Awareness and possible treatment options toward COVID-19 among selected healthcare professionals in National Capital Region

Background@#Since December 2019, SARS-CoV-2, otherwise known as coronavirus disease 2019 (COVID-19), has caused worldwide panic and is now a serious problem. As the situation worsens, the need for an official cure becomes more crucial and different methods are being considered for treating infected COVID-19 patients. @*Objectives@#This study aimed to emphasize and further elaborate on the existing and possible treatment methods against COVID-19 and assess the awareness of healthcare professionals (doctors, medical technologists, and nurses) on the treatments for COVID-19. @*Methodology@#The study utilized an exploratory sequential mixed methods design following the treatment and misinformation theories models. The respondents were selected based on inclusion and exclusion criteria and recruited through the snowball sampling technique. The study used an adapted survey questionnaire on the pathophysiology of COVID-19 and possible treatment options. Descriptive statistical analysis for quantitative data and open thematic coding is used in an online qualitative deductive data analysis. @*Results@#Based on the data, webinars, lectures, and discussions were the primary source of information among healthcare professionals. Most of the respondents showed proficiency with remdesivir among investigational selective medicines. Chloroquine was the top choice among selected repurposed drugs. They were aware of the convalescent plasma therapy that uses antibodies from the blood plasma of recovered COVID-19 patients. They were not aware of the different herbal treatments used to treat COVID-19. @*Conclusion@#Hence, chloroquine (repurposed drug), remdesivir (investigational drug), and convalescent plasma (adjunctive therapy) are the most well-known treatments for COVID-19. Most of the respondents were aware of the action and side effects of chloroquine, remdesevir, and convalescent plasma therapy.

Investigation of New Benzimidazole Derivative Compounds Effects on A549 Cell Line

Abstract Chronic inflammation is a common indication of several diseases, e.g. asthma, chronic obstructive pulmonary disease (COPD), atherosclerosis, etc. Benzimidazole derivatives are preferable compounds to design new analgesic and anti-inflammatory substances due to their unique biological features. We aimed to investigate the effect of a newly synthesized benzimidazole derivative, ORT-83, on A549 human lung adenocarcinoma cell line. ORT-83 was synthesized, and a non-cytotoxic concentration of ORT-83 on A549 cells was detected with MTT assay. To analyze the anti-inflammatory effect of ORT-83, an inflammatory cell culture model was established by stimulating A549 cell line with IL1-β (10 ng/ml). After 2 hours of treatment with IL1-β to induce inflammation, A549 cells were exposed to ORT-83 (0.78 µg/ml) for 24 hours. Thereafter gene expression analyses were performed with qRT-PCR. We found that ORT-83 significantly suppressed the gene expression levels of the proinflammatory cytokines; IL-6, NFkB, and TNF-α. However, the increased levels of IL-10 (2.8 folds) by IL-1β induction did not change after ORT-83 and/or dexamethasone (Dex: positive control) treatments. While Dex; a COX-2 inhibitor, reduced the COX-2 expression level in inflammatory cells from 10.03 folds to 0.71 folds, ORT-83 reduced its level to 4.37 folds. iNOS expression levels did not change in any experimental groups. In conclusion, we showed that ORT-83 exerted its anti-inflammatory effects by repressing the gene expression of proinflammatory cytokines in the inflammation-induced A549 cell line. Although ORT-83 had a weaker COX-2 inhibitory effect compared to Dex, it was shown to be still a strong anti-inflammatory compound.

Desarrollo de un producto anti-toxina shiga para la prevención del síndrome urémico hemolítico / Development of a product anti-Shiga toxin for prevention of the hemolytic uremic syndrome

El síndrome urémico hemolítico (SUH) típico es una enfermedad huérfana causada por cepas de Escherichia coli productoras de toxina Shiga (Stx) y caracterizada por daño renal agudo, anemia hemolítica microangiopática y plaquetopenia. Es endémico en Argentina, el país con mayor incidencia de SUH en el mundo. Debido al rol fundamental de la Stx en su patogenia, se puede considerar que, como otras toxemias conocidas, el SUH podría ser tratado con anticuerpos. Este trabajo describe el desarrollo de un nuevo tratamiento capaz de neutralizar el efecto tóxico de distintas variantes de la Stx. El tratamiento consiste en fragmentos F(ab')2 provenientes de un antisuero equino cuya eficacia y potencia contra Stx1 y Stx2 se comprobó en diferentes modelos preclínicos. El producto mostró ser seguro en animales, presentó la farmacocinética descripta para compuestos similares y se pudo establecer una posible ventana terapéutica para su adecuada administración. En conjunto, los resultados preclínicos obtenidos validan la realización de un estudio clínico de primer uso en humanos. En dicho estudio, que se realizará en el Hospital Italiano de Buenos Aires, se analizará la seguridad y la farmacocinética del producto en voluntarios adultos sanos. Estos resultados sentarán las bases para la realización del estudio clínico fase II en pacientes pediátricos con infección por cepas de E. coli productoras de Stx.

