Eficácia e segurança da tripla terapia com Selexipague comparada à dupla terapia para tratamento de hipertensão arterial pulmonar: revisão rápida de evidências / Effectiveness and safety of triple therapy with Selexipag compared dual therapy for treatment of pulmonary arterial hypertension: rapid response review of evidence

Selexipague e outros medicamentos de controle da Hipertensão Arterial Pulmonar grupo 1. Indicação: Tratamento de Hipertensão Arterial Pulmonar grupo 1. Pergunta: Há superioridade em eficácia e segurança da tripla terapia com selexipague, comparado a dupla terapia, disponível no SUS, no tratamento de Hipertensão Arterial Pulmonar grupo 1? Métodos: Revisão rápida de evidências (overview) de ensaios clínicos randomizados e revisões sistemáticas, com levantamento bibliográfico realizado na base de dados PUBMED, utilizando estratégia estruturada de busca. A qualidade metodológica das revisões sistemáticas foi avaliada pela ferramenta risco de viés da Cochrane. Resultados: Foi selecionado um ensaio clínico randomizado, especificamente um artigo contendo análise de subgrupo de dados desse estudo. Conclusão: As evidências demonstraram redução do número de hospitalizações relacionadas à HAP e de eventos de progressão da doença no tratamento de selexipague em tripla terapia em pacientes na classe funcional II, quando comparada à dupla terapia sem selexipague. A tripla terapia é tão segura quanto a dupla terapia, pois tem riscos similares de eventos adversos e eventos adversos sérios. A tripla terapia não é diferente da dupla terapia no risco da mortalidade geral

Selexipag and other drugs for the control of Pulmonary Arterial Hypertension group 1. Indication: Treatment of Pulmonary Arterial Hypertension group 1. Question: Is there superiority in efficacy and safety of triple therapy with selexipag, compared to dual therapy, available in the SUS, in the treatment of ulmonary Arterial Hypertension group 1? Methods: Rapid review of evidence (overview) of randomized clinical trials and systematic reviews, with a bibliographic survey carried out in the PUBMED database, using a structured search strategy. Results: A randomized clinical trial was selected, specifically an article showing a subgroup analysis of data from this study. Conclusion: Evidence showed a reduction in the number of Pulmonary Arterial Hypertension related hospitalizations and disease progression events in the treatment of selexipag in triple therapy in patients in functional class II, when compared to dual therapy without selexipag. Triple therapy is as safe as dual therapy, as it has similar risks of adverse events and serious adverse events. Triple therapy is no different from dual therapy in the risk of overall mortality

Efeito protetor da acetamida em bovinos indica monofluoroacetato como princípio tóxico de Palicourea marcgravii (Rubiaceae) / Protective effect of acetamide in cattle indicates that monofluoroacetate is the toxic principle of Palicourea marcgravii (Rubiaceae)

