Stevens-Johnsonsyndrome (SJS) and toxic epidermal necrolysis (TEN) are rare life-threaten- ing cutaneous drug reactions, with skin and mucous membrane involvement that are consid- ered a spectrum of the same disease. In SJS, there is <10% of epidermal detachment and in TEN there is >30% with SJS/TEN overlap lying between these two extremes. The incidence of SJS/TEN is approximately 0,05–2 cases/million per year for the general population, in devel- oped countries where the data is available. In patients with AIDS the incidence is estimated to be 1 to 2 per 1000 individuals. The disease is associated with significant morbidity and mor- tality. In larger published series of patients, mortality has been reported to be between 4 and 60%, while long-term sequelae is as high as 50% in children and more than 80% in adults.[3–7] [8–10]
OBJECTIVE: To determine the conjunctival bacterial flora present in patients with Stevens-Johnsonsyndrome. METHODS: A prospective study of the conjunctival bacterial flora was performed in 41 eyes of 22 patients with Stevens-Johnsonsyndrome. The information gathered included the patient’s sex and age, the duration of disease, the cause of Stevens-Johnsonsyndrome, and treatments. Scrapings of the inferior conjunctival fornix were performed in both eyes. Fourteen days before scraping, the patients were asked to interrupt all topical medication and start using 0.5% nonpreserved methylcellulose. The microbiological evaluation included microorganism identification and determination of antibiotic sensitivity.
Stevens-Johnsonsyndrome (SJS) and its severe variant, toxic epidermal necrolysis (TEN), are acute inflammatory vesiculobullous reactions of the skin and mucous membranes. Cold medicines including non-steroidal anti-inflammatory drugs and multi-ingredient cold medications are reported to be important inciting drugs. Recently, we reported that cold medicine related SJS/TEN (CM-SJS/TEN) with severe mucosal involvement including severe ocular surface complications (SOC) is associated with HLA-A*02:06 and HLA-B*44:03 in the Japanese. In this study, to determine whether HLA-B*44:03 is a common risk factor for CM-SJS/TEN with SOC in different ethnic groups we used samples from Indian, Brazilian, and Korean patients with CM-SJS/TEN with SOC, and investigated the association between CM-SJS/TEN with SOC and HLA-B*44:03 and/or HLA-A*02:06. We found that HLA-B*44:03 was significantly associated with CM-SJS/TEN with SOC in the Indian and Brazilian but not the Korean population, and that HLA- A*02:06 might be weakly associated in the Korean- but not the Indian and Brazilian population.
Stevens-Johnsonsyndrome (SJS) and toxic epidermal necrolysis (TEN) are acute and severe reactions of the skin and mucosa that can lead to serious clinical outcomes and morbidity. The pathogeneses of SJS and TEN are unclear, although there is evidence of an association with humoral and cell-mediated im- munity. Due to the similarity between the clinical and histopath- ological indings and etiology, the two diseases are regarded as being two variants of the same process, difering solely in terms of the degree of surface area afected . There is no speciic treatment other than support therapy. Drugs that may be responsible should be discontinued, appropriate treatment should be administered if infection is involved.
Objective: Case report of Stevens-Johnsonsyndrome (SJS) associated with Chickenpox disease and literature review in children. Case description: Female, 6 years old, started with ocular pruritus followed by papular erythematous lesions on the chest and fever (38.5ºC/101,3ºF). She was examined at a basic health unit, where it was prescripted gentian violet, analgesics and antihistamines. On the same day, there was an increase in the number of lesions at the extremities. She sought after a tertiary care in her city of origin; after hospitalization, it was started antibiotic therapy and anti-inflammatory drugs due to the suspicion of infected chickenpox. Two days later, she presented conjunctival hyperemia, eyelid edema and pruritic vesicular lesions at the extremities. Then, she was referred to a children's hospital in Criciúma with the diagnosis of Chickenpox with secondary infection. She presented submandibular lymphadenopathy, odynophagia and scaly and purulent lesions in the oral mucosa. The laboratory showed leukocytosis without left shift, hematuria, negative blood culture and uroculture; other exams without further alterations. Antibiotic therapy with oxacillin, aciclovir and topical tobramycin was started in isolation. After three days, with the hypothesis of SJS, it was started a supportive treatment, with significant improvement of the general state and progressive remission of the cutaneous lesions.Comments: Stevens-JohnsonSyndrome (SJS) and Toxic Epidermal Necrolysis (TEC) constitute a spectrum of cutaneous reactions that affects all ages. The diagnosis is essentially clinical and there are no specific diagnostic criteria or histopathological findings. The most effective and safe treatment still is support.
