global incidence of ADR was 3.1/100 days at risk (95% CI 2.7–3.5), with 3.5 ADR/100 days at risk with pegaspargase (95% CI 2.9–4.2), 1.2/100 days at risk with rituximab (95% CI 0.8–1.8) and 11.6/100 days at risk with thioguanine (95% CI 9.4–14.2). Controversial additional measures of prevention, other than those already used, were identified. Conclusion: ADR are frequent in pediatric oncohematological patients, mainly blood disorders and infectious diseases. Findings regarding incidence and preventability may be useful to compare data between different centers and to evaluate new possibilities for action or prevention.
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Affiliation(s)
- Kristopher Amaro-Hosey
- Clinical Pharmacology Service, Vall d'Hebron University Hospital, Barcelona, Spain.,Department of Pharmacology, Therapeutics and Toxicology, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Immaculada Danés
- Clinical Pharmacology Service, Vall d'Hebron University Hospital, Barcelona, Spain.,Department of Pharmacology, Therapeutics and Toxicology, Universitat Autònoma de Barcelona, Barcelona, Spain.,Vall d'Hebron Research Institute, Barcelona, Spain
| | - Lourdes Vendrell
- Clinical Pharmacology Service, Vall d'Hebron University Hospital, Barcelona, Spain.,Department of Pharmacology, Therapeutics and Toxicology, Universitat Autònoma de Barcelona, Barcelona, Spain.,Vall d'Hebron Research Institute, Barcelona, Spain
| | - Laura Alonso
- Vall d'Hebron Research Institute, Barcelona, Spain.,Department of Pediatric Hematology and Oncology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Berta Renedo
- Pharmacy Service, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Luis Gros
- Vall d'Hebron Research Institute, Barcelona, Spain.,Department of Pediatric Hematology and Oncology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Xavier Vidal
- Clinical Pharmacology Service, Vall d'Hebron University Hospital, Barcelona, Spain.,Department of Pharmacology, Therapeutics and Toxicology, Universitat Autònoma de Barcelona, Barcelona, Spain.,Vall d'Hebron Research Institute, Barcelona, Spain
| | - Gloria Cereza
- Department of Pharmacology, Therapeutics and Toxicology, Universitat Autònoma de Barcelona, Barcelona, Spain.,Vall d'Hebron Research Institute, Barcelona, Spain.,Catalan Institute of Pharmacology Foundation, Vall Hebron University Hospital, Barcelona, Spain
| | - Antònia Agustí
- Clinical Pharmacology Service, Vall d'Hebron University Hospital, Barcelona, Spain.,Department of Pharmacology, Therapeutics and Toxicology, Universitat Autònoma de Barcelona, Barcelona, Spain.,Vall d'Hebron Research Institute, Barcelona, Spain
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Ronchetti S, Ayroldi E, Ricci E, Gentili M, Migliorati G, Riccardi C. A Glance at the Use of Glucocorticoids in Rare Inflammatory and Autoimmune Diseases: Still an Indispensable Pharmacological Tool? Front Immunol 2021; 11:613435. [PMID: 33584696 PMCID: PMC7874096 DOI: 10.3389/fimmu.2020.613435] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 12/04/2020] [Indexed: 12/11/2022] Open
Abstract
Since their discovery, glucocorticoids (GCs) have been used to treat almost all autoimmune and chronic inflammatory diseases, as well as allergies and some forms of malignancies, because of their immunosuppressive and anti-inflammatory effects. Although GCs provide only symptomatic relief and do not eliminate the cause of the pathology, in the majority of treatments, GCs frequently cannot be replaced by other classes of drugs. Consequently, long-term treatments cause adverse effects that may, in turn, lead to new pathologies that sometimes require the withdrawal of GC therapy. Therefore, thus far, researchers have focused their efforts on molecules that have the same efficacy as that of GCs but cause fewer adverse effects. To this end, some GC-induced proteins, such as glucocorticoid-induced leucine zipper (GILZ), have been used as drugs in mouse models of inflammatory pathologies. In this review, we focus on some important but rare autoimmune and chronic inflammatory diseases for which the biomedical research investment in new therapies is less likely. Additionally, we critically evaluate the possibility of treating such diseases with other drugs, either GC-related or unrelated.
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Affiliation(s)
- Simona Ronchetti
- Pharmacology Division, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Emira Ayroldi
- Pharmacology Division, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Erika Ricci
- Pharmacology Division, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Marco Gentili
- Pharmacology Division, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Graziella Migliorati
- Pharmacology Division, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Carlo Riccardi
- Pharmacology Division, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
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