O presente trabalho teve como objetivo avaliar e comparar o efeito protetor da acetamida nas intoxicações experimentais por monofluoroacetato (MF) e por folhas frescas de Palicourea marcgravii em bovinos, no intuito de confirmar, de forma prática, que esse composto é o princípio tóxico responsável pelo quadro clínico-patológico e pela morte dos animais intoxicados por essa planta. Três bovinos receberam MF, por via oral, na dose de 0,5mg/kg e, em seguida, a dois desses animais administraram-se acetamida, por via oral, nas doses de 0,38 e 2,0g/kg. Outros dois bovinos receberam 1,0g/kg de P. marcgravii, em seguida, a um deles administrou-se 1,0 g/kg de acetamida. Acetamida, quando administrada em quantidades suficientes (maior dose), evitou o aparecimento dos sinais clínicos e a morte de todos os animais que receberam MF ou P. marcgravii. Tal efeito protetor foi, de fato, confirmado após uma semana, quando o mesmo protocolo experimental foi repetido, para cada bovino, porém sem a administração de acetamida. Todos os bovinos não tratados com acetamida manifestaram sinais clínicos e morreram subitamente. O quadro clínico-patológico manifestado pelos bovinos intoxicados por MF ou P. marcgravii foi semelhante e, caracterizou-se por "morte súbita". Os animais em geral, apresentaram taquicardia, taquipnéia, tremores musculares, jugular repleta com pulso venoso positivo, polaquiúria, instabilidade, perda de equilíbrio, por vezes, cambaleavam e apoiavam a cabeça no flanco. Na fase final, todos os animais deitavam-se e levantavam-se com maior frequencia, deitavam ou caíam em decúbito lateral, esticavam os membros, faziam movimentos de pedalagem, apresentavam respiração ofegante, arritmia, opistótono, nistagmo, mugiam e morriam. A duração da "fase dramática" variou de 2 a 26min. À necropsia verificaram-se, em geral, aurículas, jugulares, ázigos e pulmonares leve a moderadamente ingurgitadas, leve a acentuado edema da subserosa da vesícula biliar, sobretudo, na sua inserção no fígado, bem como moderada quantidade de líquido espumoso róseo na traquéia e brônquios. O exame histopatológico revelou, no rim de todos os animais, leve até acentuada degeneração hidrópico-vacuolar das células epiteliais dos túbulos uriníferos contornados distais associada à picnose nuclear; no fígado, havia leve a moderada congestão, discreta a moderada tumefação e moderada vacuolização de hepatócitos, predominantemente, centrolobular, necrose de coagulação individual ou de grupos de hepatócitos e corpúsculos de choque. Os dados obtidos neste trabalho comprovam, de forma prática, que MF é o princípio tóxico de P. marcgravii responsável pelo quadro clínico-patológico e a morte dos animais que ingerem e se intoxicam naturalmente por essa planta, uma vez que a acetamida atua como antídoto eficaz (efeito antagônico) de forma idêntica em ambas as intoxicações.

The aim of the study was to evaluate and compare the protective effect of acetamide in experimental poisoning by fresh leaves of Palicourea marcgravii and monofluoroacetate (MF) in catlle, in order to prove in a practical way that this compound is the toxic principle responsible for the clinical signs and death of animals that ingested the plant. MF was administered orally in single doses of 0.5mg/kg to three cows; a few minutes later, two of these cows received, orally, single doses of acetamide (0.38 or 2.0g/kg). Two other cows ingested 1.0g/kg of P. marcgravii, and one of these cows received some minutes later 1.0g/kg of acetamide. Adequate doses of acetamide, administered right after the poisoning by P. marcgravii or MF, were able to prevented the onset of clinical signs and avoid the death of all animals. One week later, the experiments were repeated, but without the antidote. All animals not treated with acetamide showed symptoms of poisoning and died suddenly. MF and P. marcgravii caused the same clinical and pathological picture of "sudden death" in cattle. Clinically, the cattle presented palpitation, abdominal breathing, muscle tremors, engorged jugular vein with positive pulse, pollakiuria, slight loss of balance with sometimes swaying gait, the animals laying down and with the head on their flank. In the "dramatic phase", all the animals fell into lateral decubitus, stretched the limbs, made paddling movements, presented opistotonus, arrhythmia, nystagmus, and died. The "dramatic phase" lasted from 2 to 26 minutes. At postmortem examination, the heart auricles, jugulars and pulmonary veins were slightly to moderately ingurgitated; slight to marked edema of the subserosa was seen in fixation sites of gall bladder to the liver. In one cow, pulmonary edema was observed. Histopathology revealed in all cows slight to marked hydropic-vacuolar degeneration of the epithelial cells of the distal convoluted uriniferous tubules associated with nuclear pyknosis. Coagulation necrosis of individual or groups of hepatocytes and slight to moderate hepatic congestion with numerous shock corpuscles were also observed. The experimental results showed in practice that MF is the toxic principle responsible for the clinical-pathological picture and death of the cattle that ingested P. marcgravii, since acetamide acts as an efficient antidote (antagonistic effect), identical in both poisonings.

Increasing pathomorphism of pulmonary tuberculosis: an observational study of slow clinical, microbiological and imaging response of lung tuberculosis to specific treatment. Which role for linezolid?

