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1.
Braz. j. biol ; 84: e248726, 2024. tab, graf
Article in English | LILACS-Express | MEDLINE, LILACSEXPRESS, LILACS, VETINDEX | ID: biblio-1364515

ABSTRACT

Abstract The present study aimed to investigate the beneficial of prepared black rice anthocyanins nano-composite (An-AgNps) against hepatotoxicity induced by methotrexate (MTX) in rats. Anthocyanins nano-composite was prepared by silver as the metallic ion reduction and were characterized by IR and SEM. The rats in our experiment were divided into five groups. Serum lipid profile, serum transaminases (ALT and AST), ALP, LDH, TBA, GSH and SOD were examined. The results show that SEM of An-AgNps has average particle size from 70 to 130nm. In the group treated with MTX; TC, TG, LDL-c, ALT, AST, ALP, LDH and TBA levels were significantly (P≤0.05) increased than NC, while, HDL-c, SOD and GSH levels were significantly (P≤0.05) decreased. On the other hand, An-AgNps + MTX treated groups were reversed the levels of all biomarkers similar to NC. In conclusion, the results show that An-AgNps has a protective effect on MTX-induced hepatotoxicity and oxidative stress.


Resumo O presente estudo teve como objetivo investigar o benefício de nanocompósito de antocianinas de arroz preto preparado (An-AgNps) contra a hepatotoxicidade induzida por metotrexato (MTX) em ratos. O nanocompósito de antocianinas foi preparado a partir da prata por meio da redução do íon metálico e caracterizado por IR e SEM. Os ratos em nosso experimento foram divididos em cinco grupos, e foram examinados o perfil lipídico sérico, as transaminases séricas (ALT e AST), ALP, LDH, TBA, GSH e SOD. Os resultados mostram que SEM de An-AgNps tem tamanho médio de partícula de 70 a 130 nm. No grupo tratado com MTX, os níveis de TC, TG, LDL-c, ALT, AST, ALP, LDH e TBA aumentaram significativamente (P ≤ 0,05) do que NC, enquanto os níveis de HDL-c, SOD e GSH diminuíram significativamente (P ≤ 0,05). Por outro lado, nos grupos tratados com An-AgNps + MTX, foram revertidos os níveis de todos os biomarcadores semelhantes ao NC. Em conclusão, os resultados mostram que o An-AgNps tem um efeito protetor contra a hepatotoxicidade induzida pelo MTX e o estresse oxidativo.

2.
Rev. argent. reumatolg. (En línea) ; 32(3): 19-23, set. 2021. ilus
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1365497

ABSTRACT

Se describe el caso clínico de una paciente con diagnóstico histológico de mastitis granulomatosa idiopática, enfermedad poco frecuente en la que se utilizan inmunosupresores como tratamiento descripto y puede confundirse con otras entidades atendidas en la especialidad. Se describe el caso y se realiza una revisión de la literatura.


The clinical case of a patient with a histological diagnosis of idiopathic granulomatous mastitis is described, a rare disease in which immunosuppressants are used as the described treatment and can be confused with other entities treated in the specialty. The case is described and a literature review is carried out.

3.
Medicina (B.Aires) ; 81(4): 641-644, ago. 2021. graf
Article in Spanish | LILACS | ID: biblio-1346518

ABSTRACT

Resumen Histoplasma capsulatum es un hongo ambiental que se encuentra distribuido comúnmente en los valles de los ríos Ohio y Mississippi, América Central, Sudamérica y Asia. Las zonas más afectadas en Argentina son las cuencas de los ríos Paraná y de La Plata. Los pacientes con histoplasmosis tienen una amplia variedad de manifestaciones clínicas. La mayoría son asintomáticos, mientras que aquellos con com promiso de la inmunidad celular tienen un riesgo aumentado de padecer la forma diseminada. Presentamos el caso de una mujer adulta, en tratamiento con metotrexato por una artritis seronegativa, que desarrolló la forma diseminada de la enfermedad, y que representó un desafío diagnóstico debido a la dificultad para identificar el agente etiológico.


Abstract Histoplasma capsulatum is an environmental fungus commonly found in the Ohio and Mississippi River valleys, Central and South America, and Asia. The most affected areas in Argentina are the Paraná and de La Plata river basins. Patients with histoplasmosis can have a wide range of clinical presentations. Most of them are asymptomatic, while those with compromised cellular immunity are at increased risk for the disseminated form. We present the case of a patient undergoing treatment with methotrexate for seronegative arthritis who developed the disseminated form of the disease, and who represented a diagnostic challenge due to the difficulty in identifying the etiologic agent.


