No abstract

Este estimat că un procent important, de până la 90%, din pacienţii cu insuficienţa renală cronică dezvoltă hiperparatiroidism secundar (HPS). Cu toate că boala prezintă multiple manifestări, cea mai importantă caracteristică patologică, din punctul de vedere al mortalităţii crescute, e reprezentată de calcificările ectopice arteriale, miocardice şi valvulare cardiace. Acestea sunt progresive şi conduc la hipertensiune arterială, hipertrofie ventriculară stângă, blocuri atrio-ventriculare, angină pectorală şi infarct miocardic. Aşadar riscul evenimentelor cardio-vasculare este mult crescut. Eşecul terapiei medicamentoase în a stăpâni progresia bolii reprezintă o indicaţie pentru paratiroidectomie. In HPS sunt afectate toate glandele paratiroide, de aici necesitatea de a decela intraoperator 4 glande, prin explorare cervicală bilaterală. Totuşi, având în vedere posibilitatea unor localizări ectopice a acestor glande cât şi eventualitatea unora supranumerare, este de dorit a avea preoperator o hartă imagistică cât mai exactă, evitând astfel riscul recurenţei postoperatorii. Investigaţiile imagistice disponibile sunt reprezentate de ecografia regiunii cervicale, scintigrafia paratiroidiană şi de cele de linia a doua-examinare CT sau RMN. Dacă în hiperparatiroidismul primar, unde există un singur adenom paratiroidian (sau două), rezultatele imagistice preoperatorii sunt satisfăcătoare, în HPS există destule cazuri în care imagistica nu evidenţiază toate cele patru glande paratiroide. Cuvinte cheie: paratiroide, hiperparatiroidism secundar, insuficienţa renală cronică, scintigrafie

Background Hypersensitivity reactions induced by chemotherapeutic drugs may influence the course of the oncologic disease by preventing doctors from prescribing first‐line therapy. In order to prevent another hypersensitivity reaction to the culprit chemotherapeutic agent, the physician can decide between two possibilities: premedication or desensitisation protocols. Rapid drug desensitisation showed successful results for most patients, but some of them may develop symptoms. Although omalizumab is not licensed as premedication or adjuvant therapy in chemotherapy desensitisation protocols, there have been published some case reports and small sample size studies that indicated promising results. Methods We reviewed all the published literature regarding the use of omalizumab during chemotherapy desensitisation protocols. Results and conclusions We found a great heterogeneity between the doses and the interval between omalizumab injections and chemotherapy ‐ rapid drug desensitisation, but most of the studies showed promising results. As a corollary, we propose a dose regimen of omalizumab administered before the first desensitisation protocol. Then, omalizumab should be administered one day before every chemotherapy regimen. Omalizumab might be used as an adjuvant therapy and might be a solution for a hopeless situation.

The continuous variability of SARS-CoV-2 and the rapid waning of specific antibodies threatens the efficacy of COVID-19 vaccines. We aimed to evaluate antibody kinetics one year after SARS-CoV-2 vaccination with an mRNA vaccine in healthcare workers (HCW), with or without a booster. A marked decline in anti-Spike(S)/Receptor Binding Domain (RBD) antibody levels was registered during the first eight months post-vaccination, followed by a transitory increase after the booster. At three months post-booster an increased antibody level was maintained only in HCW vaccinated after a prior infection, who also developed a higher and long-lasting level of anti-S IgA antibodies. Still, IgG anti-nucleocapsid (NCP) fades five months post-SARS-CoV-2 infection. Despite the decline in antibodies one-year post-vaccination, 68.2% of HCW preserved the neutralization capacity against the ancestral variant, with a decrease of only 17.08% in the neutralizing capacity against the Omicron variant. Nevertheless, breakthrough infections were present in 6.65% of all participants, without any correlation with the previous level of anti-S/RBD IgG. Protection against the ancestral and Omicron variants is maintained at least three months after a booster in HCW, possibly reflecting a continuous antigenic stimulation in the professional setting.

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