The typical hemolytic uremic syndrome (HUS) is an orphan disease caused by Shiga toxin(Stx) -producing Escherichia coli strains and characterized by acute kidney damage, microangiopathic hemolytic anemia and low platelet count. It is endemic in Argentina, the country with the highest incidence of HUS in the world. Stx is essential for its development and therefore, HUS is considered a toxemic non-bacteremic disorder, which could be treated with antibodies. Herein we describe the development of a new treatment capable of neutralizing the toxic effect of Stx and its variants. The treatment consists of F(ab')2 fragments from an equine antiserum whose efficacy and potency against Stx1 and Stx2 were proved in different preclinical models. The product was shown to be safe in animals. Furthermore, the anti-Stx F(ab')2 pharmacokinetic was shown to be similar to that of analogous compounds and a therapeutic window for its administration was determined. Altogether, these preclinical results warrant testing in humans. The phase I clinical trial will be performed at the Hospital Italiano in Buenos Aires to evaluate the safety and pharmacokinetics of the product in healthy adult volunteers. Based on the results of this study, a phase II clinical trial will be planned in pediatric patients diagnosed with infection by Stx-producing E. coli strains.

Nanocristais de hidroximetilnitrofural: preparação, caracterização fí­sico-quí­mica, avaliação da atividade in vitro antileishmania / Hydroxymethylnitrofurazone nanocrystals: optimization, characterization, leishmanicidal activity evaluation

De acordo com a Organização Mundial de Saúde, existem atualmente 17 doenças tropicais negligenciadas prevalentes em 149 países, afetando aproximadamente um bilhão de pessoas, a nível global. A leishmaniose, problema de saúde prevalente nos países em desenvolvimento, é endêmica em aproximadamente 98 países e territórios, com 350 milhões de pessoas em risco e 12 milhões de casos de infecção no mundo. A transmissão da doença ocorre pela picada de flebotomíneos fêmeas infectadas. Essa doença apresenta três formas principais: leishmaniose cutânea (LC), leishmaniose mucocutânea (LMC) e leishmaniose visceral (LV). Enquanto a leishmaniose cutânea é a forma mais comum da doença, a leishmaniose visceral é a mais grave e pode ser fatal se não for tratada. Em 2016, o Brasil reportou 3.626 e 12.690 casos de LC e LV, respectivamente. O candidato a fármaco hidroximetilnitrofural (NFOH) mostrou atividade contra o parasita da doença de chagas e da leishmaniose. Embora o NFOH seja promissor para o tratamento da leishmaniose, esse possui baixa solubilidade em água. A nanotecnologia tem sido empregada como plataforma para o desenvolvimento de formas farmacêuticas inovadoras com maior eficácia e segurança. A redução do tamanho de partículas em escala nanométrica permite aumentar a biodisponibilidade oral de fármacos pouco solúveis em água. Os nanocristais apresentam vantagens, tais como, o aumento da solubilidade de saturação e da velocidade de dissolução, decorrentes do aumento da área superficial da partícula. Além disso, esses apresentam maior adesividade às membranas biológicas, membrana celular e superfície do trato gastrointestinal. No presente trabalho utilizou-se a moagem por via úmida em escala reduzida para a obtenção dos nanocristais de NFOH. Diferentes tensoativos foram avaliados empregando o método selecionado, os tensoativos poloxamer 188 e poloxamer 407 foram os que favoreceram a redução do tamanho das partículas. Tal característica foi observada na caracterização físico-química das nanosuspensões de NFOH. A utilização desse método permitiu a obtenção de nanocristais de NFOH, com diâmetro hidrodinâmico médio (DHM) de 184,8 ± 0,5 a 325,9 ± 2,2 nm, índice de polidispersão (IP) de 0,21 ± 0,01 a 0,57 ± 0,01 e DHM de 191,3 ± 2,1 a 326,8 ± 4,6 nm e IP de 0,21 ± 0,01 a 0,50 ± 0,01, respectivamente para o poloxamer 188 e 407. O uso de ambos os tensoativos resultaram em distribuição monomodal de tamanho das partículas. As formulações foram obtidas por meio de planejamento fatorial completo e experimentos por superfície de resposta tendo como variáreis independentes as concentrações de NFOH, dos tensoativos e o tempo de moagem. A resposta, DHM, foi determinada utilizando espalhamento de luz dinâmica (DLS). Adicionalmente, as avaliações empregando calorimetria exploratória diferencial (DSC) e difração de raio X (DRX) revelaram que não houve interação entre o fármaco e os excipientes, assim como, não foi observada alteração na estrutura cristalina do NFOH. A microscopia eletrônica de varredura demonstrou a morfologia característica do estado cristalino. Além disso, a preparação liofilizada apresentou instabilidade após armazenamento por três meses a temperatura de 25 e 4 °C