Subject(s)
Humans , Female , Arthritis/drug therapy , Histoplasmosis/diagnosis , Histoplasmosis/drug therapy , Argentina , Methotrexate , Histoplasma
4.
Arch. argent. pediatr ; 119(5): e550-e553, oct. 2021. ilus
Article in Spanish | LILACS, BINACIS | ID: biblio-1292810

ABSTRACT

Las leucemias son las neoplasias malignas más frecuentes en la infancia; la leucemia linfoblástica aguda (LLA) es la más frecuente. Desde principios de los 80, la adición de metotrexato intratecal a los esquemas de quimioterapia ha sido beneficiosa para prevenir la recidiva en el sistema nervioso central y evitar el uso de radioterapia. Su mecanismo de acción es la inhibición de la enzima dihidrofolato reductasa, por lo que posee múltiples efectos adversos (neurotoxicidad aguda, subaguda o crónica) después de la infusión intratecal o de dosis altas por vía intravenosa.Se presenta un paciente de 11 años con diagnóstico de LLA de línea T (LLA-T), que presenta hemiparesia faciobraquial y afasia de expresión de instauración aguda 8 días después de la administración intratecal de metotrexato. Luego de excluir otras patologías más frecuentes de origen vascular y la evolución típica del cuadro, con resolución espontánea ad integrum de los síntomas, se arribó al diagnóstico de encefalopatía subaguda reversible por metotrexato.


Leukemias are the most frequent malignant neoplasms in childhood; acute lymphoblastic leukemia (ALL) is the most frequent. The addition of intrathecal methotrexate to chemotherapy regimens has been beneficial in preventing relapse to the central nervous system and avoiding the use of radiation therapy. Due to its mechanism of action, by inhibiting the enzyme dihydrofolate reductase, when it is used systemically, it has multiple expected adverse effects such as mucositis, myelosuppression and it has also been observed after intrathecal administration or high intravenous doses, acute, subacute neurotoxicity where stroke like syndrome is found. We present an 11-year-old patient diagnosed with T-ALL, who manifested after 8 days of intrathecal administration of methotrexate, faciobrachial hemiparesis and acute onset expression aphasia. The diagnosis of subacute encephalopathy reversible by methotrexate was reached by excluding other more frequent pathologies and the typical evolution, with spontaneously ad integrum resolution of the symptoms


Subject(s)
Humans , Child , Stroke/chemically induced , Neurotoxicity Syndromes , Precursor Cell Lymphoblastic Leukemia-Lymphoma/drug therapy , Methotrexate/adverse effects , Antimetabolites, Antineoplastic/adverse effects
5.
Rev. méd. Urug ; 37(1): e201, mar. 2021. tab
Article in Spanish | LILACS, BNUY | ID: biblio-1180958

ABSTRACT

Resumen: Introducción: en los últimos años se viene presentando un fenómeno de disminución en las defunciones vinculadas al embarazo ectópico gracias a los avances en el diagnóstico precoz, lo que a su vez abrió las puertas al tratamiento médico con metotrexate en pacientes seleccionadas. El objetivo del presente trabajo es reportar la experiencia del tratamiento con metotrexate en el departamento de Paysandú y determinar secundariamente la satisfacción de las usuarias frente a éste y su fertilidad posterior. Método: se presenta un estudio retrospectivo, observacional, de los embarazos ectópicos tubarios tratados con metotrexate en Paysandú, durante el período del 1º de enero de 2014 al 31 de diciembre de 2017, comprendiendo cuatro años. Se consideró fracaso del tratamiento médico cuando fue necesario tratamiento quirúrgico y se definió como fertilidad futura al tiempo que transcurrió hasta lograr una gestación intrauterina espontánea. Resultados: se registraron 67 embarazos ectópicos en cuatro años, 13 recibieron metotrexate intramuscular con un porcentaje de éxito de 69,2%. Se determinó una fertilidad posterior de 25%. Conclusiones: el uso de metotrexate en el embarazo ectópico se practica en Paysandú desde hace casi una década con buenos resultados y una buena aceptación por parte de las usuarias.


Summary: Introduction : In recent years there has been a decrease in deaths related to ectopic pregnancy, thanks to progress made in early diagnosis, which in turn allowed for medical treatment with methotrexate in selected patients. The study's first objective is to report the experience of methotrexate treatment in the Department of Paysandú and its secondary objective is to determine users' satisfaction towards this treatment and find about their subsequent fertility. Method: a retrospective, observational study is presented of tubal ectopic pregnancies treated with methotrexate in Paysandú, from January 1, 2014 to December 31, 2017, during a 4-year period. Failure of medical treatment was defined as the cases requiring surgical treatment and subsequent fertility was defined as the time it took to achieve a spontaneous intrauterine gestation. Results: 67 ectopic pregnancies were recorded in four years, 13 of which received intramuscular methotrexate with a success rate of 69.2%. Subsequent fertility was found to be 25%. Conclusions: methotrexate has been used to treat ectopic pregnancies in Paysandú for almost a decade, with good results and acceptable rates of user satisfaction.


