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2.
Arch. argent. pediatr ; 119(4): e360-e363, agosto 2021. tab
Article in Spanish | LILACS, BINACIS | ID: biblio-1281901

ABSTRACT

La infección por virus de la hepatitis C en pediatría se produce principalmente por transmisión vertical. La historia natural en niños consiste en alta tasa de eliminación espontánea, infección asintomática o cambios histológicos mínimos. Las complicaciones suelen observarse en la adolescencia o en la edad adulta. El tratamiento clásico con interferón pegilado y ribavirina presenta efectos adversos, es de duración prolongada y logra una respuesta virológica sostenida (RVS) en el 50 % de los pacientes con infección por genotipo 1. Los nuevos antivirales de acción directa se encuentran disponibles para su indicación a partir de los 12 años, con excelente tolerancia y alta tasa de RVS. Se sugiere conducta terapéutica expectante en pacientes asintomáticos hasta acceder a la medicación. Reportamos el caso de un adolescente con hepatitis C crónica sin cirrosis que recibió tratamiento durante 12 semanas con ledipasvir/sofosbuvir y se logró una RVS.


Hepatitis C virus infection in children occurs mainly through vertical transmission. The natural history at this age consists in a high rate of spontaneous clearance, asymptomatic infection, or minimal histological changes. Disease complications are commonly seen in adolescence or adulthood. The classic treatment with pegylated interferon and ribavirin presents adverse effects, prolonged duration and achieves sustained viral response (SVR) in 50 % of patients with genotype 1 infection (the most frequent). New direct-acting antiviral treatments have been available in recent years for their indication from 12 years of age with excellent tolerance and a high SVR rate. Expectant therapeutic behavior is suggested in asymptomatic patients until they can access to them. We report the case of an adolescent with chronic hepatitis C without cirrhosis who received 12 weeks treatment with ledipasvir/sofosbuvir, achieving SVR.


Subject(s)
Humans , Male , Adolescent , Antiviral Agents/therapeutic use , Benzimidazoles/therapeutic use , Hepatitis C, Chronic/drug therapy , Fluorenes/therapeutic use , Sofosbuvir/therapeutic use , Sustained Virologic Response
3.
Brasília; CONITEC; ago. 2021.
Non-conventional in Portuguese | LILACS, BRISA | ID: biblio-1291826

