RESUMO JUSTIFICATIVA E OBJETIVOS:O Strongyloides stercoralis é um agente comum de infecção do trato gastrintestinal. Em pacientes imunodeprimidos este nematódeo pode causar hiper-infecção, com manifestações pulmonares e sepse por germes gram-negativos. O objetivo deste relato foi apresentar um caso com evolução letal e ressaltar a importância do diagnóstico e do tratamento precoce. RELATO DO CASO: Paciente do sexo masculino, 60 anos, com diagnóstico de tumor de timo, submetido a tratamento cirúrgico, radioterapia e quimioterapia. Foi consultado na emergência relatando queixa de diarréia e dispnéia, sendo admitido na UTI após apresentar quadro de insufi ciência respiratória aguda hipoxêmica e choque refratário, evoluindo para óbito. SUMMARY BACKGROUND AND OBJECTIVES: StrongyloidesStercoralis is a common cause of gastrointestinal infection. This nematode can produce an overwhelming hyperinfection syndrome, especially in the immunocompromised patient. Typically, patients present with pulmonary symptoms, but subsequently they can acquire Gram-negative sepsis. The objective of this report is to describe a lethal case and call attention to the importance of early diagnosis and treatment. CASE REPORT: Male patient, 60 year-old with diagnosis of timoma, treated with surgery, radiotherapy and chemotherapy in the past. He presented to the emergency room complaining of diarrhea and dyspnea, and then transferred to the ICU after development of hypoxemic acute respiratory failure and refractory septic shock, and despite treatment the patient died. A bronchial sample of sputum showed Strongyloides stercoralis worms. CONCLUSIONS: Strongyloides stercoralis infection symptoms are usually mild, but in the setting of impaired host immunity, a disseminated and severe illness may occur. Clinicians must be aware for patients from endemic areas. Diagnosis may be established through sputum and stool examination for Strongyloides stercoralis worms.
The study has shown that acute bronchoconstriction is an uncommon adverse reaction following the use of metered-dose inhalers. In addition, the study suggests that one of the inert constituents currently within metered-dose inhalers is the likely source of the irritant leading to bronchoconstriction.
SummaryThis was a multicentre, double-blind study in 454 patients to compare the effectiveness and tolerability of fluticasone propionate nasal spray (FPANS) 200llg used once daily for 8 weeks on its own or in combination with oral cetirizine IOmg once daily in the treatment of seasonal allergic rhinitis. The results showed no significant difference between treatments in any of the symptoms or in the proportion of symptom-free days. Watery eyes were recorded as being the most troublesome symptom in the previous hayfever season, whilst during the study patients were, on average, free of eye symptoms for 56% of the time. Additionally, no difference was detected between the two groups with regard to the use of rescue medication. More than 75% of patients concluded at the end of the study that their symptoms had been adequately controlled and, similarly, investigators rated both treatments as being successful for the majority of patients. Overall, this study suggests that there is no significant difference in efficacy between FPANS 200llg, taken once daily in the morning, and FPANS 200llg once daily in combination with oral cetirizine IOmg, in the prophylactic treatment of seasonal allergic rhinitis.Seasonal allergic rhinitis (SAR), defined as a noninfectious inflammatory reaction of the nasal mucosa to allergens such as pollen from grasses and trees, clinically presents with symptoms ranging from uncomfortable nasal congestion, chronic or recurrent sneezing and rhinorrhoea, to headache and cough. Additionally, some patients complain of nasal itching, eye irritation, and wheeziness (seasonal allergic asthma»)1,2J The pathogenesis of seasonal allergic rhinitis is believed to involve immediate type 1 allergic reactions with diagnosis confirmed by the 'skin prick test' if necessary.
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