Resumo: Introdução: nos últimos anos, observou-se uma diminuição dos óbitos relacionados à gravidez ectópica, graças aos avanços no diagnóstico precoce, que por sua vez abriram as portas para o tratamento médico com metotrexato em pacientes selecionadas. Objetivo: o objetivo deste trabalho é relatar a experiência do tratamento com metotrexato no Departamento de Paysandú e determinar secundariamente a satisfação das usuárias com o mesmo e sua consequente fertilidade. Métodos: apresenta-se um estudo retrospectivo e observacional de gestações ectópicas tubárias tratadas com metotrexato em Paysandú, durante o período de 1º de janeiro de 2014 a 31 de dezembro de 2017. Considerou-se como falha do tratamento médico quando o tratamento cirúrgico foi necessário e definiu-se fertilidade futura como o tempo decorrido até a obtenção de uma gravidez intrauterina espontânea. Resultados: foram registradas 67 gestações ectópicas em quatro anos, 13 receberam metotrexato intramuscular com taxa de sucesso de 69,2%. Uma fertilidade subsequente de 25% foi determinada. Conclusões: o uso do metotrexato na gravidez ectópica é praticado em Paysandú há quase uma década com bons resultados e boa aceitação pelas usuárias.


Subject(s)
Pregnancy, Ectopic/therapy , Methotrexate/therapeutic use , Retrospective Studies , Fertility , Observational Study
6.
West Indian med. j ; 69(1): 15-20, 2021. tab, graf
Article in English | LILACS-Express | LILACS | ID: biblio-1341869

ABSTRACT

ABSTRACT Objective: To investigate obesity and insulin resistance and associated factors in patients with rheumatoid arthritis (RA). Methods: We included a cohort of patients with RA. In the clinical research, duration of disease, existence of clinical remission (disease activity index [DAS] 28 below 2.6) and amount of the relevant disease-modifying anti-rheumatic drugs were derived from clinical datum. Cumulative corticosteroid dose was calculated by duration of corticosteroid usage and ratio of physiologic dose. Insulin resistance was calculated with the homeostasis model of assessment of insulin resistance. Results: A total of 64 patients aged between 22 and 77 with RA were studied. Insulin resistance was detected in 34.4% (n = 22) of patients. There was a statistically significant correlation between body mass index and DAS28 scores (r = 0.469, p = 0.000). We found that the incidence of insulin resistance was lower in patients treated with methotrexate at least 1 year (p = 0.001). As long as we did not detect insulin resistance, none of the patients (n = 7) treated with tumour necrosis factor (TNF) blockers. Cumulative steroid dose, presence of obesity and DAS28 were the best predictors for insulin resistance according to multivariate linear regression analysis (R2c = 0.242, F = 6.39, p < 0.001). In this model R2c for cumulative steroid dose was 0.113 (F = 7.88 p < 0.007) and obesity was 0.147 (F = 10.67, p = 0.02). Conclusion: Obesity and long-standing corticosteroid usage were determinants of insulin resistance in patients with RA. Medications such as methotrexate, TNF blockers may help to reduce insulin resistance.

7.
Article in Chinese | WPRIM | ID: wpr-912397

ABSTRACT

Primary vitreoretinal lymphoma (PVRL) is one of the most common type of primary intraocular lymphoma. The current treatment options include local ocular radiotherapy (radiotherapy), systemic chemotherapy (chemotherapy), local ocular chemotherapy, and combination therapy. The treatment options are different at different stages of PVRL, however, there is no uniform treatment guideline. Local ocular chemotherapy can make the drug reach effective therapeutic concentration in the eye, and it can be repeated many times. At the same time, it can avoid the adverse reactions caused by systemic medication or radiotherapy. It is an ideal choice for relieving ocular symptoms. At present, the mainstream ocular local chemotherapeutics are methotrexate (MTX) and rituximab (RTX). The basic consensus about the intravitreal injection of MTX (IVM) is the induction-consolidation-maintenance model, however, the time of each stage and frequency of IVM are diverse. The time interval of intravitreal injection of RTX is also variable, ranging from 1 time/week to 1 time/months and so on. Corneal epithelial lesions caused by frequent MTX injections and the higher recurrence rate after RTX treatment are the main reasons for changing the treatment plan. For patients with primary central nervous system lymphoma and PVRL, combined treatment with neurology department is necessary to save patient's lives, ophthalmology treatment relieves ocular symptoms and improves the patient's quality of life. For patients with PVRL alone without central nervous system involvement, ophthalmology treatment is necessary to control patient's eye symptoms, and close follow-up should be followed to find the involvement of the central nervous system in time, and then combined with neurological treatment to save patient’s lives.