According to the World Health Organization, there are currently 17 neglected tropical diseases prevalent in 149 countries, affecting approximately one billion people globally. Leishmaniasis, a health problem prevalent in developing countries, is endemic in approximately 98 countries and territories, with 350 million people at risk and 12 million cases of infection worldwide. The transmission of the disease occurs by the bite of infected female sandflies. This disease has three main forms: cutaneous leishmaniasis (CL), mucocutaneous leishmaniasis (MCL) and visceral leishmaniasis (VL). While cutaneous leishmaniasis is the most usual form of the disease, visceral leishmaniasis is the most serious and can be fatal if left untreated. In 2016, Brazil reported 3.626 and 12.690 cases of LC and LV, respectively. The drug candidate for hydroxymethylnitrofurazone (NFOH) showed activity against the parasite of chagas disease and leishmaniasis. Although NFOH is promising for the treatment of leishmaniasis, it has low solubility in water. Nanotechnology has been used as a platform for the development of innovative pharmaceutical forms with greater effectiveness and safety. Particle size reduction on the nanoscale enables the oral bioavailability of poorly water-soluble drugs to be increased. Nanotechnology has been used as a platform for the development of innovative pharmaceutical forms, improving effectiveness and safety. Particle size reduction on the nanoscale enables the oral bioavailability of poorly water-soluble drugs to be increased. Nanocrystals have advantages such as increased saturation solubility and dissolution rate due to the increase in the surface area of the particle. In addition, this present greater adhesiveness to the biological membranes, cell membrane and surface of the gastrointestinal tract. In the present work, wet scale milling was used to obtain NFOH nanocrystals. Different surfactants were evaluated using the selected method, poloxamer 188 and poloxamer 407 surfactants favored the reduction of particle size. This characteristic was observed in the physical-chemical characterization of NFOH nanosuspensions. The use of NFOH nanocrystals with a mean hydrodynamic diameter (DHM) of 184.8 ± 0.5 to 325.9 ± 2.2 nm, polydispersity index (IP) of 0.21 ± 0, 01 to 0.57 ± 0.01 for poloxamer 188 and DHM of 191.3 ± 2.1 at 326.8 ± 4.6 nm and IP of 0.21 ± 0.01 at 0.50 ± 0.01 for poloxamer 407, both with monomodal size distribution. The formulations were obtained by means of complete factorial planning and surface response experiments having as independent variables the concentrations of NFOH, surfactants and milling time. The response, DHM, was determined using dynamic light scattering (DLS). In addition, evaluations using differential scanning calorimetry (DSC) and X-ray diffraction (DRX) revealed that there was no change in the crystal structure of NFOH and interaction between the drug and the excipients. Scanning electron microscopy demonstrated the characteristic morphology of the crystalline state. In addition, the lyophilized preparation was instable after storage for three months at 25 and 4 ° C

Ethical issues on the "synthetic" phosphoethanolamine clinical trial / Questões éticas sobre o ensaio clínico da fosfoetanolamina "sintética"

Summary Notwithstanding its approval by the National Committee for Ethics in Research (Conep) on April 19, 2016, a trial of the so-called "synthetic" phosphoethanolamine (syn-phospho) pill in cancer patients raises ethical concerns. An analysis by a laboratory contracted by the Ministry of Science, Technology and Innovation (MCTI) revealed that syn-phospho contained a great amount of impurities and did not meet standards of pharmaceutical quality required for an investigational drug. Cytotoxicity against human tumor cell lines and in vivo rodent xenograft tumor assays consistently failed to demonstrate a potential anticancer activity of syn-phospho. Preclinical safety studies of syn-phospho were also insufficient to support a trial of this investigational drug in cancer patients. Moreover, the ethical approval decision apparently overlooked two previous findings that suggested a possible enhancement of mammary carcinoma cell proliferation by phosphoethanolamine, and an apparent increase in lung metastases (rat implanted tumor assay) by syn-phospho. The syn-phospho risk-benefit ratio is clearly unfavorable and, thus, this trial in cancer patients does not fulfill a key requirement to make a clinical research ethical. There are also concerns regarding whether the study design is robust enough (scientific validity), and the social value of the trial of syn-phospho in cancer patients is questionable.

Resumo Não obstante a sua aprovação pela Comissão Nacional de Ética em Pesquisa (Conep) em 19 de abril de 2016, um ensaio da pílula de fosfoetanolamina "sintética" (sin-fosfo) em pacientes com câncer levanta preocupações éticas. Uma análise feita por um laboratório contratado pelo Ministério da Ciência, Tecnologia e Inovação (MCTI) revelou que a sin-fosfo continha grande quantidade de impurezas e não satisfazia os padrões de qualidade farmacêutica exigidos para um medicamento experimental. Os ensaios de citotoxicidade com linhagens de células originárias de tumores humanos e testes in vivo em roedores com tumores xeno-enxertados falharam consistentemente em demonstrar uma potencial atividade anticâncer da sin-fosfo. Os estudos pré-clínicos de segurança da sin-fosfo também foram insuficientes para apoiar a realização de um ensaio desse medicamento experimental em pacientes com câncer. Além disso, a aprovação ética aparentemente desconsiderou dois achados anteriores, sugerindo uma possível exacerbação da proliferação de células de carcinoma de mama pela fosfoetanolamina, e um aparente aumento de metástases pulmonares (ensaio de tumores implantados em ratos) pela sin-fosfo. A relação risco-benefício é claramente desfavorável para a sin-fosfo e, portanto, esse ensaio em pacientes com câncer não atende um requisito essencial para que uma pesquisa clínica seja ética. Há também preocupações quanto ao delineamento do estudo ser suficientemente robusto (validade interna), e o valor social do ensaio da sin-fosfo em pacientes com câncer é questionável.