ABSTRACT

INTRODUÇÃO: No dia 12 de março de 2021 a ANVISA concedeu o registro para comercialização de rendesivir no Brasil como primeiro e único medicamento com indicação aprovada em bula, para tratamento de pacientes com COVID-19 com pneumonia e necessidade de suplementação de oxigênio (baixo ou alto fluxo e ventilação mecânica não invasiva). A autorização fornecida pela ANVISA para uso do medicamento no Brasil, diverge da recomendação da OMS que desaconselha o uso do rendesivir para tratamento de pacientes hospitalizados por COVID-19, independente de sua gravidade usando como base os resultados interinos do estudo Solidarity (14). Este estudo revelou que o uso do rendesivir, assim como outros antivirais analisados, não foi capaz de reduzir de forma significativa a mortalidade geral ou de nenhum subgrupo estudado, nem retardar o início da ventilação mecânica ou reduzir o tempo de hospitalização. A redução do tempo de internação para a ANVISA foi um critério importante para o contexto brasileiro devido a constante falta de leitos disponíveis para o tratamento dos pacientes acometidos pela COVID-19. DEMANDANTE: Gilead Sciences Farmacêutica Brasil Ltda. PERGUNTA: O uso do rendesivir é eficaz e seguro para tratamento de pacientes hospitalizados com COVID-19 e que necessitam de suplementação de oxigênio (de baixo ou alto fluxo e ventilação mecânica não invasiva)? EVIDÊNCIAS CLÍNICAS: As evidências avaliadas baseiam-se em quatro ensaios clínicos randomizados, onde dois compararam rendesivir com placebo e outros dois comparando rendesivir com cuidado padrão. Foram obtidos resultados favoráveis ao rendesivir com maior probabilidade de recuperação no 29º dia (Hazard Ratio [HR] 1,29, 95%IC 1,12-1,49, p<0,001) em um dos estudos. Para o desfecho mortalidade no 29º dia, os resultados do mesmo ensaio foram significativos apenas para o subgrupo de pacientes que necessitavam de suplementação de oxigênio de baixo ou alto fluxo (HR = 0,30, 95%IC 0,14- 0,64). Ao sumarizar os dados dos quatro estudos observou-se que em pacientes hospitalizados com COVID-19, o uso do rendesivir comparado com o grupo controle não resultou em diferenças estatisticamente significativas tanto quanto os desfechos de mortalidade (Risco Relativo [RR]: 0,98, 95%IC 0,84-1,14); necessidade de ventilação mecânica (RR: 0,77, 95%IC 0,48-1,22) e recuperação (RR: 1,09, 95%IC 1,03-1,15), segundo três estudos. O rendesivir comparado com placebo e cuidado padrão pode reduzir em 25% o risco da ocorrência de eventos adversos sérios (RR: 0,75, 95%IC 0,63-0,90). AVALIAÇÃO ECONÔMICA: Os resultados do modelo econômico apresentado pelo demandante têm limitações que tornam incertos os resultados do modelo econômico apresentado, de forma que a sua utilização para tomada de decisão sobre a tecnologia é duvidosa. ANÁLISE DE IMPACTO ORÇAMENTÁRIO: O impacto orçamentário incremental após a proposta de redução de preço pelo demandante foi estimado em aproximadamente 28 bilhões de reais, como melhor cenário. MONITORAMENTO DO HORIZONTE TECNOLÓGICO: Foram identificadas oito tecnologias potenciais para a indicação clínica. O opaganib consiste no primeiro agente de uma nova classe farmacológica, a dos inibidores de esfingosina-quinases. Outro potencial medicamento para a indicação a ser administrado por via oral e em combinação ao cuidado padrão (não especificado no protocolo do estudo), é o fostamatinib. O reparixin é um análogo do ibuprofeno e sua eficácia para o tratamento de pacientes com pneumonia grave acometidos por COVID-19 está sendo avaliada. O BDB-001 e o ravulizumab têm como alvo farmacológico o fator C5a do sistema complemento. Os anticorpos monoclonais canaquinumab, mavrilimumab e tocilizumabe também estão em desenvolvimento. Além disso, foram identificados três depósitos de patentes relacionados ao rendesivir no Instituto Nacional da Propriedade Intelectual. CONSIDERAÇÕES FINAIS: O balanço entre os aspectos positivos e negativos do rendesivir foi desfavorável ao seu uso no tratamento de pacientes com COVID-19. Apesar do baixo risco de eventos adversos, houve uma baixa confiança na eficácia do medicamento, uma vez que os resultados dos estudos são discrepantes e baseados em uma análise de subgrupo de apenas um estudo. O impacto orçamentário estimado foi considerado elevado. RECOMENDAÇÃO PRELIMINAR DA CONITEC: Diante do exposto, a Conitec, em sua 98ª Reunião Ordinária, realizada no dia 10 de junho de 2021, deliberou que a matéria fosse disponibilizada em consulta pública com recomendação preliminar desfavorável à incorporação no SUS do rendesivir para o tratamento da doença causada pelo coronavírus 2019 (COVID19), em pacientes adultos com pneumonia que requerem suplementação de oxigênio de baixo ou alto fluxo. Foi discutido, emplenária, que a evidência disponívelsobre a tecnologia emavaliação foi baseada emestudos adaptativos heterogêneos, com importantes limitações metodológicas, que podem se traduzir em resultados devidos apenas ao acaso. Além disso, o perfil de segurança do rendesivir, quando comparado aos medicamentos de cuidado padrão, mostrou que o medicamento está associado a um risco aumentado de bradicardia em pacientes diagnosticados com COVID-19. CONSULTA PÚBLICA: Foram recebidas 90 contribuições, sendo 34 contribuições técnico-científicas e 56 de experiência e opinião. Diante das argumentações apresentadas, o plenário da Conitec entendeu que não houve argumentação suficiente para mudança de entendimento acerca de sua recomendação preliminar, com base nas evidências científicas apresentadas, tampouco na redução de preço proposta pelo fabricante. Desse modo, a Comissão, diante das incertezas quanto à eficácia do medicamento, manteve a posição desfavorável à incorporação do rendesivir para o tratamento dos pacientes hospitalizados com pneumonia provocada pelo COVID-19 com necessidade de suplementação de oxigênio. DELIBERAÇÃO FINAL: O Plenário da Conitec, em sua 100ª Reunião Ordinária, no dia 05 de agosto de 2021, deliberou por unanimidade recomendar a não incorporação do rendesivir para o tratamento de pacientes com COVID-19 com necessidade de suplementação de oxigênio (baixo ou alto fluxo, ventilação não invasiva) no âmbito do SUS, com base nas incertezas quanto à eficácia do medicamento. Foi assinado o Registro de Deliberaçã nº 651/2021. DECISÃO: Não incorporar o rendesivir para tratamento de pacientes com Covid-19 hospitalizados com pneumonia e necessidade de suplementação de oxigênio, no âmbito do Sistema Único de Saúde ­ SUS, conforme a Portaria nº 60, publicada no Diário Oficial da União nº 171, seção 1, página 77, em 9 de setembro de 2021.