8.
Article in Chinese | WPRIM | ID: wpr-908700

ABSTRACT

Objective:To explore the curative effect of methylprednisolone combined with methotrexate in the treatment of ankylosing spondylitis (AS) and its regulation of serum interleukin (IL)-17/IL-4.Methods:A total of 117 patients with AS in the First Hospital of Baoding from July 2016 to June 2019 were selected as prospective research subjects, and they were simply randomized into three groups, with 39 cases in each group. The control group A was treated with methotrexate, the control group B was treated with methylprednisolone, and the observation group was treated with methotrexate combined with methylprednisolone. The chi-square test was used to compare the clinical efficacy and the incidence of adverse reactions in the three groups. F-test was used to compare the thoracolumbar spine mobility, Bath AS disease activity index (BASDAI), Bath AS function index (BASFI) scores, the levels of serum high mobility protein 1 (HMGB1), matrix metalloproteinase-3 (MMP-3), interleukin (IL)-4, IL-17, and IL-17/IL-4 before and after the treatment of the three groups. Results:The total effective rate of treatment in the observation group was better than that in the control groups A and B :92.31%(36/39) vs. 74.36%(29/39) and 69.23%(27/39), P<0.05. After the course of treatment, the BASDAI and BASFI scores in the observation group were lower than those in the control group A and B, and the thoracolumbar spine mobility were higher than those in the control group A and B: (3.36 ± 1.03) scores vs. (4.62 ± 1.19), (4.98 ± 1.25) scores; (3.70 ± 0.89) scores vs. (4.36 ± 0.96), (4.64 ± 0.95) scores; (4.96 ± 1.17) cm vs. (4.18 ± 1.02), (3.98 ± 1.15) cm, (5.93 ± 1.32) cm vs.(5.02 ± 1.15), (4.92 ± 1.25)cm, P<0.05. After the course of treatment, serum HMGB1, MMP-3, IL-17, IL-17/IL-4 in the observation group were lower than those in the control group A and B: (20.25 ± 6.41) μg/L vs. (27.81 ± 7.63), (29.26 ± 7.31) μg/L; (4.83 ± 1.06) μg/L vs. (9.26 ± 1.25), (9.71 ± 1.28) μg/L; (13.41 ± 5.06)ng/L vs.(17.62 ± 5.61), (19.06 ± 6.14) ng/L; 0.51 ± 0.27 vs. 0.92 ± 0.41, 1.04 ± 0.45, P<0.05; and IL-4 was higher than that in the control groups A and B: (26.15 ± 4.94) ng/L vs. (19.16 ± 5.14), (18.32 ± 5.26) ng/L, P<0.05. There was no significant difference in the incidence of adverse reactions among the three groups ( P>0.05). Conclusions:The combination of methylprednisolone and methotrexate in the treatment of AS can significantly reduce serum HMGB1 and MMP-3 levels, regulate serum IL-17/IL-4 and further improve the therapeutic effect, and it has high safety.

9.
Article in Chinese | WPRIM | ID: wpr-879086

ABSTRACT

Methotrexate(MTX) is a commonly used antimetabolite, which can be used in the treatment of a variety of diseases. However, hepatotoxicity in the use of MTX severely limits its clinical use. Therefore, how to prevent and treat hepatotoxicity of MTX has become an urgent clinical problem. This paper summarizes and analyzes relevant literatures on the prevention and treatment of hepa-totoxicity caused by MTX with traditional Chinese medicines and natural medicines in recent years. MTX-induced hepatotoxicity mechanisms include folate pathway, oxidative stress damage and adenosine pathway, of which oxidative stress theory is the main research direction. A total of 14 kinds of traditional Chinese medicine and natural medicine extracts including white peony root, and 21 kinds of natural monomer compounds, including berberine, play an anti-MTX-induced hepatotoxic effect by resisting oxidative stress, inhibiting inflammation and regulating signal pathways. According to current studies on the prevention and treatment of hepatotoxicity induced by MTX with traditional Chinese medicines and natural medicines, there are insufficiencies, such as partial and superficial mechanism studies, inadequate combination of experimental research and clinical practice, non-standard experimental design and lack of application of advanced technologies and methods. This paper systematically reviewed the effects and mechanisms of traditional Chinese medicines and natural medicines against hepatotoxicity induced by MTX and defined current studies and deficiencies, in the expectation of proposing new study strategies and directions and providing scientific basis for rational clinical use of MTX and development of new drugs against MTX hepatotoxicity.


Subject(s)
Chemical and Drug Induced Liver Injury/prevention & control , Drug-Related Side Effects and Adverse Reactions , Humans , Liver/metabolism , Medicine, Chinese Traditional , Methotrexate/toxicity , Oxidative Stress
10.
Article in Chinese | WPRIM | ID: wpr-878932

ABSTRACT

To systemically evaluate the efficacy and safety of sinomenine combined with methotrexate(SIN+MTX) in the treatment of rheumatoid arthritis(RA). Literature databases of Wanfang, CNKI, VIP, SinoMed, PubMed, Cochrane Library and Web of Science were retrieved comprehensively for relevant clinical trials. The literature retrieval time was from database establishment to February 4, 2020. The quality of literatures was assessed by the Cochrane Evaluation Handbook 5.1.0, and qualified literature was reviewed and analyzed by using the RevMan 5.3 statistical software. Twenty randomized controlled trials met the inclusion criteria, and were enrolled in the Meta-analysis. The results showed that SIN+MTX remarkably reduced DAS28(MD=-0.85, 95%CI[-1.03,-0.67], P<0.000 01), and improved total efficiency(P<0.000 01). SIN+MTX could inhibit swollen joint count(MD=-1.19, 95%CI[-1.75,-0.63], P<0.000 1), tender joint count(MD=-1.58, 95%CI[-2.89,-0.28], P=0.02) and reduce morning stiffness time(MD=-8.44, 95%CI[-11.82,-5.07], P<0.000 01) compared with control group. The results showed that SIN+MTX was equal to control group in grip strength(SMD=0.20,95%CI[-1.11,1.51],P=0.77). SIN+MTX remarkably alleviated the erythrocyte sedimentation rate(MD=-9.87, 95%CI[-14.52,-5.22], P<0.000 1), C-reactive protein(SMD=-0.30, 95%CI[-0.51,-0.09], P=0.005), and rheumatoid factor(MD=-11.23,95%CI[-13.81,-8.65],P<0.000 01). The frequency of adverse reactions were reduced compared with that in the control group(P<0.000 01). Current clinical studies demonstrate that the efficacy and safety of SIN+MTX in the treatment of RA were superior to control group. However, due to the low quality and quantity of the included studies, high-quality randomized controlled trials are necessary to support the clinical evidences.