Declaración de la Academia Chilena de Medicina sobre el Título V de la Ley 20. 850 (Ley Ricarte Soto) y su proyecto de reglamento "De los ensayos clínicos de productos farmacéuticos y elementos de uso médico" / Declaration of the Chilean Academy of Medicine of Law 20. 850 "On clinical trials of pharmaceutical products and medical devices" and of the bylaw that will regulate its application

In Chile, high cost treatments required by selected medical conditions are financed by the State, according to Law 20.850. A bylaw under discussion by the Senate regulates clinical trials, posing complex issues that will endanger local interest in front-line research: 1) The exclusive and mandatory control bestowed to the Institute of Public Health during all stages of the trials and also the surveillance of institutions performing clinical trials, overriding their Clinical Research Review Boards; 2) The 10 year period during which any adverse event is assumed to have been caused by the medication or devise evaluated by the trial, unless the contrary is proven in a judicial process; 3) Individuals submitted to the trials are entitled to free post trial access to the treatment received during the study, financed by the trial supporting entities and as long as the drug or devise is considered to be useful. While agreeing with the need to have a National Registry of Clinical Trials, we predict that the mentioned critical issues in the bylaw will lead to difficulties and unnecessary judicial processes, thus limiting clinicians’ interest in performing research. We propose to modify the bylaw, excluding responsibilities on events associated with the natural evolution of the medical condition, with patients’ ageing or with comorbidities and clinical events considered unpredictable when the protocol was accepted. We recommend that the free post trial access should be a joint decision involving the patient and the attending physician, taking in consideration that the volunteer has been exposed to risks and burdens, or when discontinuation of treatment entails a vital risk until the treatment under study has been approved and becomes available in the national market.

En Chile los tratamientos de alto costo requeridos por seleccionadas condiciones médicas son financiados por el Estado, de acuerdo a la Ley 20.85, que se hizo efectiva en noviembre de 2015. Un reglamento de esta ley -actualmente en discusión por el Senado- incluye la regulación de los ensayos clínicos y plantea importantes aspectos que van a poner en riesgo la realización de investigaciones clínicas avanzadas: 1) El control exclusivo y mandatorio otorgado al Instituto de Salud Pública durante todas las etapas de los ensayos y la vigilancia de las instituciones que los realizan, que sobrepasa las atribuciones de los Comités de Ética Científica Institucionales; 2) El período de hasta 10 años después de la aparición de cualquier efecto adverso, durante el cual se asume causado por el medicamento o dispositivo evaluado en el ensayo, mientras no se demuestre lo contrario en un proceso judicial; 3) Los participantes de los estudios tienen derecho a continuar con el tratamiento recibido durante el estudio una vez terminado este, financiado por las entidades que patrocinan los estudios y mientras el fármaco o dispositivo se consideren útil. Estamos de acuerdo con la necesidad de contar con un Registro Nacional de Ensayos Clínicos. Sin embargo, predecimos que los aspectos críticos del reglamento causarán dificultades y procesos judiciales innecesarios, lo que limitará el interés de los clínicos en realizar investigación. Proponemos que el reglamento debe modificarse a fin de excluir responsabilidades sobre eventos asociados con la evolución natural de la condición clínica, el envejecimiento del paciente, comorbilidades y eventos clínicos no predecibles cuando se aceptó el estudio. Recomendamos que el acceso gratuito posterior al estudio debe constituir una decisión conjunta del paciente y su médico tratante, considerando los riesgos y la carga a que se expuso el paciente, o al riesgo vital secundario a la suspensión del tratamiento del estudio mientras no esté disponible en el mercado nacional.

A "miracle" cancer drug in the era of social media: A survey of Brazilian oncologists' opinions and experience with phosphoethanolamine / Uma "milagrosa" droga contra o câncer na era da mídia social: uma pesquisa sobre a opinião e a experiência dos oncologistas brasileiros com a fosfoetanolamina

Summary Introduction: Patients who are treating cancer have often used alternative therapies. In the internet era, information can be broadcasted widely, and this happened with phosphoethanolamine in Brazil, where this substance was claimed by the population to be the "cure for cancer." Method: This is a cross-sectional study developed by the Brazilian Society of Clinical Oncology (SBOC). An objectively structured questionnaire was sent by e-mail and SMS to active MDs members of the SBOC. Descriptive statistics was used to evaluate the data. Statistical significance between the variables was tested by Pearson's Chi-squared test (p<0.05 was considered significance). Results: The survey was sent to 1,072 oncologists, and 398 (37.1%) answered at least part of it. One hundred and fifteen (28.9%) had followed patients who had used phosphoethanolamine. Among these, 14 (12.2%) observed adverse events and four (3.5%) attributed clinical benefit to the substance. Most of the oncologists (n=331; 83.2%) believe that it should only be used as part of a clinical trial protocol. Most physicians did not recommend this drug to their patients (n=311; 78.1%). Oncologists in Southeast, South and Midwest Brazil were more likely to have patients taking the drug compared to the Northern and Northeastern regions. Conclusion: This is the first survey to assess the opinion and experience of oncologists about this alternative therapy. Most oncologists in Brazil do not believe that synthetic phosphoethanolamine is active in cancer treatment, do not recommend its use without proper evaluation, and state that it should only be available to patients in the context of clinical trials.