Subject(s)
Humans , Antiviral Agents/therapeutic use , Respiration, Artificial , SARS-CoV-2/drug effects , COVID-19/drug therapy , Unified Health System , Brazil , Cost-Benefit Analysis
4.
Medicina (B.Aires) ; 81(2): 252-256, June 2021. graf
Article in English | LILACS | ID: biblio-1287277

ABSTRACT

Abstract The clinical management of hepatitis C virus (HCV) infection presents several challenges today. WHO's goal is to eliminate it by 2030. It is an ambitious goal and difficult to meet given the barriers to care that arise. This is possible today thanks to the discovery of direct-acting antivirals (DAAs). This treatment achieves a high cure rate and is virtually free of adverse effects. To try to comply with this, in addition to the use of DAAs, it is necessary to reduce the rate of undiagnosed patients and facilitate the access of those diagnosed to care and treatment. For that, it is proposed to carry out a simplified treatment of HCV. This involves reducing controls during and after treatment. This simplification varies according to whether patients have cirrhosis or not. In this way, it seeks to increase significantly the number of patients treated and cured to reduce the burden on public health of this disease.


Resumen El manejo clínico de la infección por el virus la hepatitis C (HCV) presenta varios desafíos en la actualidad. El objetivo de la OMS es eliminarlo para el 2030. Es un objetivo ambicioso y muy difícil de cumplir dadas las barreras al cuidado que se presentan. Sin embargo, esto es posible hoy gracias al descubrimiento de los antivirales de acción directa (AAD). Este tratamiento logra una alta tasa de curación y prácticamente está libre de efectos adversos. Para tratar de cumplirlo, además del uso de los AAD, es nece sario reducir la tasa de pacientes no diagnosticados y facilitar el acceso de los diagnosticados al cuidado y el tratamiento. Para eso se propone llevar adelante el tratamiento simplificado del HCV. Esto implica reducir los controles durante y después del tratamiento. Esta simplificación varía según los pacientes tengan o no cirrosis. De esta manera se busca aumentar significativamente el número de pacientes tratados y curados para así poder reducir el impacto en la salud pública de esta enfermedad.


Subject(s)
Humans , Hepatitis C/drug therapy , Hepatitis C, Chronic/drug therapy , Antiviral Agents/therapeutic use , Hepacivirus , Liver Cirrhosis
5.
Arch. argent. pediatr ; 119(3): 208-212, Junio 2021. tab, ilus
Article in English, Spanish | LILACS, BINACIS | ID: biblio-1223006

ABSTRACT

La infección crónica con el virus C de la hepatitis constituye un problema de salud a nivel mundial, tanto en niños como en adultos. Su eliminación espontánea puede ocurrir durante la infancia temprana, y luego es infrecuente. Aunque la mayoría de los casos son asintomáticos en la infancia y adolescencia, al llegar a la edad adulta, los pacientes pueden evolucionar a la cirrosis y presentar complicaciones, que incluyen el carcinoma hepatocelular. Un tratamiento eficaz debe tener como meta la eliminación del virus, lo que significaría la curación de la enfermedad. Recientemente, el advenimiento de varios agentes antivirales de acción directa ha posibilitado una alta resolución de la infección, del 97-100 % de los casos. Para lograr este objetivo costo-efectivo, es fundamental la concientización de los pediatras en la detección de los pacientes infectados y su derivación al especialista hepatólogo pediatra para la implementación del tratamiento adecuado.


Chronic hepatitis C virus infection is a health problem worldwide, both in children and adults. Its spontaneous resolution may occur during early childhood, and then it becomes uncommon. Although most cases are asymptomatic during childhood and adolescence, as adults, patients may progress to cirrhosis and develop complications, including hepatocellular carcinoma. The goal of an effective treatment should be virus elimination, i.e., disease cure. Recently, the emergence of several direct-acting antivirals has enabled a high rate of infection resolution in 97-100 % of cases. To achieve this cost-effective objective, it is critical to raise awareness among pediatricians so that they can detect infected patients and refer them to a pediatric liver specialist for an adequate management.