Subject(s)
Antirheumatic Agents/adverse effects , Arthritis, Rheumatoid/drug therapy , Drugs, Chinese Herbal/adverse effects , Humans , Methotrexate/adverse effects , Morphinans
11.
Acta Pharmaceutica Sinica ; (12): 1712-1718, 2021.
Article in Chinese | WPRIM | ID: wpr-881565

ABSTRACT

Methotrexate (MTX) injection has a short half-life and significant toxic side effects. In order to overcome the demerits of MTX injection, MTX@COF was prepared for subcutaneous injection by loading MTX in crosslinked cyclodextrin metal-organic framework (COF) in this study. The cationic lipid material (2, 3-dioleoyl-propyl)-trimethylamine (DOTAP) was then coated on the MTX@COF surface by solvent evaporation. Different surface charge characteristics were observed in the coated MTX@COF@DOTAP with no significant change in particle morphology. The in vitro release behaviors of sustained-release particles were investigated in water and phosphate buffer (pH 7.4), and the in vivo release characteristics were evaluated for pharmacokinetics in rats. The in vitro release results showed that the cumulative release of MTX, MTX@COF and MTX@COF@DOTAP within 6 h was 92.70%, 36.31% and 18.19% in water, respectively; the cumulative release of MTX, MTX@COF and MTX@COF@DOTAP within 4 h was 90.82%, 79.37% and 58.30% in phosphate buffer, respectively; the results showed that MTX@COF can significantly delay the release of MTX, the modification to MTX@COF by DOTAP can further delay the release of MTX. Pharmacokinetic studies in rats showed that the mean retention time [MRT(0-t)] and the time to peak (Tmax) of the subcutaneous injection of MTX@COF@DOTAP group were significantly prolonged compared with the MTX@COF group and the MTX group. The area under the concentration-time curve [AUC(0-t)] of the MTX@COF@DOTAP subcutaneous injection group was 1.8 times high as that of the MTX group. In this study, MTX@COF@DOTAP particles had a certain sustained-release effect, and could prolong the bioavailability of MTX by subcutaneous injection, which provided a new idea for the development of new MTX dosage forms.

12.
Article in Chinese | WPRIM | ID: wpr-887884

ABSTRACT

A case of primary oral mucosal diffuse large B-cell lymphoma(DLBCL)due to long-term use of methotrexate(MTX)for the treatment of rheumatoid arthritis(RA)was admitted to the Department of Hematology,Fujian Medical University Union Hospital.We analyzed and discussed the clinical features,diagnosis and treatment,and prognosis of specific malignant lymphoma induced by MTX in this RA patient.Our purpose is to improve the awareness and knowledge of other iatrogenic immunodeficiency-associated lymphoproliferative disorders of clinicians and pathologists.This study provides a new reference for the clinical diagnosis and treatment of MTX-associated DLBCL.


Subject(s)
Arthritis, Rheumatoid/drug therapy , Humans , Lymphoma, Large B-Cell, Diffuse/drug therapy , Lymphoproliferative Disorders , Methotrexate/adverse effects
13.
Acta Pharmaceutica Sinica B ; (6): 3035-3059, 2021.
Article in English | WPRIM | ID: wpr-922741

ABSTRACT

Various boron-containing drugs have been approved for clinical use over the past two decades, and more are currently in clinical trials. The increasing interest in boron-containing compounds is due to their unique binding properties to biological targets; for example, boron substitution can be used to modulate biological activity, pharmacokinetic properties, and drug resistance. In this perspective, we aim to comprehensively review the current status of boron compounds in drug discovery, focusing especially on progress from 2015 to December 2020. We classify these compounds into groups showing anticancer, antibacterial, antiviral, antiparasitic and other activities, and discuss the biological targets associated with each activity, as well as potential future developments.