Resumo Introdução: Alguns pacientes com diagnóstico de câncer utilizam terapias alternativas. Na era da internet, as informações podem se dissipar de forma rápida e abrangente, como foi o caso da fosfoetanolamina no Brasil, onde foi aclamada pela população como sendo a "cura para o câncer". Método: Trata-se de um estudo transversal desenvolvido pela Sociedade Brasileira de Oncologia Clínica (SBOC). Através de e-mail e SMS, enviou-se um questionário com perguntas objetivas para oncologistas membros ativos da SBOC. Os dados foram avaliados por meio de estatística descritiva. A significância estatística entre as variáveis ​​foi testada pelo teste Qui-quadrado de Pearson (p<0,05 foi considerado significativo). Resultados: O questionário foi enviado para 1.072 oncologistas, tendo 398 (37,1%) respondido pelo menos parte dele. Cento e quinze (28,9%) tinham pacientes que fizeram uso da fosfoetanolamina. Desses, 14 (12,2%) observaram eventos adversos e quatro (3,5%) atribuíram benefício clínico para a substância. A maioria (n=331; 83,2%) acreditava que ela só deveria ser utilizada dentro de um ensaio clínico. A principal recomendação dada aos pacientes foi contra o seu uso (n=311; 78,1%). Oncologistas das regiões Sudeste, Sul e Centro-Oeste tiveram mais pacientes que tomaram a substância quando comparados com as regiões Norte e Nordeste. Conclusão: Este é o primeiro estudo que avalia a opinião dos oncologistas sobre essa terapia alternativa e sua experiência. A maioria dos oncologistas brasileiros não acredita que a fosfoetanolamina sintética seja ativa no tratamento do câncer, não recomendando seu uso sem avaliação adequada, e afirmam que a substância só deve estar disponível no contexto de ensaios clínicos.

Advances in the diagnosis and control of lymphomas / Avances en el diagnóstico y control de linfomas

Abstract Lymphoproliferative disorders have increased in last decades. Immunohistochemistry analysis is required to categorize them in different clinical entities, as has been stablished by WHO. Advances in imaging have set the PET-CT as a standard staging procedure in most cases. Knowledge of the biology of these malignancies has allowed therapeutic advances with different approaches, including development of monoclonal antibodies, conjugated antibodies, immunomodulatory agents, as well as inhibition of specific pathways. Although new drugs are promising, the cost-benefit impact requires to be evaluated in pharmacoeconomic clinical trials.

Resumen Los padecimientos linfoproliferativos han incrementado en las últimas décadas. Es fundamental la evaluación con inmunohistoquímica para clasificarlos en las diferentes entidades que establece la clasificación de la OMS. Los avances en técnicas de imagen han colocado al PET-CT como un procedimiento de estadificación estándar. El conocimiento de la biología de estas neoplasias ha permitido avances terapéuticos con el desarrollo de anticuerpos monoclonales solos o conjugados, como agentes inmunomoduladores, así como a través de la inhibición de vías específicas. Aun cuando los resultados con estos nuevos fármacos son promisorios, el impacto costo-beneficio requiere evaluarse en estudios prospectivos con análisis farmacoeconómico.

Non-clinical studies in the process of new drug development - Part II: Good laboratory practice, metabolism, pharmacokinetics, safety and dose translation to clinical studies

The process of drug development involves non-clinical and clinical studies. Non-clinical studies are conducted using different protocols including animal studies, which mostly follow the Good Laboratory Practice (GLP) regulations. During the early pre-clinical development process, also known as Go/No-Go decision, a drug candidate needs to pass through several steps, such as determination of drug availability (studies on pharmacokinetics), absorption, distribution, metabolism and elimination (ADME) and preliminary studies that aim to investigate the candidate safety including genotoxicity, mutagenicity, safety pharmacology and general toxicology. These preliminary studies generally do not need to comply with GLP regulations. These studies aim at investigating the drug safety to obtain the first information about its tolerability in different systems that are relevant for further decisions. There are, however, other studies that should be performed according to GLP standards and are mandatory for the safe exposure to humans, such as repeated dose toxicity, genotoxicity and safety pharmacology. These studies must be conducted before the Investigational New Drug (IND) application. The package of non-clinical studies should cover all information needed for the safe transposition of drugs from animals to humans, generally based on the non-observed adverse effect level (NOAEL) obtained from general toxicity studies. After IND approval, other GLP experiments for the evaluation of chronic toxicity, reproductive and developmental toxicity, carcinogenicity and genotoxicity, are carried out during the clinical phase of development. However, the necessity of performing such studies depends on the new drug clinical application purpose.

Novos anticoagulantes orais (NOACs) na prevenção de acidente vascular encefálico (AVE) e fenômenos tromboembólicos em pacientes com fibrilação atrial / New oral anticoagulants (NOACs) in prevention of stroke brain and thromboembolic events in patients with atrial fibrillation

