Centro Medico Docente La Trinidad

Miranda, Venezuela

Centro Medico Docente La Trinidad

Miranda, Venezuela
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Risquez F.,Centro Medico Docente la Trinidad
Reproductive BioMedicine Online | Year: 2010

Transvaginal ultrasound-guided oocyte retrieval has gained universal acceptance with an excellent safety record overall. However, even with contemporary ultrasound resolution, the aspiration needle can injure adjacent pelvic organs and blood vessels and result in external and internal bleeding. Although the idea that Doppler ultrasound might reduce the risk of blood vessel injury during follicular aspiration seems to be plausable, measurement of peritoneal blood loss and the validity of this opinion has never been appropriately tested. Using a proposed classification method in an IVF programme, it was estimated that a significant peritoneal bleeding occurred in 56/898 (6%) of IVF patients. Although Doppler ultrasound was routinely used in all patients, it did not predict 24/53 (45%) of the patients with moderate peritoneal bleeding. In 8/53 cases (15%) with moderate peritoneal bleeding, vaginal bleeding was also detected and correctly predicted during oocyte aspiration using colour Doppler vaginal vessel imaging. Colour Doppler ultrasound guidance is an easily accessible technology with a theoretical promise to improve IVF safety and, with proper usage, has the potential to reduce haemorrhagic complications. © 2010, Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved.


Simons F.E.R.,University of Manitoba | Ardusso L.R.F.,National University of Rosario | Bil M.B.,University Hospital Ospedali Riuniti | El-Gamal Y.M.,Ain Shams University | And 6 more authors.
Journal of Allergy and Clinical Immunology | Year: 2011

The WAO Guidelines focus on recommendations for the basic initial treatment of anaphylaxis, as summarized below. Prepare for anaphylaxis assessment and management of anaphylaxis in healthcare settings. Have a posted, written emergency protocol and rehearse it regularly. As soon as the clinical diagnosis of anaphylaxis is made, discontinue exposure to the trigger, if possible; for example, discontinue an intravenously administered diagnostic or therapeutic agent. Assess the patient rapidly (circulation, airway, breathing, mental status, and skin). Simultaneously and promptly: call for help; inject epinephrine (adrenaline) by the intramuscular route in the mid-anterolateral aspect of the thigh; and place the patient on the back or in a position of comfort with the lower extremities elevated. When indicated at any time during the anaphylactic episode, administer supplemental oxygen, give intravenous fluid resuscitation, and initiate cardiopulmonary resuscitation with continuous chest compressions. At frequent and regular intervals, monitor the patient's blood pressure, cardiac rate and function, respiratory status and oxygenation and obtain electrocardiograms; start continuous noninvasive monitoring, if possible. Patients with anaphylaxis refractory to the above measures, for example, those requiring intubation and mechanical ventilation and those requiring intravenous epinephrine or another vasopressor should, if possible, be transferred to a healthcare facility where additional support is available. Ideally, this includes specialists in emergency medicine, critical care medicine and/or anesthesiology, trained and experienced nurses and technicians, and appropriate medications, supplies, and equipment. Where such skilled support is not available, physicians should, if possible, obtain additional training and experience in the management of refractory anaphylaxis and additional training in lifesupport measures. At the time of their discharge from the healthcare setting, equip patients with epinephrine for self-administration, an anaphylaxis emergency action plan, and medical identification to facilitate prompt recognition and treatment of anaphylaxis recurrences in the community. Advise patients that they need follow-up visits with a physician, preferably an allergy/immunology specialist, to confirm their specific anaphylaxis trigger(s), prevent recurrences by avoiding specific trigger(s), and receive immunomodulation, if relevant. The authors thank Professor G. Walter Canonica, WAO President, 2008- 2009, for initiating this project and appointing the WAO Anaphylaxis Special Committee, and Professor Richard F. Lockey,WAO President, 2010-2011, for his support.We express our sincere appreciation to all representatives of the 84 WAO member societies and members of the WAO Board of Directors who reviewed the Guidelines and provided important input. We are grateful to Jacqueline Schaffer, MAMS, for illustrating the principles of anaphylaxis assessment and management promulgated in the Guidelines. We acknowledge the assistance provided by the WAO Secretariat, Milwaukee, WI, and by Lori McNiven, Health Sciences Centre, Winnipeg, MB, Canada. © 2010 American Academy of Allergy, Asthma and Immunology.