Objective: To analyze studies that evaluate the association between Stevens-JohnsonSyndrome and blindness available at PUBMED, to identify the main publications on the subject and to know the association rates. Methods: This is a cross-sectional analytical study, conducted with 7 observational and cross-sectional articles, selected regardless of language. The selected articles were classified and evaluated, based on the criteria proposed by the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) initiative, which contains items with recommendations of what is necessary to contain in a quality observational study. For each chapter judged, the articles were classified as: adequate; inadequate and insufficient. Results: Of the topics recommended by the STROBE initiative, "Title and Summary" was the one with the highest percentage in appropriate, 92.85%, while "Other Information", where the authors write about research funding, got the highest percentage in inadequate, 100% and "Introduction" the highest percentage in insufficient, 28.57%. As for association fees, these were between 2.2% and 60%. Final considerations: It is concluded that there is a difficulty for researchers to organize and expose their funding and that the association fees are heterogeneous, depending on the proposed methodology.
Purpose: To evaluate the efficacy of scleral contact lenses use on the manage- ment of ocular sequelae from Stevens-Johnsonsyndrome patients. Methods: In a retrospective study, patients who suffered sequelae of Stevens- Johnsonsyndrome and started the use of scleral contact lenses were followed. Patients were submitted to an evaluation of symptoms through a questionnaire; ophthalmologic exam (visual acuity measurement, biomicroscopy, ocular surface staining with fluorescein drops, Schirmer test).
This study aimed to analyze demographic and clinical aspects of patients diagnosed with StevensJohnsonSyndrome (SJS) and Toxic Epidermal Necrolysis (TEN), as well as identifying the actions of health professionals for the management of Adverse Drug Reactions (ADR) in a public hospital in Distrito Federal, Brazil. A descriptive and retrospective research was held, with quantitative approach. Data collected from all the records of 22 patients admitted with diagnosed with SJS and TEN, from January 2005 to September 2012. Data were analyzed using descriptive statistics. Of these cases, 9 were diagnosed with NET and 7, with SJS; there were more females (14); aged from 21 to 40 years (10); 21 were cured; the drugs more used were the antiepileptic ones (10). Fragility in clinical registers and in the actions to monitor the cases of ADR in this health service was observed.
Purpose: To evaluate the epidemiology, possible etiologic factors, complications and treatment of a group of patients with ocular complications secondary to Stevens-Johnsonsyndrome. Methods: Twenty-two consecutive patients with Stevens-Johnsonsyndrome were studied. The patients were examined according to the following protocol: identification, previous clinical history, systemic and ophthalmologic mani- festations and possible etiologic factors. Results: A total of 22 patients with Stevens-Johnsonsyndrome were identified. Fifteen patients (68%) were female, 7 (32%) male. Ten patients were caucasian (45.4%), 9 brownish (22%), 2 black (9%) and 1 yellow (4.5%). Mean age was 27.1 (8 to 62). Medications were the most commonly identified etiologic factor (90.9%), follo- wed by skin herpetic infection (4.5%) and idiopathic (4.5%). Dipirone (36.3%) was the most frequently identified agent, followed by seizure medications (22.7%), non-steroidal anti- inflammatory drugs (13.6%), sulfonamides (9.0%), penicillin (4.5%), spironolactone (4.5%) and dihydroprogestagen and stradiol (4.5%). Twenty-one patients (95.4%) had ophthalmo- logic complications and sixteen patients (72.7%) underwent ophthalmologic surgical procedures. Conclusions: The results of this study show important epidemiological aspects of Ste- vens-Johnsonsyndrome in our environment, specially related to age, etiology and ocular complications.