JUSTIFICATIVA E OBJETIVOS: Pacientes com fibrilação atrial (FA) estão mais propensos à ocorrência de eventos vasculares, como acidente vascular encefálico (AVE) e fenômenos tromboembólicos, sendo necessária anticoagulação oral. A varfarina, o anticoagulante mais utilizado, tem uma série de limitações referentes ao seu uso. Nesse contexto, foram desenvolvidos novos anticoagulantes orais (NOACs): inibidores da trombina (dabigatrana) e do fator Xa (rivaroxabana e apixabana). Essa revisão sistemática procurou elencar os principais resultados de Ensaios Clínicos Randomizados (ECRs) abordando o tema NOACs em pacientes com fibrilação atrial para a prevenção de acidente vascular encefálico e/ou fenômenos tromboembólicos. CONTEÚDO: Foram pesquisados Ensaios Clínicos Randomizados, cegos ou abertos, em indivíduos adultos, nas bases PubMed, Scopus, Web of Science, SciELO, LILACS e Cochrane CENTRAL. A avaliação da qualidade dos estudos foi feita utilizando a escala Downs & Black. Foram selecionados cinco Ensaios Clínicos Randomizados e descritos os seus resultados. A rivaroxabana se mostrou não inferior a varfarina no que diz respeito ao desfecho combinado embolismo sistêmico e acidente vascular encefálico, enquanto que a apixabana e a dabigatrana 150mg mostraram-se superiores. Todos os três medicamentos estiveram associados a menor incidência de hemorragia intracraniana quando comparado a varfarina. A apixabana mostrou perfil mais favorável em relação à ocorrência de qualquer sangramento. CONCLUSÕES: os Ensaios Clínicos Randomizados selecionados demonstraram a eficácia dos NOACs na prevenção de acidente vascular encefálicos e/ou embolismo sistêmico em pacientes com fibrilçao atrial. Contudo, são necessários mais estudos para preencher as lacunas do conhecimento quanto à eficácia e segurança desta nova classe de anticoagulantes orais.

BACKGROUND AND OBJECTIVES: Patients with atrial fibrillation (AF) are more likely to the occurrence of vascular events including stroke and thromboembolism systemic. Thus anticoagulation is necessary to prevent these events. Warfarin is the current gold standard but has a number of limitations regarding your use. In this context, new oral anticoagulants (NOACs) were developed: thrombin inhibitors (dabigatran) and factor Xa inhibitors (rivaroxaban and apixaban). The aim of this systematic review was to analyze the results of the main randomized clinical trials (RCTs) envolving NOACs in patients with atrial fibrillation for the prevention of stroke and/or thromboembolic events. CONTENTS: Double blinded or open label randomized clinical trials envolving patients with FA testing these drugs were researched in PubMed, Scopus, Web of Science, SciELO, LILACS and Cochrane CENTRAL. The quality assessment of studies used the Downs & Black Scale Five randomized clinical trials were selected, envolving 57.457 patients. Dabigatran, apixaban and rivaroxaban were at least non inferior to the warfarin in the outcome of stroke and systemic embolism. Apixaban and dabigatran 150mg were also superior than warfarin in efficacy. All three drugs were associated with a lower incidence of intracranial hemorrhage. Apixaban was related to lower risk of total bleeding. CONCLUSIONS: NOACs have efficacy to prevent AVE and systemic thromboembolism in patients with FA. However further studies are needed to resolve the issues that remain open and to provide more security to the use of these drugs in clinical practice.

Prescripción de Medicaciones no aprobadas (off label y sin licencia) en Recién Nacidos hospitalizados. Estudio multicéntrico en cinco hospitales de Asunción y Gran Asunción / Prescription of Off-label and Unlicensed Drugs in Hospitalized Newborns: a Multicenter Study in Five Hospitals in Greater Asuncion, Paraguay

Introducción: La falta de suficientes estudios clínicos sobre la eficacia y seguridad de las medicaciones en la población neonatal, conduce a la utilización de alternativas con medicaciones no aprobadas. Objetivos: Determinar la prevalencia de la utilización de medicaciones no aprobadas por la Food and Drug Administration (EEUU) en los neonatos hospitalizados en diferentes niveles de atención de cinco hospitales de Asunción y Gran Asunción. Metodología: Estudio observacional, descriptivo con componente analítico, transversal. Se incluyeron recién nacidos de las salas de terapia intensiva, intermedia y cuidados mínimos de cinco hospitales. Variables: Peso de nacimiento, edad gestacional, sexo, vía del parto, edad postnatal al ingreso al estudio, sala de internación, asistencia respiratoria mecánica y tipo y número de medicaciones no aprobadas (MNA) por paciente en el momento de llenarse el cuestionario. Los datos fueron cargados y analizados en SPSS 17 y se expresaron en proporciones y medias. Se utilizó la prueba de chi cuadrado y se consideró un error alfa del 5%. Resultados: Se analizaron 105 pacientes con edad postnatal al ingreso al estudio de 12±8 días y 11±8 días de hospitalización. Recibieron MNA 41 neonatos (39%) con 92 prescripciones no autorizadas, en mayor proporción en la unidad de terapia intensiva (49%), con respecto a las salas de los otros niveles (p=0,01). El número de MNA por neonato fue de 2,29±1,7 (rango1 a 8). Las MNA más frecuentemente utilizadas fueron antibióticos (42%), omeprazol y ranitidina (11%) y los corticoides (9%). Conclusiones: La prevalencia de utilización de medicaciones no aprobadas fue elevada y se demostró asociación con el uso de asistencia respiratoria mecánica y presencia de infecciones .

Introduction: The scarcity of clinicalstudies on the efficacy and safety ofmedications in newborns leads tothe use of alternative treatment using unapproved drugs...

