V současnosti jsou estetické zákroky pomocí výplňových materiálů (VM) zejména na bázi hyaluronové kyseliny (HA) celosvětově hojně rozšířeny. Tento fenomén však s sebou nese i problémy, jako jsou nekontrolovaná produkce a variabilita kvality výplní, stejně jako neodborné aplikace. Roste proto výskyt nežádoucích reakcí a komplikací, z nichž zejména vaskulární mohou být velmi vážné až fatální. V důsledku rychlé globalizace a rozmachu sociálních médií dochází k posunu vnímání krásy napříč různými generacemi. V tomto kontextu je nezbytné, aby lékař uměl identifikovat motivaci pacienta. Rozlišil mezi tím, co si pacient přeje, a tím, co skutečně potřebuje, a přetvořil často přehnaná očekávání na realistické cíle (1). Komplikace spojené s aplikací dermálních výplní jsou tradičně rozděleny do čtyř základních kategorií: hypersenzitivní reakce, cévní příhody, infekce a opožděné zánětlivé změny. Jiné dělení zohleduje časový průběh komplikací na akutní (vaskulární okluze, zánětlivé reakce, reakce související s injekční aplikací, šíření materiálu) a opožděné (záněty, nodulární léze, dyspigmentace, dislokace výplně). Článek se zabývá pouze nevaskulárními komplikacemi a pro přehlednost je dělí na hypersenzititvní reakce (alergie), infekce, noduly, otoky, změny zabarvení kůže a ostatní. Pro optimální zvládání nežádoucích účinků je zásadní mít k dispozici praktický a přehledný protokol s rozhodovacím algoritmem. Součástí bezpečné praxe by měla být také interdisciplinární spolupráce.
Aesthetic interventions using hyaluronic acid-based filler materials are now widespread worldwide. However, this phenomenon also brings with it problems. Uncontrolled production and variation in the quality of fillers. Application of fillers by non-experts. Increasing incidence of adverse reactions and complications. Vascular complications can be very serious or even fatal. Due to rapid globalization and the rise of social media, there is a shift in the perception of beauty across generations. Therefore, it is essential for the physician to be able to identify the patient's motivation and differentiate between what the patient wants and what he or she actually needs and transform exaggerated expectations into realistic goals (1). Complications associated with the application of dermal fillers are commonly divided into four basic categories: hypersensitivity reactions, vascular events, infections, and delayed inflammatory changes. Another division considers the time course into acute (vascular occlusion, inflammatory reactions, injection-related reactions, spread of material) and delayed (inflammation, nodular lesions, dyspigmentation, dislocation of the filler). The article deals only with non-vascular complications and for clarity divides them into hypersensitivity reactions (allergy), infections, nodules, edema, skin discoloration and others. For optimal management of adverse effects, it is essential to have a practical and clear protocol with a decision-making algorithm. Interdisciplinary collaboration should also be part of safe practice.
- Keywords
- výplň rtu,
- MeSH
- Hypersensitivity etiology complications MeSH
- Edema etiology MeSH
- Hematoma etiology MeSH
- Skin Diseases, Infectious etiology MeSH
- Hyaluronic Acid * administration & dosage adverse effects MeSH
- Humans MeSH
- Plastic Surgery Procedures * methods adverse effects MeSH
- Check Tag
- Humans MeSH
Úvod: Klonálne ochorenie mastocytov a/alebo zvýšená koncentrácia bazálnej sérovej tryptázy patria medzi rizikové faktory závažnejšieho až život ohrozujúceho priebehu anafylaktickej reakcie po bodnutí blanokrídlym hmyzom. Pre rizikovosť týchto pacientov by mala byť každému takémuto pacientovi navrhnutá realizácia jedinej kauzálnej terapie – venómovej imunoterapie (VIT). Materiál a metódy: Vytvorili sme prospektívnu štúdiu, ktorú tvorilo 93 pacientov (58 mužov, 35 žien), ktorí spĺňali indikačné kritériá na liečbu VIT. Pacientov sme do štúdie zaradzovali postupne a dáta boli zhromažďované od roku 2015 do roku 2023. Zadefinovali sme základnú charakteristiku súboru, zamerali sme sa na identifikáciu pacientov s elevovanou koncentráciou sérovej bazálnej tryptázy (> 8 ng/ml) a systémovou mastocytózou, špecifiká priebehu ich systémovej alergickej reakcie po bodnutí blanokrídlym hmyzom, toleranciu liečby a výskyt nežiaducich účinkov. Výsledky: Z celkovo 93 zaradených pacientov liečených VIT sme zaznamenali u 15 pacientov (16,7 %) trvalo elevované koncentrácie sérovej bazálnej tryptázy (sBT) > 8 ng/ml. U jedného pacienta sme diagnostikovali systémovú mastocytózu. U pacientov s elevovanými hodnotami sBT sme pri systémovej alergickej reakcii po bodnutí blanokrídlym hmyzom častejšie pozorovali poruchu vedomia a hypotenziu. Z hľadiska tolerancie liečby sme pozorovali približne porovnateľný výskyt nežiaducich účinkov u pacientov s eleváciou ako aj bez elevácie sBT počas podávania VIT a prevažná väčšina nežiaducich účinkov bola v zmysle lokálnych reakcií. Celkovo 53,3 % pacientov liečených VIT s elevovanou koncentráciou sBT prekonalo prirodzenú reexpozíciu blanokrídlym hmyzom, pričom ani u jedného pacienta nedošlo k rozvoju systémovej alergickej reakcie s nutnosťou podania adrenalínového autoinjektora. Záver: Alergia na jed blanokrídleho hmyzu patrí medzi život ohrozujúci stav, pričom jej výskyt je oveľa častejší a priebeh závažnejší u pacientov s elevovanými koncentráciami bazálnej sérovej tryptázy a/alebo klonálnym ochorením mastocytov. U každého pacienta s potvrdeným klonálnym ochorením mastocytov je potrebné anamnesticky pátrať po výskyte alergickej reakcie na jed blanokrídleho hmyzu a zvažovať indikáciu venómovej imunoterapie ako jedinej kauzálnej liečby.