Sanchez-Borges M.,Clinica El Avila | Sanchez-Borges M.,Centro Medico Docente la Trinidad | Caballero-Fonseca F.,Centro Medico Docente la Trinidad | Capriles-Hulett A.,Centro Medico Docente la Trinidad | Gonzalez-Aveledo L.,Centro Medico Of Caracas
Journal of the European Academy of Dermatology and Venereology | Year: 2015

Background A subset of patients with chronic spontaneous urticaria (CSU) experience disease exacerbations after receiving non-steroidal anti-inflammatory drugs (NSAIDs). This condition has been designated as Aspirin-Exacerbated Cutaneous Disease (AECD). Objectives The purpose of this study was twofold: (i) Investigate the demographic and clinical features of patients affected by AECD; (ii) To compare patients with AECD and NSAID-tolerant CSU patients for those characteristics. Methods Patients with AECD and a group of unselected CSU patients tolerant to NSAIDs were studied. Demographic and clinical data were obtained by direct questioning and physical examination. Laboratory investigations and allergen skin prick tests were performed only in selected patients, as guided by the medical history. Results Of 423 CSU patients admitted in the clinics, 52 (12.2%) had AECD. Compared with NSAID-tolerant CSU patients, AECD patients had significantly longer disease duration (57.7 ± 118.4 vs. 24.4 ± 36.6 months, P < 0.05), higher prevalence of angio-oedema (72.7 vs. 30.9%, P < 0.05) and atopy (83.8% vs. 58.4%, P < 0.05) and more frequent involvement of the face and upper respiratory tract (54.5% vs. 29.6%, P < 0.05). Conclusions AECD is a distinct phenotype that should be considered for inclusion as a separate subtype of chronic spontaneous urticaria. © 2014 European Academy of Dermatology and Venereology.


Sanchez-Borges M.,Centro Medico Docente la Trinidad | Gonzalez-Aveledo L.A.,Centro Medico Of Caracas
Allergy, Asthma and Immunology Research | Year: 2010

Purpose: To investigate the incidence and clinical characteristics of angioedema associated with the use of angiotensin-converting enzyme inhibitors (ACEIs) in an outpatient allergy department. Methods: A retrospective review of medical records of new patients seen in an allergy clinic. Demographic and clinical data of patients with ACEI-induced angioedema were analyzed. Results: Nine (0.37%) out of 2,421 new patients attending the allergy clinic developed ACEI-associated angioedema. Enalapril was the drug most frequently incriminated. The onset of the angioedema was as early as after the first dose or as late as 2 years after beginning treatment. Six patients experienced life-threatening angioedema involving the tongue, oropharynx, or larynx, and two patients required transfer to the intensive care unit. One patient required a tracheostomy. Conclusions: Angiotensin-converting enzyme inhibitor treatment is often responsible for angioedema, especially involving the upper airways. Due to the high proportion of the population exposed to ACEIs and to the severity of this adverse effect, it is important that physicians consider ACEIs as possible inducers when evaluating patients with acute or recurrent angioedema. © Copyright The Korean Academy of Asthma, Allergy and Clinical Immunology.


Sanchez-Borges M.,Centro Medico Docente La Trinidad | Fernandez-Caldas E.,Inmunotek S.L. | Fernandez-Caldas E.,University of South Florida
Current Opinion in Allergy and Clinical Immunology | Year: 2015

Purpose of review To present currently available information on oral mite anaphylaxis. Recent findings Oral mite anaphylaxis (pancake syndrome) is a new syndrome characterized by severe symptoms triggered by the intake of foods containing mites and their allergens. Breathlessness, face and/or laryngeal angioedema, wheezing, rhinorrhea, cough, dysphagia, and wheals are the most frequent clinical manifestations. Summary Pancake syndrome can occur in individuals at any age and in any geographical location. Foods made with wheat and corn flour, especially pancakes, are the most common inducers of the clinical picture. Both, domestic and storage mites have been incriminated. Increased physician awareness is required for early diagnosis and treatment, and for the prevention of future episodes in predisposed individuals. © 2015 Wolters Kluwer Health, Inc.