Subject(s)
Humans , Male , Female , Pregnancy , Infant, Newborn , Infant , Child, Preschool , Child , Adolescent , Hepatitis C/therapy , Hepatitis C/transmission , Antiviral Agents/therapeutic use , Hepatitis C/etiology , Infectious Disease Transmission, Vertical
6.
Buenos Aires; Comisión Nacional de Evaluación de Tecnologías de Salud; 19 Abril 2021. 17 p. (Informe de Evaluación de Tecnologías Sanitarias COVID N°01, 1).
Monography in Spanish | LILACS, BRISA, BINACIS, ARGMSAL | ID: biblio-1178400

ABSTRACT

INTRODUCCIÓN: El presente informe es producto del trabajo colaborativo de la Comisión Nacional de Evaluación de Tecnologías de Salud (CONETEC), dependiente del Ministerio de Salud de la Nación y creada por RM N° 623/2018. La CONETEC realiza evaluaciones y emite recomendaciones a la autoridad sanitaria sobre la incorporación, forma de uso, financiamiento y políticas de cobertura de las tecnologías sanitarias desde una perspectiva global del sistema de salud argentino. En sus evaluaciones y recomendaciones, la CONETEC tiene en cuenta criterios de calidad, seguridad, efectividad, eficiencia y equidad, evaluados bajo dimensiones éticas, médicas, económicas y sociales. Sus resultados son consensuados mediante discusiones públicas y ponderados a través de un marco de valor explícito, con la participación de todos los actores involucrados en el proceso de toma de decisiones en salud. Los informes y recomendaciones de esta comisión surgen de este proceso público, transparente y colaborativo, siendo de libre consulta y acceso para toda la sociedad. El objetivo del presente informe es evaluar parámetros de eficacia, seguridad y conveniencia de Remdesivir para el tratamiento de pacientes con COVID-19. OBJETIVO: El objetivo del presente informe es evaluar parámetros de eficacia, seguridad y conveniencia de Remdesivir para el tratamiento de pacientes con COVID-19. METODOLOGIA: Se realizó una evaluación de tecnología sanitaria, basada en evidencia proveniente de revisiones sistemáticas vivas y guías de práctica clínica de alta calidad metodológica para brindar parámetros actualizados y balanceados que sean de utilidad para la toma de decisiones en los diferentes niveles de gestión. RESULTADOS: Efectos en la Salud: Se identificaron tres revisiones sistemáticas que cumplen con los criterios de inclusión del presente informe. Las revisiones sistemáticas identificadas incluyeron 6 estudios aleatorizados para remdesivir en COVID-19 que aleatorizaron un total de 7797 pacientes. La mayoría de los estudios analizados incluyeron pacientes con enfermedad severa a crítica ya que la mortalidad promedio varió entre 8,3% y 12,6%. Uno de los estudios incluyó pacientes leves con una mortalidad del 2%. En relación con el desenlace mortalidad se postuló un posible efecto de subgrupo en el que remdesivir reduciría la mortalidad en pacientes con enfermedad menos severa mientras que no afectaría la mortalidad en pacientes con enfermedad más severa. Sin embargo, el análisis de credibilidad del efecto de subgrupo resultó moderado por lo que continúa siendo incierto si existe o no un efecto diferencial de remdesivir según la severidad de la enfermedad. CONCLUSIONES: El cuerpo de evidencia disponible hasta el momento muestra que remdesivir podría asociarse a beneficios modestos sin eventos adversos severos. La certeza en los efectos de remdesivir sobre la salud de pacientes con COVID-19 es baja. Remdesivir no se encuentra disponible en Argentina. La dificultad para su adquisición en el país y el elevado costo comparativo de esta intervención podría afectar la distribución equitativa de la misma y su disponibilidad en un contexto de alta demanda. Las guías de práctica clínica identificadas entregan recomendaciones condicionales pero discordantes en cuanto a su dirección.


Subject(s)
Humans , Antiviral Agents/therapeutic use , Adenosine Monophosphate/analogs & derivatives , Alanine/analogs & derivatives , COVID-19/drug therapy , Severity of Illness Index , Cost-Benefit Analysis , Therapeutic Index
8.
Electron. j. biotechnol ; 50: 16-22, Mar. 2021. ilus, tab
Article in English | LILACS | ID: biblio-1292419

ABSTRACT

BACKGROUND: Cecropin P1, acting as an antimicrobial, has a broad-spectrum antibacterial activity with some antiviral and antifungal properties. It is a promising natural alternative to antibiotics which is originally isolated from the pig intestinal parasitic nematode Ascaris suum. Many studies have shown that Cecropin P1 is helpful for the prevention or treatment of clinical diseases. Therefore, it is very necessary to establish a safe, nontoxic, and efficient expression method of Cecropin P1. RESULTS: The results indicated that the recombinant protein was about 5.5 kDa showed by Tricine­SDS­ PAGE and Western blot. And Cecropin P1 was efficiently secreted and expressed after 12 h of induction, with an increasing yield over the course of the induction. Its maximum concentration was 7.83 mg/L after concentration and purification. In addition, in vitro experiments demonstrated that Cecropin P1 not only exerted a strong inhibitory effect on Escherichia coli, Salmonella sp., Shigella sp., and Pasteurella sp., but also displayed an antiviral activity against PRRSV NADC30-Like strain. CONCLUSIONS: Collectively, the strategy of expressing Cecropin P1 in Saccharomyces cerevisiae is harmless, efficient, and safe for cells. In addition, the expressed Cecropin P1 has antiviral and antibacterial properties concurrently.