SCARD may be defined as usually requiring hospital internment, at times in intensive therapy or burn care units for close observation of vital signs and viscera function. This group of drug reactions includes anaphylaxis, Stevens- Johnsonsyndrome ( SJS ), toxic epidermal necrolysis ( TEN ), drug hypersensitivity, and depending on the systemic involvement, erythroderma, acute generalized exanthema- tous pustulosis ( AGEP ), cutaneous necrosis induced by anti- coagulants, drug-induced vasculitis and reactions like serum disease. 4
Purpose: To study the therapeutic potential of amniotic mem- brane transplantation in cases of severe acute chemical ocular burn and Stevens-Johnsonsyndrome. Methods: We retros- pectively reviewed the records of eight patients, with a total of ten eyes, submitted to amniotic membrane transplantation for treatment of ocular chemical burns and Stevens-Johnson syn- drome in the acute phase between January 1999 and May 2008 in the Ophthalmology Department of UNIFESP. Data relating to sex, age, degree of chemical burns, etiology, affected eye, ophthalmological findings, extension of amniotic membrane, surgeries, additional time between the injury and surgery in days, visual acuity before and after surgery, epithelial defect healing (days), complications and time of follow-up in months were collected. Results: The average age of patients was 35.7 ± 23.04 years, with six men and two women. Three patients (four eyes) had Stevens-Johnsonsyndrome and five patients (six eyes) had chemical ocular burn. The epithelial defect was healed at an average of 27.8 ± 4.7 days (ranging from 20 and 35 days). All patients presented limbal stem cell deficiency in a median follow-up of 7.8 ± 2.8 months (ranging from six and twelve months) and four eyes developed symblepharon. Conclusions: The results suggest that the amniotic membrane transplantation represents an additive that can be carried out in the serious cases of ocular chemical burn and Stevens- Johnsonsyndrome with the finality of promoting the epithe- lialization and abolishing the inflammation and its conse- quences, if compared with other studies that treated similar cases with medical therapy only. On the other hand, it is not possible to avoid the limbic deficiency in these cases, which in the future will need limbal stem cell transplantation or other surgeries for correction of the ocular surface.
This is a systematic review (SR) which examined the issue of Stevens-Johnsonsyndrome (SJS) in adults. Electronic literature surveys were implemented in BVS®, LILACS®, MEDLINE®, SCIELO® and PubMed® databases. Eleven were elected (11) articles published in the historical period from 2007 to 2015, in Portuguese, Spanish and English, with the majority consisting of case studies. Patients described in articles, the average age of 39,42 being the youngest had 22 years and the oldest 61 years old, 53,85% (n=07) were female, 53,85% (n=07) developed SJS and 46,15% (n=06) progressed to Toxic Epidermal Necrolysis (TEN), 15,40% (n=02) had epilepsy or AIDS, 23,10% (n=03) consumed antibiotics, 92,30% (n=12) did not come to death. The study demonstrated the complexity and the potential of SJS, with almost half of those have evolved to NET. Therefore, it is of fundamental importance a greater awareness of society to mitigate the SSJ.
Toxic epidermal necrolysis is an adverse immunological skin reaction secondary in most cases to the administration of a drug. Toxic epidermal necrolysis, Stevens-Johnsonsyndrome, and multiform exudative erythema are part of the same disease spectrum. he mortality rate from toxic epidermal necrolysis is approximately 30%. he pathophysiology of toxic epidermal necrolysis is similar in many respects to that of supericial skin burns. Mucosal involvement of the ocular and genital epithelium is associated with serious sequelae if the condition is not treated early. It is generally accepted that patients with toxic epidermal necrolysis are better treated in burn units, which are experienced in the management of patients with extensive skin loss. Treatment includes support, elimination, and coverage with
Case description: Female child, five years old without a history of relief. In August 2015, she appealed to general practice by fe- ver, malaise and with two erythematous and ulcerated lower lip injuries. This was seen as chickenpox. Two days later it was com- plicated by similar lesions on the vaginal mucosa, palpebral edema and bilateral ocular mucopurulent exudates. Because total food refusal, she turned to a private emergency service, where she was hospitalized. Given the lack of improvement, she was transfer- red to the hospital of her home area three days later, prostrate with multiple aphthous lesions on the oral and vaginal mucosa, dis- persed subconjunctival hemorrhages and keratitis. She was admitted to the pediatric service. Given the clinical picture of ulcera- tive stomatitis, purulent conjunctivitis and vulvoganite, the clinical diagnosis of Stevens-Johnsonsyndrome was assumed. Comments: Stevens-Johnsonsyndrome is characterized by a delayed hypersensitivity skin reaction, which affects the skin and mucous membranes. It constitutes a dermatological emergency with high potential for morbidity and mortality, difficult to diagnose in clinical practice of the family physician. Family physician need to pay special attention to the skin lesions or mu- cous membranes which are associated with drugs, viral infections, cancer or just injuries that concern some degree of suspicion should not be delayed urgent hospital referral.