Sanchez-Borges M.,Centro Medico Docente la Trinidad | Suarez Chacon R.,Policlinica Metropolitana | Capriles-Hulett A.,Centro Medico Docente la Trinidad | Caballero-Fonseca F.,Centro Medico Docente la Trinidad | Fernandez-Caldas E.,Inmunotek
Journal of Allergy and Clinical Immunology | Year: 2013

Oral mite anaphylaxis is a new syndrome characterized by severe allergic symptoms occurring immediately after eating foods made with mite-contaminated wheat flour. This syndrome, which is more prevalent in tropical environments, is triggered more often by pancakes, and for that reason, it has been designated "the pancake syndrome." Because cooked foods are able to induce the symptoms, it has been suggested that thermoresistant allergens are involved in its pathogenesis. A variety of this syndrome can occur during physical exercise (dust mite ingestion-associated exercise-induced anaphylaxis). © 2012 American Academy of Allergy, Asthma & Immunology.


Sanchez-Borges M.,Centro Medico Docente La Trinidad | Caballero-Fonseca F.,Centro Medico Docente La Trinidad | Capriles-Hulett A.,Centro Medico Docente La Trinidad
Journal of Investigational Allergology and Clinical Immunology | Year: 2013

Nonsedating antihistamines are the first-choice treatment for all forms of urticaria. In patients with recalcitrant urticaria who do not respond to conventional doses of antihistamines, current guidelines recommend increasing doses by up to 4 times in order to obtain better control of the disease. Although few studies have been conducted, there are convincing data from controlled trials for cetirizine, levocetirizine, and desloratadine that support the use of increased doses of such drugs in unresponsive patients. The use of higher doses of antihistamines has not been associated with increased adverse effects or somnolence. More studies with other second-generation antihistamines are required in order to improve the treatment of patients with severe, recalcitrant urticaria. © 2013 Esmon Publicidad.


Sanchez-Borges M.,Centro Medico Docente La Trinidad
Medical Clinics of North America | Year: 2010

Adverse reactions to drugs have been classified as predictable (related to the pharmacologic actions of the drug) and unpredictable (related to the individual's immunologic response or genetic susceptibility). The term "drug hypersensitivity" refers to the symptoms or signs initiated by an exposure to a drug at a dose normally tolerated by nonhypersensitive persons. In this article, the current knowledge on hypersensitivity reactions to nonsteroidal antiinflammatory drugs is discussed. © 2010 Elsevier Inc. All rights reserved.


Sanchez-Borges M.,Centro Medico Docente La Trinidad | Caballero-Fonseca F.,Centro Medico Docente La Trinidad | Capriles-Hulett A.,Centro Medico Docente La Trinidad
Immunology and Allergy Clinics of North America | Year: 2013

It has been recognized that a high proportion of chronic urticaria patients experience symptom aggravation when exposed to aspirin and NSAIDs. This clinical picture is known as Aspirin-exacerbated cutaneous disease. The pathogenesis of these exacerbations is related to the inhibition of cyclooxygenase-1 leading to a decreased synthesis of PGE2 and an increased cysteinyl leukotriene production in the skin and subcutaneous tissues. Patient management comprises the treatment of the underlying cutaneous disease with nonsedating antihistamines and other medications, avoidance of COX-1 inhibitors, and the use of alternative NSAIDs that do not inhibit COX-1 for the relief of pain, inflammation and fever. © 2013 Elsevier Inc.


Sanchez-Borges M.,Centro Medico Docente la Trinidad
World Allergy Organization Journal | Year: 2013

Antibiotics are used extensively in the treatment of various infections. Consequently, they can be considered among the most important agents involved in adverse reactions to drugs, including both allergic and non-allergic drug hypersensitivity [J Allergy Clin Immunol 113:832-836, 2004]. Most studies published to date deal mainly with reactions to the beta-lactam group, and information on hypersensitivity to each of the other antimicrobial agents is scarce. The present document has been produced by the Special Committee on Drug Allergy of the World Allergy Organization to present the most relevant information on the incidence, clinical manifestations, diagnosis, possible mechanisms, and management of hypersensitivity reactions to non beta-lactam antimicrobials for use by practitioners worldwide. ©2013 Sánchez-Borges et al.

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