Resistencia a antibióticos de última línea en cocos Gram positivos: la era posterior a la vancomicina / Resistance to "last resort" antibiotics in Gram-positive cocci: The post-vancomycin era

En los últimos años se han desarrollado nuevas alternativas para el tratamiento de infecciones por patógenos Gram positivos multirresistentes, entre los cuales Staphylococcus aureus resistente a la meticilina (SARM) y los enterococos resistentes a la vancomicina (ERV) se consideran un verdadero reto terapéutico, y aunque el uso de la vancomicina en infecciones graves causadas por SARM ha generado serias dudas en los últimos años, continúa siendo escasa la información clínica de respaldo al uso de agentes terapéuticos que la superen en eficacia. El linezolid, la daptomicina y la tigeciclina son agentes que tienen actividad contra los cocos Gram positivos y que fueron aprobados e introducidos en la terapia clínica en la década pasada. Además, se han probado o están en las fases finales de desarrollo otros agentes como las cefalosporinas de última generación (ceftarolina y ceftobiprol). El propósito de esta revisión fue describir las nuevas alternativas terapéuticas, particularmente en la era posterior a la vancomicina, y repasar las características químicas más relevantes de los compuestos y su espectro de actividad, haciendo énfasis en sus mecanismos de acción y resistencia.

New therapeutic alternatives have been developed in the last years for the treatment of multidrug-resistant Gram-positive infections. Infections caused by methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE) are considered a therapeutic challenge due to failures and lack of reliable antimicrobial options. Despite concerns related to the use of vancomycin in the treatment of severe MRSA infections in specific clinical scenarios, there is a paucity of solid clinical evidence that support the use of alternative agents (when compared to vancomycin). Linezolid, daptomycin and tigecycline are antibiotics approved in the last decade and newer cephalosporins (such as ceftaroline and ceftobiprole) and novel glycopeptides (dalvavancin, telavancin and oritavancin) have reached clinical approval or are in the late stages of clinical development. This review focuses on discussing these newer antibiotics used in the "post-vancomycin" era with emphasis on relevant chemical characteristics, spectrum of antimicrobial activity, mechanisms of action and resistance, as well as their clinical utility.

Acceso al producto en investigación post ensayo clínico en pacientes infectados con el virus VIH naïve al tratamientoantirretroviral / Acceso al producto en post clinical ensayo investigación en con el virus infected patients naïve HIV antiretroviral al tratamiento

Objetivos. Describir las principales características del acceso al producto en investigación (terapia antirretroviral) una vez finalizado el ensayo clínico, el cual demostró ser beneficioso para los participantes con infección VIH, nunca antes tratados con terapia antirretroviral. Materiales y métodos. Se realizó un estudio retrospectivo enel cual se incluyó a población adulta peruana con infección por el VIH naïve al tratamiento antirretroviral que participó en ensayos clínicos en el periodo 1995-2012. Se recolectaron datos de las visitas de inspección realizadas a ensayos clínicos, en los cuales participaron pacientes con la infección VIH naïve al tratamiento antirretroviral, y que además describían la continuidad del tratamiento antirretroviral post ensayo clínico. Resultados. El 82,3 por cento de los sujetos iniciaron el acceso al producto en investigación, una vez concluida su participación en la investigación. 99,3 por cento de los sujetos en investigación que tuvieron acceso al producto en investigación, lo recibieron continuamente. La continuidad del producto en investigación fue dada por el patrocinador a través de estudios de extensión o de un acceso expandido por un periodo muy variable de tiempo.En la actualidad, sólo el 53,6 por cento de los sujetos continúan tratándos e con el mismo esquema antirretroviral usado durante el ensayo clínico. Conclusiones. Los patrocinadores de los ensayos clínicos no están realizando un adecuado a seguramiento del acceso al productoen investigación a este grupo de sujetos en investigación. El suministro de los fármacos antirretrovirales a estos pacientes, en la actualidad, está casi completamente realizado por el Estado Peruano, a través del programa TARGA...

Objectives. Describe the main characteristics of access to investigational product (ART)once the trial has ended, which proved to be beneficial for participants with HIV infection,never treated with antiretroviral therapy. Materials and methods. A retrospective studywhich included Peruvian adults with HIV naïve to antiretroviral therapy who participatedin clinical trials in the period 1995-2012 was performed. Data from inspection visits toclinical trials, which included patients with HIV infection in antiretroviral treatmentnaïve, and also described the continuity of antiretroviral therapy after clinical trial, werecollected. Results. 82.3 per cent of subjects initiated access to investigational product, oncetheir participation in research. 99.3 per cent of subjects in research that had access toinvestigational product received it continuously. The continuity of the investigationalproduct was given by the sponsor through studies of extension or expanded by a variableperiod of time access. Currently, only 53.6 per cent of patients continue to be treated with thesame antiretroviral scheme used during the clinical trial. Conclusions. Sponsors ofclinical trials are not doing an adequate assurance of access to investigational product inthis group of subjects in research. The provision of antiretroviral drugs to these patients,at present, is almost completely carried out by the Peruvian government, through theHAART program...