A literatura contemporânea do controle motor revela um número de diferentes medidas que servem para definir a variabilidade motora. No entanto, para a maioria dos pesquisadores, uma simples estatística de variância em torno da média (ou a sua raiz quadrada designada por desvio padrão) expressa a variabilidade das respostas dos processos motores. Outra medida muito utilizada é o coeficiente de variação, isto é, o desvio padrão dividido pela média, que tem a vantagem de ser independente das unidades das observações. A variabilidade dos intervalos inter-resposta sucessivos durante o tapping tem sido usada como índice de variabilidade em movimentos rítmicos. Stevens (1886) desenvolveu um procedimento de sincronização-continuação: neste procedimento, o participante deve bater com a mão (tapping) em simultâneo com uma sequência periódica de sinais sonoros e, em seguida, continuar a bater com o mesmo ritmo sem a referência sonora. O elemento de interesse é a série dos intervalos inter-resposta da fase de continuação. Este autor sugeriu que a variação observada aumenta com a duração média dos intervalos e propôs dois fatores para explicar essas variações: flutuações de longa duração como consequência de um processo cognitivo e flutuações de curta duração relacionadas com uma limitação motora. Embora o tapping seja uma tarefa bastante simples, uma questão de fato é que nós não temos o tapping regular e preciso.
qual se vincula. Nesse sentido, Johnson censura Shakespeare ao preocupar-se mais em proporcionar prazer que instruir, quando as prescrições advindas da chamada “reciclagem aristotélica” (a partir do século XVI) normatizam a exaltação das virtudes e o rechaço dos vícios. Alegando-se, diz que Shakespeare pensa mais de modo razoável que moralmente. Escrevendo sem propósito moral aparente, como o diz Johnson, “he makes no just distribution of good or evil, nor is always careful to shew in the virtuous a disapprobation of the wicked” (ibidem, p. 9). Se o intento primeiro e último do escritor deve ser, de acordo com o crítico inglês, “to make the world better” (ibidem, p. 16), Shakespeare passaria ao largo dos fundamentos de justiça e virtude que o escritor deveria ter como mirada. O poeta inglês incorreria outra vez em “falhas de composição” ao criar uma espécie de maleabilidade nas vozes dos seus personagens, uma vez que, para Johnson, a configuração dos personagens de Shakespeare não se concilia com o preceito aristotélico de conformidade entre estilos alto e baixo (isto é, os registros das vozes elocutivas) e as matérias tratadas que decorrem do emprego destes estilos.
cuidadosamente no criado mudo. A seguir, pegue o papel que vem com as instruções e leia-o. Verá que, em letras muito pequenas, há uma declaração que diz o seguinte: "Todos os termômetros retais feitos pela Johnson & Johnson são pessoalmente testados". Agora, feche os olhos e repita em voz alta cinco vezes: ESTOU MUITO FELIZ PORQUE NÃO TRABALHO PARA O CONTROLE DE QUALIDADE DA JOHNSON & JOHNSON!!!
Apesar de parecer muito restrita, Johnson e Johnson (1997, p. 14) definem aprendizagem colaborativa como sendo: “conjunto de métodos para a aplicação em grupos com o objetivo de desenvolver habilidades de aprendi- zagem, conhecimento pessoal e relações sociais, onde cada membro do grupo é responsável tanto pela sua aprendizagem como pela do restante do grupo”. Dessa definição se desprendem pelo menos três idéias centrais. A primeira delas se refere a “conjunto de métodos para a aplicação em grupos”. Conforme se expressa, estes métodos têm como propósito a modificação, ao menos em parte, do conjunto de relações que se estabelecem entre o profes- sor e seus alunos e entre os próprios alunos. Sua aplicação em grupos deve ser direcionada para o desenvolvimento de atividades em sala de aula e tam- bém fora dela. Trata-se de que os alunos trabalhem em grupo não só para que desenvolvam as tarefas propostas, mas para que percebam o próprio processo de aprender. A segunda idéia está relacionada com “desenvolver habilidades de aprendizagem, conhecimento pessoal e relações sociais”, pois entrando no desenvolvimento de habilidades e na aquisição de conhecimento, se tem como fundamento a idéia de que tão importante como o que se aprende é também como se aprende. E essa maneira de ensinar e aprender leva os alunos à forma de se relacionar, de viver e de aprender. Os métodos exclusivamente expositivos levam os alunos à passividade e também a um descompromisso em relação a todo o processo. Já na aprendizagem colaborativa busca-se que os alunos além de adquirir conhecimentos, aprendam a relacionar-se com os outros, a expressar e compartilhar idéias, aceitar a diversidade e a desenvolver uma interdependência positiva com seus pares. Por último, a definição forne- ce uma característica fundamental da aprendizagem colaborativa, que se ex- pressa em “cada membro do grupo é responsável tanto pela sua aprendiza- gem como pela do restante do grupo”. Busca-se que os alunos se comprome- tam com a sua aprendizagem e aprendam a aprender junto com outros, que seja também sua responsabilidade a aprendizagem dos colegas e onde o êxito do grupo depende de cada um e de todos.