14.
Article in Portuguese | LILACS | ID: biblio-1146948

ABSTRACT

Introdução: A quimioterapia, uma das formas de tratamento de neoplasias malignas, tem sua administração associada a inúmeras drogas, sendo uma delas o metotrexato (MTX), de alta toxicidade, responsável por inúmeros fatores agravantes para a saúde e bem-estar do paciente. Uma das principais complicações é a mucosite oral, manifestação clínica resultante do tratamento oncológico que pode interferir no tratamento e na cura. Objetivo: Avaliar, comparativamente, por meio de um estudo retrospectivo, o efeito do laser preventivo na ocorrência da mucosite oral quimioinduzida em pacientes com osteossarcoma não metastático submetidos a altas doses de MTX, bem como a intensidade da mucosite oral, utilizando o laser preventivo após os ciclos quimioterápicos contendo o medicamento MTX nos pacientes atendidos no Hospital de Câncer infantojuvenil de Barretos/SP. Método: Estudo de coorte com coleta retrospectiva em prontuários. Os pacientes foram divididos em dois grupos, um submetido à terapia profilática com laser de baixa intensidade após infusão do MTX e outro grupo não submetido a essa terapia. Resultados: Os dados obtidos mostraram que houve redução da gravidade da mucosite oral com o uso da laserterapia preventiva, com resultados estatisticamente significativos (p<0,001), corroborando os resultados encontrados na literatura. Conclusão: O uso da laserterapia é uma terapêutica auxiliar importante na prevenção e na redução da severidade da mucosite oral em pacientes submetidos a altas doses de MTX, diminuindo o número de internações por mucosite e os atrasos no protocolo terapêutico, o que reduz gastos e melhora o prognóstico para o paciente.


Introduction: Chemotherapy, one of the treatments for malignant neoplasms, is associated to innumerous drugs, one of them methotrexate (MTX), of high toxicity, responsible for several health damages and impact on the patient's well-being. One of the main complications is oral mucositis, a clinical manifestation resulting from the oncologic treatment that can interfere in the treatment and cure. Objective: To evaluate comparatively through a retrospective study, the effect of preventive laser in the occurrence of chemo-induced oral mucositis in patients with non-metastatic osteosarcoma submitted to high doses of methotrexate (MTX), and the intensity of oral mucositis, using the preventive laser after the chemotherapy cycles containing the drug methotrexate (MTX) in the patients treated at the Child and Adolescent Cancer Hospital of Barretos/SP. Method:Retrospective cohort study with charts review. The patients were divided in two groups, one submitted to low-intensity laser prophylaxis therapy after infusion of MTX and another group not submitted to prophylactic therapy. Results: The data obtained showed that preventive laser-therapy reduced the severity of oral mucositis with statistically significant results (p<0.001), corroborating the results found in the literature. Conclusion: The use of laser therapy is an important auxiliary therapy in the prevention and reduction of severity of oral mucositis in patients submitted to high doses of MTX, reducing the number of hospitalizations and delays in therapeutic protocol, which reduces costs and improves the patient prognosis.


Introducción: La quimioterapia, es uma de las formas de tratamiento de las neoplasias malignas, tiene su administración asociada a numerosas drogas siendo una de ellas el metotrexato (MTX), de alta toxicidad, responsable de numerosos factores agravantes para la salud y bienestar del paciente. Una de las principales complicaciones es la mucositis oral, manifestación clínica resultante del tratamiento oncológico que puede interferir en el tratamiento y cura. Objetivo: Evaluar, comparativamente, a través de um estudio retrospectivo, el efecto del láser preventivo em la aparición de la mucositis oral quimio inducida em pacientes com osteosarcoma no mestastásico sometido a altas dosis de MTX, bien como la intensidade de la mucositis oral, utilizando el láser preventivo después de los ciclos quimioterápicos que contiene el medicamento MTX en los pacientes antendidos en el Hospital del Cáncer Infantojuvenil de Barretos/SP. Método: Estudio de coorte con colección retrospectiva en prontuários. Los pacientes fueron divididos em dos grupos, uno sometido a terapia profiláctica con láser de baja intensidade después de la infusión de MTX y otro grupo no sometido a terapia profiláctica. Resultados: Los dados obtenidos mostraron que hubo una reducción en la severidad de la mucositis oral con el uso de la terapia láser preventiva, con resultados estáticamente significativos (p<0,001), corroborando los resultados encontrados em la literatura. Conclusión: El uso de la terapia con láser es una terapia auxiliar importante en la prevención y reducción de la severidad de la mucositis oral em pacientes sometidos a altas dosis de MTX, diminuendo el número de internaciones por mucositis y retrasos en el protocolo terapéutico, lo que reduce los gastos y mejora el pronóstico para el paciente.


Subject(s)
Humans , Male , Female , Stomatitis/radiotherapy , Methotrexate/adverse effects , Low-Level Light Therapy , Stomatitis/chemically induced , Stomatitis/prevention & control , Bone Neoplasms/drug therapy , Osteosarcoma/drug therapy , Retrospective Studies , Cohort Studies , Antimetabolites, Antineoplastic/adverse effects
15.
Braz. J. Pharm. Sci. (Online) ; 57: e19147, 2021. tab, graf
Article in English | LILACS | ID: biblio-1350231