Pharmacologic Therapy for Nonalcoholic Fatty Liver Disease / 대한내과학회지

Weight loss via lifestyle modification remains the most efficient treatment for NAFLD. Weight loss and exercise are the cornerstones of therapy, but achieving long-term lifestyle modification is not free from difficulties. Pharmacologic therapy should be considered for patients with NAFLD unable to achieve or maintain lifestyle-induced weight loss. Unfortunately, there is no approved drug for NAFLD currently. Current treatment methods for NAFLD can be divided roughly into those methods that target components of metabolic syndrome using weight reduction and insulin sensitizers (pioglitazone) and those that use antioxidants (Vitamin E) to benefit the liver. Pioglitazone has been shown to improve steatosis, hepatocellular ballooning, and inflammation and also to reduce the risk of fibrosis progression in several randomized-controlled trials (RCTs). In a large RCT, large doses of vitamin E improved all histological lesions except for fibrosis. Compared with a placebo, Metformin lowered ALT, but did not improve liver histology. Recently, novel anti-diabetic agents (GLP-1 analogues, DPP IV inhibitors) and probiotics that alter the gut microbiome were shown to mildly benefit ALT and liver histology. In this report, we systemically review current pharmacologic therapies and other promising agents that were not considered in the most recent guidelines for the treatment of NAFLD.

Experimental drugs for treatment of autoimmune myocarditis / 中华医学杂志(英文版)

<p><b>OBJECTIVE</b>To review the experimental drugs for the treatment of autoimmune myocarditis.</p><p><b>DATA SOURCES</b>The literatures published in English about different kinds of experimental drugs based on different therapeutic mechanisms for the treatment of autoimmune myocarditis were obtained from PubMed from 2002 to 2013.</p><p><b>STUDY SELECTION</b>Original articles regarding the experimental drugs for treatment of autoimmune myocarditis were selected.</p><p><b>RESULTS</b>This study summarized the effects of the experimental drugs for the treatment of autoimmune myocarditis, such as immunomodulators and immunosuppressants, antibiotics, Chinese medicinal herbs, cardiovascular diseases treatment drugs, etc. These drugs can significantly attenuate autoimmune myocarditis-induced inflammation and fibrosis, alleviate autoimmune myocarditis-triggered overt lymphocyte proliferation, and meanwhile reduce Th1 cytokines (IFN-γ and IL-2) and increase Th2 cytokines (IL-4 and IL-10).</p><p><b>CONCLUSION</b>This study summarized recent advances in autoimmune myocarditis treatment and further proposes that traditional Chinese medicine and immune regulators will play important roles in the future.</p>

Closed-loop management model of clinical investigational product for new drug of traditional Chinese medicine / 中国中药杂志

This paper discussed the management regulations and technical requirements of clinical investigational product for new drug of traditional Chinese medicine, analyzed some common problems on the management of them, and proposed the establishment of closed-loop management model and management requirements in various aspects.

Desarrollo de nuevos medicamentos: oportunidades y beneficios para el Perú / Development of new drugs: opportunities and benefits for Peru

El desarrollo de drogas innovadoras permite la obtención de nuevos medicamentos para así prevenir y tratar mejor las enfermedades, ello mejora la calidad de vida y la hace más productiva; por tanto, la misión de la investigación farmacéutica es desarrollar drogas seguras y eficaces. Los ensayos clínicos permiten evaluar los perfiles de seguridad y eficacia de nuevos medicamentos, dispositivos médicos y pruebas diagnósticas. La investigación y el desarrollo de nuevas drogas es un proceso largo y costoso en donde por cada 5000 a 10 000 nuevos compuestos que ingresan a las pruebas preclínicas, solo uno es aprobado. En la actualidad, el desarrollo de drogas muestra un crecimiento de 7,6% con respecto al 2011. Según ClinicalTrials.gov, el 5% de los ensayos se implementan en Latinoamérica, en donde, Perú ocupa el quinto lugar, con un descenso de estudios aprobados desde el año 2009. De otro lado, según el Reporte Global de Competitividad del Foro Económico Mundial, Perú ocupa el puesto 61 con retos principalmente en el funcionamiento de sus instituciones públicas, inversión en I&D y capacidad tecnológica. La complejidad de la I&D de medicamentos explica la búsqueda de locaciones competitivas para el desarrollo de estudios clínicos. La Investigación Clínica es una industria humanizada por su plataforma ética enunciada en las guías de buenas prácticas clínicas, y que exige de nuestro país desarrollar un valor diferenciador que contribuya con el desarrollo de conocimiento y su competitividad.

The development of innovative drugs allows coming up with new medicines to prevent and better treat illnesses. This improves people´s quality of life and makes it more productive. Therefore, the mission of pharmaceutical research is to develop safe and effective drugs. Clinical trials allow the evaluation of the safety and efficacy profiles of new medicines, medical devices and diagnostic tests. Research and development (R&D) of new drugs is a long and costly process, where out of every 5000 to 10000 new components that enter preclinical testing, only one is approved. Compared to 2011, drug development has increased by 7.6%. According to ClinicalTrials.gov, 5% of the trials take place in Latin America, and Peru is in the fifth position. On the other hand, according to the Global Competitiveness Report issued by the World Economic Forum, Peru ranks 61st, its biggest challenges being the functioning of its public institutions, investment in R&D and technological capacity. The complexity of drug R&D results in a search for competitive places to develop clinical trials. Clinical Research is a humanized industry due to its ethical platform, stated in the guidelines of good clinical practices. This industry demands our country to develop a differentiating value that contributes to the development of knowledge and its competitiveness.