Subject(s)
Peptides/pharmacology , Saccharomyces cerevisiae/drug effects , Anti-Bacterial Agents/pharmacology , Antiviral Agents/pharmacology , Peptides/chemistry , In Vitro Techniques , Recombinant Proteins , Microbial Sensitivity Tests , Blotting, Western
9.
Braz. j. med. biol. res ; 54(2): e9542, 2021. tab
Article in English | LILACS, ColecionaSUS | ID: biblio-1142580

ABSTRACT

Influenza viruses exacerbate chronic obstructive pulmonary disease (COPD) with considerable morbidity and mortality. Zanamivir and oseltamivir are effective in treating influenza. However, their efficacy in relieving influenza symptoms in COPD patients remains unknown, with the lack of controlled trials in this subject. Therefore, we conducted this randomized controlled trial to investigate the clinical efficacy of both interventions in this population. Patients were allocated to two groups (80 patients each): oseltamivir (OSELTA) and zanamivir (ZANA) groups. Oseltamivir (75 mg) was orally administered twice daily for 5 days, while zanamivir (10 mg) was inhaled twice daily for 5 days. Clinical parameters including body temperature, influenza symptoms (i.e., sore throat, cough, etc.), and serial blood tests were recorded on days 1, 3, and 7. We analyzed primary (changes in body temperature) and secondary outcomes (changes in non-specific symptoms) using the pre-protocol and intention-to-treat analyses. Differences between groups were assessed using t-test. Oseltamivir and zanamivir significantly reduced body temperature on the 3rd day after treatment; however, the number of patients who reported clinical improvement in influenza-like symptoms was significantly higher in the OSELTA group compared to the ZANA group on days 3 (85 vs 68.8%, P=0.015) and 7 (97.5 vs 83.8%, P=0.003). However, no significant changes in hematological (white blood cells and its subtypes) and inflammatory (C-reactive protein) parameters were noted (P>0.05). Our results suggested that oseltamivir and zanamivir are effective in reducing body temperature, while oseltamivir led to better clinical improvement regarding influenza-like symptoms in patients with COPD.


Subject(s)
Humans , Male , Female , Middle Aged , Antiviral Agents/therapeutic use , Pulmonary Disease, Chronic Obstructive/complications , Pulmonary Disease, Chronic Obstructive/drug therapy , Influenza, Human/drug therapy , Oseltamivir/therapeutic use , Zanamivir/therapeutic use , Enzyme Inhibitors/therapeutic use , Neuraminidase
10.
Chinese Journal of Hepatology ; (12): 319-325, 2021.
Article in Chinese | WPRIM | ID: wpr-879638

ABSTRACT

Viral hepatitis C is one of the important causes of liver cirrhosis and hepatocellular carcinoma. There are approximately 10 million cases of chronic hepatitis C virus (HCV) infection in China. However, over 70% of HCV infections of China have not yet been detected. According to the goal of "eliminating viral hepatitis as a public health threat by 2030" of the World Health Organization Viral Hepatitis Strategy, and the fact that medical institutions remain the main places for detecting HCV infections or patients in China at present, we established the " In-hospital process for viral hepatitis C screening and management in China (Draft)", with intention to promote the multidisciplinary collaboration and cooperation among the departments of clinic, laboratory, infection control, management, and etc. in medical institutions, and strengthen consultation and referral of patients with detected HCV antibodies and advance the diagnosis and antiviral treatment of patients with chronic hepatitis C.


Subject(s)
Antiviral Agents/therapeutic use , China/epidemiology , Hepacivirus/genetics , Hepatitis C/epidemiology , Hepatitis C, Chronic/epidemiology , Hospitals , Humans , Liver Neoplasms/drug therapy
11.
Chinese Journal of Hepatology ; (12): 313-318, 2021.
Article in Chinese | WPRIM | ID: wpr-879637

ABSTRACT

The World Health Organization (WHO) has set the goal of eliminating viral hepatitis as a threat to public health by 2030. Blocking mother-to-child transmission (MTCT) of hepatitis B virus (HBV) is the key step for eliminating viral hepatitis, at the same time, it is the hotspot in the field of hepatitis B prevention and control as well. The China Foundation of Hepatitis Prevention and Control (CFHPC) organized a team of specialists to develop an algorithm for preventing MTCT of HBV, based on the most recent hepatitis B guidelines and the latest evidence. The algorithm covers 10 continuous steps from pregnant management to follow-up postpartum. Among the 10 steps, screening, antiviral therapy during pregnancy, and infant's immunization are the core components in the algorithm.