During recent years, a progressive emerging of tuberculosis occurred, related to the overall increased age of general population, primary and secondary (iatrogenic) immunodeficiencies, the availability of invasive procedures, surgical interventions and intensive care supports, bone marrow and solid organ transplantation, and especially the recent immigration flows of people often coming from areas endemic for tuberculosis, and living with evident social-economical disadvantages, and with a reduced access to health care facilities. Since January 2006, at our reference centre we followed 81 consecutive cases of pulmonary tuberculosis, with 65 of them which remained evaluable for the absence of extrapulmonary complications, and a continuative and effective clinical and therapeutic follow-up. The majority of episodes of evaluable pulmonary tuberculosis (49 cases out of 65: 75,4 percent) occurred in patients who immigrated from developing countries. In two patients multiresistant (MDR) Mycobacterium tuberculosis strains were found, while two more subjects (both immigrated from Eastern Europe) suffered from a disease due to extremely resistant (XDR) M. tuberculosis strains. Although enforcing all possible measures to increase patients' adherence to treatment (empowerment, delivery of oral drugs under direct control, use of i.v. formulation whenever possible), over 72 percent of evaluable patients had a very slow clinical, microbiological, and imaging ameliorement (1-6 months), with persistance of sputum and/or bronchoalveolar lavage (BAL) fluid positive for M.tuberculosis microscopy and/or culture for over 1-4 months (mean 9.2±3.2 weeks), during an apparently adequate treatment. When excluding patients suffering from XDR and MDR tuberculosis, in four subjects we observed that off-label linezolid adjunct together with at least three drugs with residual activity against tuberculosis, led to a significantly more rapid clinical-radiological improvement...

Acute oral toxicity of insect repellent N,N-diethylphenylacetamide in mice, rats and rabbits and protective effect of sodium pentobarbital.

Median lethal dose (LD50) of undiluted liquid insect repellent N,N-diethylphenylacetamide (DEPA) in male mice, rats and rabbits was 900, 825 and 635 mg/kg respectively when administered by gavage. Signs of DEPA intoxication point to stimulation of central nervous system (CNS). Acetazolamide (10 mg/kg), sodium bicarbonate (40 mg/kg), and atropine (5 mg/kg) when injected (ip) 5 min after a lethal oral dose of DEPA (1700 mg/kg) did not prevent mortality, while sodium pentobarbital (SPB; 20 mg/kg) when injected 5 min after or 15 min before DEPA provided greater protection to the animals. SPB pretreatment elevated the LD50 of DEPA to 1780 and 1535 mg/kg in mice and rats respectively and 85% rats survived when SPB was injected 5 min after acute oral exposure to DEPA (1000 mg/kg). Carboxylesterase (CaE) inhibition is not a factor in the protection mechanism of SPB. DEPA (1000 mg/kg) when given orally elevated blood PCO2 and reduced pH, O2 content and per cent O2 saturation, while administration of SPB after the same dose of DEPA reduced the degree of acidosis and raised PCO2, and increased the O2 content and per cent O2 saturation to near normal status. The CNS depressant action of SPB may be a crucial factor in protection of rats from DEPA poisoning.

Development & evaluation of controlled release formulations of DEPA, an insect repellent.

Three controlled release formulations of the insect repellent DEPA (N, N-Diethyl phenylacetamide), Depa-A, Depa-B and Depa-C have been developed and tested on human subjects against Aedes aegypti adult mosquitoes for repellency and the results were compared to those of a solution of DEPA (Depa-0). The increase in the protection time of the formulations, as compared to Depa-0 was compared. Depa-B was found to be effective with a protection time of 7.13 and 6.15 h and percentage increase in protection time of 44.5 and 38.2 at the two application rates of 0.5 and 0.25 mg/cm2 of the repellent. This observation agreed with the studies carried out on the evaporation of the repellent formulations on two models, on adsorbing and nonadsorbing surfaces for the relative adsorption and evaporation by analysing the repellent concentrations, using an infrared spectrophotometer.