ABSTRACT

Methotrexate (MTX) is famous for its therapeutic potential against different cancers including colorectal cancer. Goal of the present investigation was to formulate MTX loaded mucoadhesive microparticles for colon targeting. The optimized formulation (MTX-MS2) was composed of mucoadhesive polymers (sodium alginate, guar gum and carbopol 940) in an appropriate ratio. MTXMS2 was developed by ionic-gelation method. The suitable particle size and zeta potential were found to be 21.10 ± 0.18 µm and 3.01 ± 0.16 mV for MTX-MS2 respectively. The % yield (98.60 ± 2.12), % entrapment efficiency (97.98 ± 1.22) and % drug loading (1.04 ± 0.03) were estimated for MTXMS2. The swelling index (0.99 ± 0.04 θ) and mucoadhesion (97.29 ± 4.61%) were significantly (***P ˂ 0.01) achieved with MTX-MS2 as compared to other formulations. The optimum drug release (96.07 ± 4.52%) was significantly achieved with MTX-MS2 at simulated gastric fluid (pH 7.4) for 36 h in a sustained manner. This profile may be attributed towards excellent mucoadhesivness of the polymers used in the formulation. Therefore, the current investigation suggests that mucoadhesive carrier system could be promising approach for colon delivery. Thus, the proposed work would be helpful for the treatment of colorectal canc


Subject(s)
In Vitro Techniques/methods , Methotrexate/agonists , Colon/abnormalities , Colorectal Neoplasms/drug therapy , Alginates/adverse effects
16.
An. bras. dermatol ; 95(supl.1): 39-52, Nov.-Dec. 2020. tab, graf
Article in English | LILACS | ID: biblio-1152777

ABSTRACT

Abstract Background: Alopecia areata is a highly frequent disease with an impact on quality of life and several treatment options with little clinical confirmatory evidence. Objective: To disseminate the recommendations of Brazilian dermatologists with expertise in the treatment of alopecia areata. Methods: Eight specialists with expertise in alopecia areata from different university centers were appointed by the Brazilian Society of Dermatology to reach a consensus on its treatment. Based on the adapted DELPHI methodology, the relevant elements were considered; then, an analysis of recent literature was carried out and the consensus was written down. Consensus on the management of alopecia areata was defined with the approval of at least 70% of the panel. Results/Conclusions: Intralesional injectable corticotherapy was considered the first option for localized disease in adults. In extensive cases with signs of activity, systemic corticosteroid therapy should be considered and can be used together with immunosuppressants (corticosteroid-sparing agents). The use of an immunosensitizer (diphencyprone) is an option for stable long-term cases. Evaluation of side effects is as important as the rate of hair regrowth.


Subject(s)
Humans , Adult , Dermatology , Alopecia Areata/drug therapy , Quality of Life , Brazil , Consensus
17.
Int. j. odontostomatol. (Print) ; 14(4): 572-574, dic. 2020. graf
Article in Spanish | LILACS | ID: biblio-1134540

ABSTRACT

RESUMEN: Las úlceras orales (UO) son uno de los signos de toxicidad por metotrexato (Mtx) aún en pacientes con esquemas de dosis bajas para el control de artritis reumatoide (AR). En estos casos establecer un diagnóstico correlacionando UO con el medicamento puede ser un reto. Presentamos 2 casos clínicos de pacientes con AR en tratamiento con Mtx, las cuales desarrollaron UO. En los dos casos, interesantemente los pacientes fueron evaluados tanto por especialistas del área médica y oral sin tener un resultado satisfactorio después de múltiples tratamientos. Las UO resolvieron posterior a la suspensión del medicamento. Se estableció el diagnóstico de Estomatitis por Metotrexato (EMtx) por un especialista en medicina oral. El manejo multidisciplinario en estos casos es clave para el establecimiento de un diagnóstico y tratamiento oportuno.


ABSTRACT: Oral ulcers (OU) are a sign of methotrexate (Mtx) toxicity, even in patients with rheumatoid arthritis (RA) that are under a low-dose regime. In those cases, establishing a diagnosis correlating OU with the medication can be quite a challenge. Here we present 2 clinical cases of RA patients under Mtx treatment that developed OU. Interestingly, in both cases the patients were evaluated by two specialists in the medical and dentistry area, and following multiple treatments there was no satisfactory result. However, oral ulcers resolved after stopping the treatment. A diagnosis of Metotrexato stomatitis was established (SMtx) by a specialist in oral medicine. Multidisciplinary management in these cases is key for the establishment of an opportune diagnosis and treatment.


Subject(s)
Humans , Female , Aged , Stomatitis, Aphthous/diagnosis , Methotrexate/adverse effects , Oral Ulcer/diagnosis , Oral Ulcer/therapy , Arthritis, Rheumatoid , Oral Ulcer/complications , Oral Ulcer/chemically induced , Toxicity
18.
Article in Spanish, English | LILACS-Express | LILACS | ID: biblio-1177981

ABSTRACT

Antecedentes. El embarazo ectópico cervical es la implantación del embrión en la zona de revestimiento del canal endocervical. Representa menos del 1% de todos los embarazos ectópicos. Reporte de Caso: Reportamos dos pacientes que acuden a consulta de emergencia por sangrado transvaginal. El diagnóstico de embarazo ectópico cervical fue realizado por ecografía transvaginal (7 y 8 semanas de gestación). Se inició tratamiento con metotrexato (paciente de 28 años) y metotrexato-ácido folínico (paciente de 35 años). Debido al aumento de la hormona gonadotropina coriónica humana se decidió realizar una histerectomía abdominal (paciente de 28 años) y curetaje-cerclaje cervical tipo McDonald (paciente de 35 años). No hubo complicaciones posteriores a la cirugía en ambas pacientes. Conclusiones: El tratamiento del embarazo ectópico cervical es controversial. Se debe elegir la terapia más apropiada para preservar la fertilidad y evitar complicaciones como la hemorragia.