Subject(s)
Algorithms , Antiviral Agents/therapeutic use , Child , China , Female , Hepatitis B/prevention & control , Hepatitis B Surface Antigens , Hepatitis B e Antigens , Hepatitis B virus , Humans , Infant , Infectious Disease Transmission, Vertical/prevention & control , Pregnancy , Pregnancy Complications, Infectious/prevention & control
12.
Mem. Inst. Oswaldo Cruz ; 116: e200603, 2021. tab, graf
Article in English | LILACS | ID: biblio-1340225

ABSTRACT

BACKGROUND In March 2020, the World Health Organization (WHO) launched the Solidarity Program, probably the largest global initiative to encourage and support research in four promising drugs, named Remdesivir, Hydroxychloroquine, β Interferon and the combination Lopinavir / Ritonavir, to reduce the mortality of Coronavirus disease 2019 (COVID-19). OBJECTIVES Considering the potential impact of Solidarity Program to restrain the current pandemic, the present study aims to investigate whether it was designed upon indicators of scientific productivity, defined as the level of the production of new scientific knowledge and of the institutional capabilities, estimated in terms of scientific publications and technological agreements. METHODS The scientific documents on Alphacoronavirus, Betacoronavirus, Gammacoronavirus and Coronavirus were retrieved from Scopus database while the technological agreements on coronavirus were obtained through Cortellis. As for the institutions and countries, we have considered the data on author's affiliations in both set of data. For comparison, we included the analysis of documents related with other drugs or therapies, such as vaccines and antibodies, which were listed in a Clarivate's report on coronaviruses research. FINDINGS Most of the analysis refers to documents on Coronavirus, the largest group. The number of documents related to WHO's drugs are almost five times higher than in the other groups. This subset of documents involves the largest and most diverse number of institutions and countries. As for agreements, we observed a smaller number of institutions involved in it, suggesting differences between countries in terms of technical and human capabilities to develop basic and/or clinical research on coronavirus and to develop new forms or products to treat or to prevent the disease. MAIN CONCLUSIONS Hence, the results shown in this study illustrate that decisions taken by an international scientific body, as WHO, were mainly based in scientific knowledge and institutional competencies.


Subject(s)
Humans , Antiviral Agents/therapeutic use , COVID-19 , World Health Organization , Drug Combinations , SARS-CoV-2
13.
Rev. méd. Minas Gerais ; 31: 31208, 2021.
Article in Portuguese | LILACS | ID: biblio-1292616

ABSTRACT

Introdução: A infecção emergente pelo Zika vírus (ZIKV) tornou-se uma ameaça à saúde global devido à associação com anormalidades neurológicas graves: a síndrome de Guillain-Barré (SGB) em adultos e a síndrome congênita do Zika vírus (SCZ) em neonatos. O presente trabalho tem como intuito descrever os avanços sobre esta infecção relacionados aos aspectos epidemiológicos, clínicos, diagnóstico, prevenção e tratamento. Revisão da Literatura: Realizou-se uma revisão literária por meio de buscas bibliográficas nas bases de dados online LILACS, MEDLINE, Scopus e Web of Science, utilizando os descritores "Zika Virus", "Guillain-Barre Syndrome", "Zika Virus Infection", "Microcephaly", e "Congenital abnormalities", enfatizando os estudos realizados após o surto 2015- 2016 no Brasil. Discussão: O ZIKV já circulava no Brasil em 2013, um ano antes do que foi sugerido durante o surto. O teste molecular RT-PCR é o primeiro procedimento para a confirmação da doença, seguido pelo ensaio sorológico MACELISA. Embora a SCZ apresente achados neurológicos não patognomônicos nos fetos, exames radiológicos revelaram anormalidades mais comumente encontradas, destacando a microcefalia com padrão singular de "gaveta". Até o momento, não existem tratamentos antivirais e as vacinas não demonstram ser uma alternativa conveniente. Os alvos candidatos para o desenvolvimento destes medicamentos são as proteínas flavivirais NS1 e NS5, e a protease NS2B-NS3. Conclusão: Estes aspectos discutidos apontam a necessidade da criação de medicamentos antivirais e contribuem para o desenvolvimento de protocolos eficientes tanto no combate a novos surtos, como ao diagnóstico voltado a detecção do ZIKV e achados neurológicos da SCZ, possibilitando um tratamento mais eficaz ao paciente.