Introduction: Clonal mast cell disease and/or increased basal serum tryptase concentration are among the risk factors for a more severe life-threatening anaphylactic reaction following a Hymenoptera insect sting. Because of the risk carried by these patients, the single available causal therapy – venom immunotherapy (VIT) should be recommended for each such patient. Material and methods: We designed a prospective study consisting of 93 patients (58 men, 35 women) who met the indication criteria for VIT treatment. Patients were enrolled and data was collected from 2015 to 2023. We defined the basic characteristics of the group, we focused on the identification of patients with an elevated concentration of serum basal tryptase (> 8 ng/mL) and systemic mastocytosis, the details of their systemic allergic reaction after a Hymenoptera insect sting, treatment tolerance, and occurrence of adverse effects. Results: From a total of 93 enrolled patients treated with VIT, we recorded persistently elevated concentrations of serum basal tryptase (sBT) > 8 ng/mL in 15 patients (16.7%). We diagnosed systemic mastocytosis in one patient. In patients with elevated sBT values, we observed loss of consciousness and hypotension more frequently during a systemic allergic reaction after a Hymenoptera sting. From the point of view of treatment tolerance, we observed a roughly comparable incidence of adverse effects and the predominant majority of adverse effects were in terms of local reactions. A total of 53.3% of patients treated with VIT with elevated concentration of sBT overcame natural re-exposure to Hymenoptera insects, while not a single patient developed a systemic allergic reaction requiring the administration of an adrenaline autoinjector. Conclusion: Hymenoptera venom allergy is a life-threatening condition, and its occurrence is much more frequent, and its course more severe in patients with elevated basal serum tryptase concentrations and/or clonal mast cell disease. In each patient with a confirmed clonal mast cell disorder, it is necessary to search for the occurrence of an allergic reaction to Hymenoptera insect venom in the patient’s history and to consider venom immunotherapy as the only causal treatment.
- MeSH
- Hypersensitivity etiology MeSH
- Anaphylaxis etiology prevention & control therapy MeSH
- Middle Aged MeSH
- Humans MeSH
- Mastocytosis * immunology MeSH
- Venom Hypersensitivity * etiology prevention & control MeSH
- Prospective Studies MeSH
- Mastocytosis, Systemic immunology MeSH
- Tryptases analysis blood MeSH
- Bee Venoms MeSH
- Wasp Venoms MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Publication type
- Case Reports MeSH
- MeSH
- Aspergillosis, Allergic Bronchopulmonary diagnosis etiology MeSH
- Asthma * complications MeSH
- Bronchiectasis diagnostic imaging complications MeSH
- Respiratory Tract Infections * classification complications MeSH
- Humans MeSH
- Disease Progression MeSH
- Check Tag
- Humans MeSH
- Publication type
- Review MeSH
- Keywords
- baricitinib,
- MeSH
- Alopecia Areata drug therapy psychology MeSH
- Dermatitis, Atopic * drug therapy psychology MeSH
- Cyclosporine administration & dosage MeSH
- Adult MeSH
- Janus Kinase Inhibitors * administration & dosage MeSH
- Humans MeSH
- Disease Progression MeSH
- Check Tag
- Adult MeSH
- Humans MeSH
- Male MeSH
- Publication type
- Case Reports MeSH
Allergic rhinitis is a common ailment in primary and acute care settings. Diagnosis is clinical, by means of history and physical examination. Referral to an allergist is considered when symptoms are difficult to manage and/or confirmation by means of further testing is desired. Management of allergic rhinitis should not be considered trivial, as multiple secondary effects can present as the course progresses. Several treatment modalities exist but should begin with glucocorticoid nasal sprays and systemic second- or third-generation antihistamines.