Background. Cervical ectopic pregnancy is the implantation of the embryo in the lining of the endocervical canal lining. It represents less than 1% of all ectopic pregnancies. Case description: We report two patients who come to the emergency room for transvaginal bleeding. The diagnosis of cervical ectopic pregnancy was made by transvaginal ultrasound (7- and 8-weeks' gestation). Treatment was started with methotrexate (28-year-old patient) and methotrexatefolinic acid (35-year-old patient). Due to the increase in human chorionic gonadotropin hormone, it was decided to perform an abdominal hysterectomy (28-year-old patient) and McDonald-type cervical curettagecerclage (35-year-old patient). There were no complications after surgery in both patients. Conclusions: The treatment of cervical ectopic pregnancy is controversial. The most appropriate therapy should be chosen to preserve fertility and avoid complications such as bleeding.

19.
Rev. bras. ginecol. obstet ; 42(12): 800-804, Dec. 2020. tab, graf
Article in English | LILACS | ID: biblio-1156064

ABSTRACT

Abstract Objective In recent years, there has been an increase in the incidence of ectopic pregnancies; therefore, it is important for tertiary centers to report their approaches and outcomes to expand and improve treatment modalities. The aim of the present study was to evaluate the general characteristics, treatment and outcomes of cases diagnosed with ectopic pregnancy. Methods In total, 432 patients treated for ectopic pregnancy between February 2016 and June 2019 were retrospectively evaluated. Results Overall, 370 patients had tubal pregnancy, 32 had cesarean scar pregnancy, 18 had pregnancy of unknown location, 6 had cervical pregnancy, and 6 had interstitial pregnancy. The most important risk factors were advanced age (> 35 years; prevalence: 31.2%) and smoking (prevalence: 27.1%). Thirty patients who did not have any symptoms of rupture and whose human chorionic gonadotropin (β-hCG) levels were ≤ 200 mIU/ml were followed-up with expectant management, while 316 patients whose β-hCG levels were between 1,500 mIU/ml and 5,000 mIU/ml did not have an intrauterine gestational sac on the transvaginal or abdominal ultrasound, did not demonstrate findings of rupture, and were treated with a systemic multi-dose methotrexate treatment protocol. In total, 24 patients who did not respond to the medical treatment, 20 patients whose β-hCG levels were > 5,000 mIU/ml, 16 patients who had shown symptoms of rupture at the initial presentation, and 6 patients diagnosed with interstitial pregnancy underwent surgery. Patients with cervical and scar pregnancies underwent ultrasound-guided curettage, and no additional treatment was needed. Conclusion The fertility status of the patients, the clinical and laboratory findings, and the levels of β-hCG are the factors that must be considered in planning the appropriate treatment.


Subject(s)
Humans , Female , Pregnancy , Adolescent , Adult , Young Adult , Pregnancy, Ectopic/epidemiology , Ultrasonography, Prenatal , Pregnancy, Ectopic/etiology , Pregnancy, Ectopic/therapy , Pregnancy, Ectopic/diagnostic imaging , Brazil/epidemiology , Abortifacient Agents, Nonsteroidal/therapeutic use , Methotrexate/therapeutic use , Retrospective Studies , Risk Factors , Treatment Outcome , Curettage , Tertiary Care Centers , Middle Aged
20.
Article | IMSEAR | ID: sea-208025

ABSTRACT

Background: Ectopic pregnancy is a commonest cause of maternal morbidity and mortality in the first trimester of pregnancy. Clinical presentation of ectopic pregnancy has changed from life threatening disease to a more benign condition for which nonsurgical treatment options are available with methotrexate administered systemically or locally. The study was done to evaluate the outcome of medical management of ectopic pregnancy with single regimen methotrexate.Methods: A cohort study was conducted over 18 months on 60 unruptured ectopic pregnancies who were treated with methotrexate injection.Results: Out of 60 unruptured ectopic pregnancies, 53 (88.3%) were successfully treated with methotrexate. Failure rate was 11.7% (7/60) patients who underwent laparotomy. Success of medical treatment was dependent on pretreatment β-hCG (≤4102.5 mIU/mL), period of gestation (≤5 weeks), size of gestational sac (≤3 cm) above which the failure rate increases. No correlation was seen between fall of β-hCG from day 4 to 7 and the success rate. Mean time to resolution of β-hCG seen was 4.3±1.25 weeks. Mean duration of hospital stay was 8.85±1.603 days. Single dose regimen of methotrexate was given to all patients and only 1/60 patients required second dose of methotrexate for suboptimal decrease of β-hCG.Conclusions: The result showed that pretreatment β-hCG level and period of gestation were good predictors for success of medical treatment.

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