Introduction: The emerging Zika virus (ZIKV) infection has become a threat to global health due to the association with severe neurological abnormalities, being Guillain-Barré syndrome (GBS) in adults, and the congenital Zika virus syndrome (SCZ) in neonates. The present work aims to describe the advances in this infection, which refer to epidemiological, clinical, diagnosis, prevention, and treatment aspects. Literature Review: A literary review was carried out through bibliographic searches in the online databases LILACS, MEDLINE, Scopus, and Web of Science, using the descriptors "Zika Virus", "Guillain-Barre Syndrome", "Zika Virus Infection", "Microcephaly", and "Congenital abnormalities", emphasizing the studies carried out after the outbreak in Brazil (2015-2016). Discussion: The ZIKV was already circulating in Brazil in 2013, one year before what was suggested during the outbreak. The first procedure for confirming the disease is through the RT-PCR molecular test, followed by the MAC-ELISA serological test. Although SCZ presents non-pathognomonic neurological findings, radiological exams revealed abnormalities most found in fetuses with the syndrome, highlighting microcephaly due to the unique "drawer" pattern. There is no antiviral treatment, and vaccines have not proved to be a convenient alternative. Candidate targets for the development of these drugs are the flaviviral proteins NS1 and NS5, and the protease NS2B-NS3. Conclusion: These aspects discussed point to the need for the creation of antiviral drugs and contribute to the development of efficient protocols both to combat new outbreaks, as well as to the diagnosis aimed at the detection of ZIKV and neurological findings of SCZ, enabling a more effective treatment for the patient.


Subject(s)
Humans , Infant, Newborn , Infant , Zika Virus , Antiviral Agents , Congenital Abnormalities , Infant, Newborn , Epidemiology , Guillain-Barre Syndrome , Diagnosis , Disease Prevention , Zika Virus Infection , Microcephaly
14.
Braz. j. med. biol. res ; 54(7): e10240, 2021. tab, graf
Article in English | LILACS | ID: biblio-1249316

ABSTRACT

Dengue is the most important arthropod-borne viral disease worldwide. Infection with any of the four dengue virus (DENV) serotypes can be asymptomatic or lead to disease with clinical symptoms ranging from undifferentiated and self-limiting fever to severe dengue disease, which can be fatal in some cases. Currently, no specific antiviral compound is available for treating DENV. The aim of this study was to identify compounds in plants from Paraguayan folk medicine with inhibitory effects against DENV. We found high virucidal activity (50% maximal effective concentration (EC50) value of 24.97 µg/mL) against DENV-2 in the ethanolic extract of the roots of Solanum sisymbriifolium Lam. (Solanaceae) without an evident cytotoxic effect on Vero E6 cells. Three saponins isolated from the root extract showed virucidal effects (EC50 values ranging from 24.9 to 35.1 µg/mL) against DENV-2. Additionally, the saponins showed inhibitory activity against yellow fever virus (EC50 values ranging from 126 to 302.6 µg/mL), the prototype virus of the Flavivirus genus, suggesting that they may also be effective against other members of this genus. Consequently, these saponins may be lead compounds for the development of antiviral agents.


Subject(s)
Saponins/pharmacology , Solanum , Dengue Virus , Antiviral Agents/pharmacology , Virus Replication , Yellow fever virus
15.
Rev. bras. cancerol ; 67(2): e-121220, 2021.
Article in Portuguese | LILACS | ID: biblio-1254344

ABSTRACT

Introdução: A hepatite C está associada ao desenvolvimento do carcinoma hepatocelular (CHC). O regime terapêutico baseado em interferon vem sendo substituído pelos antivirais de ação direta (AAD) para tratamento da infecção pelo vírus da hepatite C (HCV). Contudo, estudos recentes evidenciaram um aumento inesperado da recorrência do CHC em pacientes tratados com AAD para resolução da hepatite C. Objetivo: Avaliar o risco de recorrência de hepatocarcinoma após uso de AAD em pacientes com infecção por HCV. Método: Realizou-se um levantamento nas bases de dados PubMed, MEDLINE e LILACS de acordo com os descritores DeCS/MeSH ((hepatocellular carcinoma) AND recurrence) AND Direct-acting antiviral. A revisão obedeceu ao protocolo PRISMA e está cadastrada na plataforma PROSPERO. A análise estatística dos dados foi realizada no software RStudio. Resultados: Sete artigos foram selecionados resultando em 847 pacientes. Entre os tratados com AAD, a taxa de recorrência variou entre 11,1% e 42,1% e, no grupo controle, ocorreu em 5% a 65,6% dos pacientes. O risco relativo (RR) de recorrência do CHC no grupo de pacientes que recebeu AAD foi menor do que o risco evidenciado no grupo controle, apesar de não haver significância estatística (RR 0,71 95% IC [0,55;0,93] I²=38%, p=0,14). O tempo até o diagnóstico da recorrência teve uma média de 9,35 meses no grupo exposto à terapia e 13,42 meses no grupo controle. Conclusão: Sugere-se que a terapia com AAD não aumenta o risco de recorrência do CHC em comparação com grupos controle. Nos pacientes que desenvolveram recorrência, ocorreu com maior frequência dentro do primeiro ano após introdução dos AAD.