- MeSH
- Rhinitis, Allergic * diagnosis therapy drug therapy MeSH
- Histamine Antagonists therapeutic use MeSH
- Glucocorticoids therapeutic use administration & dosage MeSH
- Humans MeSH
- Check Tag
- Humans MeSH
- Publication type
- Journal Article MeSH
- Review MeSH
- Keywords
- upadacitinib,
- MeSH
- Dermatitis, Atopic * drug therapy genetics immunology MeSH
- Biological Therapy MeSH
- Janus Kinase 1 antagonists & inhibitors MeSH
- Arthritis, Juvenile * drug therapy MeSH
- Humans MeSH
- Treatment Outcome MeSH
- Check Tag
- Humans MeSH
- Publication type
- Case Reports MeSH
- Keywords
- tezepelumab, studie DESTINATION,
- MeSH
- Biological Therapy MeSH
- Asthma * drug therapy physiopathology MeSH
- Clinical Trials, Phase III as Topic MeSH
- Humans MeSH
- Antibodies, Monoclonal pharmacology therapeutic use MeSH
- Disease Progression MeSH
- Randomized Controlled Trials as Topic MeSH
- Treatment Outcome MeSH
- Check Tag
- Humans MeSH
BACKGROUND: Inhaled corticosteroids have been widely reported as a preventive measure against the development of severe forms of COVID-19 not only in patients with asthma. METHODS: In 654 Czech and Slovak patients with asthma who developed COVID-19, we investigated whether the correct use of inhaler containing corticosteroids was associated with a less severe course of COVID-19 and whether this had an impact on the need for hospitalisation, measurable lung functions and quality of life (QoL). RESULTS: Of the studied cohort 51.4% had moderate persistent, 29.9% mild persistent and 7.2% severe persistent asthma. We found a significant adverse effect of poor inhaler adherence on COVID-19 severity (p=0.049). We also observed a lower hospitalisation rate in patients adequately taking the inhaler with OR of 0.83. Vital capacity and forced expiratory lung volume deterioration caused by COVID-19 were significantly reversed, by approximately twofold to threefold, in individuals who inhaled correctly. CONCLUSION: Higher quality of inhalation technique of corticosteroids measured by adherence to an inhaled medication application technique (A-AppIT) score had a significant positive effect on reversal of the vital capacity and forced expiratory lung volume in 1 s worsening (p=0.027 and p<0.0001, respectively) due to COVID-19. Scoring higher in the A-AppIT was also associated with significantly improved QoL. All measured variables concordantly and without exception showed a positive improvement in response to better adherence. We suggest that corticosteroids provide protection against the worsening of lungs in patients with COVID-19 and that correct and easily assessable adherence to corticosteroids with appropriate inhalation technique play an important role in preventing severe form of COVID-19.
- MeSH
- Asthma * drug therapy MeSH
- COVID-19 * MeSH
- Adrenal Cortex Hormones MeSH
- Quality of Life MeSH
- Humans MeSH
- Forced Expiratory Volume MeSH
- Check Tag
- Humans MeSH
- Publication type
- Journal Article MeSH
- Research Support, Non-U.S. Gov't MeSH
Since its global invasion in 2019, COVID-19 has affected several aspects of patients' lives and posed a significant impact on the health care system. Several patient populations were identified to be at high risk of contracting SARS-CoV-2 infection and/or developing severe COVID-19-related sequelae. Conversely, anyone who has contracted SARS-CoV-2 is at risk to experience symptoms and signs consistent with post-COVID manifestations. Patients with asthma were initially thought to be at increased risk and severity for SARS-CoV-2 infection. However, accumulating evidence demonstrates that asthma endotypes/phenotypes and comorbidities influence the risk stratification in this population. Furthermore, initial concerns about the potentially increased risk of poor outcomes with asthma treatments such as inhaled corticosteroids and biologics have not been substantiated. In this review, we provide an update on COVID-19 and asthma, including risk of susceptibility, clinical manifestations and course in this population as well as discuss recommendations for management.
- MeSH
- Asthma * diagnosis MeSH
- COVID-19 * epidemiology complications MeSH
- Adrenal Cortex Hormones therapeutic use MeSH
- Comorbidity MeSH
- Humans MeSH
- SARS-CoV-2 MeSH
- Check Tag
- Humans MeSH
- Publication type
- Journal Article MeSH
- Review MeSH
Eozinofilní ezofagitida je chronické non IgE mediované onemocnění, postihující děti i dospělé. Dle současných poznatků se může projevovat škálou fenotypů, stejně jako jiná atopická onemocnění. Variabilita je dána vícerými patogenními mechanismy neboli endotypy, charakterizovanými převahou zánětu Th2, jenž ve svém důsledku může vést k fibrotické přestavbě tkáně. Cílem tohoto článku je nastínit základní fenotypy tohoto onemocnění s důrazem na individualizaci v diagnostickém a terapeutickém postupu. Onemocnění není považováno za prekancerózu, ale výrazně omezuje svým chronickým průběhem kvalitu života.
osinophilic esophagitis is described as a chronic non-IgE mediated disease, affecting both children and adults. According to new findings, it can manifest different phenotypes like other atopic diseases. The variability is due to multiple pathogenic mechanisms or endotypes, characterized by a predominance of Th2 inflammation, which tends to lead to fibrosis. The aim of this article is to outline the basic phenotypes of this disease with emphasis on individualization in the diagnostic and therapeutic approach. The disease is not considered a precancer, but due to its progressive chronic course it significantly reduces quality of life.