Introduction: Hepatitis C is associated with the development of hepatocellular carcinoma (HCC). The interferon-based therapeutic regimen has been replaced by direct-acting antivirals (AAD) to treat HCV virus infection. However, recent studies have shown an unexpected increase in HCC recurrence in patients treated with AAD to resolve hepatitis C. Objective: To assess the risk of hepatocarcinoma recurrence after using AAD in patients with HCV infection. Method: A survey was carried out in PubMed, MEDLINE, and LILACS databases according to the descriptors DeCS/MeSH ((hepatocellular carcinoma) AND recurrence) AND Direct-acting antiviral. The review followed the PRISMA protocol and is registered on the PROSPERO platform. The data statistical analysis was performed through RStudio software. Results: Seven articles were selected resulting in 847 patients. Among those treated with AAD, the recurrence rate varied between 11.1% to 42.1% and, in the control group, it occurred in 5% to 65.6% of the patients. The relative risk (RR) of recurrence of HCC in the group of patients who received AAD was less than the risk evidenced in the control group, although there is no statistical significance (RR 0.71 95% CI [0.55; 0.93] I²=38%, p=0.14). The mean time until the diagnosis of recurrence was 9.35 months in the group exposed to therapy and 13.42 months in the control group. Conclusion: It is suggested that therapy with AAD does not increase the risk of HCC recurrence compared to control groups. In patients who developed recurrence, it occurred more frequently within the first year after the introduction of AAD.


Introducción: La hepatitis C está asociada con el desarrollo de carcinoma hepatocelular (CHC). El régimen terapéutico basado en interferón ha sido reemplazado por antivirales de acción directa (AAD) para tratar la infección por VHC. Sin embargo, estudios recientes han mostrado un incremento inesperado en la recurrencia del CHC en pacientes tratados con AAD para resolución de la hepatitis C. Objetivo: Evaluar el riesgo de recurrencia del hepatocarcinoma después de usar AAD en pacientes con infección por VHC. Método: Se realizó una pesquisa en las bases de datos PubMed, MEDLINE y LILACS según los descriptores DeCS/MeSH ((carcinoma hepatocelular) AND recurrencia) AND antiviral de acción directa. La revisión siguió el protocolo PRISMA y está registrada en la plataforma PROSPERO. El análisis estadístico de los datos se realizó mediante el software RStudio. Resultados: Fueron seleccionados 7 artículos resultando en 847 pacientes. Entre los tratados con AAD, la tasa de recurrencia varió entre el 11,1% y el 42,1% y, en el grupo de control, ocurrió entre el 5% y el 65,6% de los pacientes. El riesgo relativo (RR) de recurrencia del CHC en el grupo de pacientes que recibieron AAD fue inferior que el riesgo evidenciado en el grupo control, aunque no hay significación estadística (RR 0,71; IC del 95% [0,55; 0,93] I²=38%, p=0,14). El tiempo hasta el diagnóstico de recidiva fue de 9,35 meses en el grupo expuesto a terapia y de 13,42 meses en el grupo control. Conclusión: Se sugiere que la terapia con AAD no aumenta el riesgo de recurrencia del CHC en comparación con los grupos control. En los pacientes que desarrollaron recurrencia, esta ocurrió con mayor frecuencia durante el primer año después de la introducción de los AAD.


Subject(s)
Humans , Liver Neoplasms/etiology , Antiviral Agents/therapeutic use , Hepatitis C/complications , Carcinoma, Hepatocellular/etiology , Neoplasm Recurrence, Local
16.
Rev. bras. cancerol ; 67(2): e-121220, 2021.
Article in Portuguese | LILACS | ID: biblio-1254542

ABSTRACT

Introdução: A hepatite C está associada ao desenvolvimento do carcinoma hepatocelular (CHC). O regime terapêutico baseado em interferon vem sendo substituído pelos antivirais de ação direta (AAD) para tratamento da infecção pelo vírus da hepatite C (HCV). Contudo, estudos recentes evidenciaram um aumento inesperado da recorrência do CHC em pacientes tratados com AAD para resolução da hepatite C. Objetivo: Avaliar o risco de recorrência de hepatocarcinoma após uso de AAD em pacientes com infecção por HCV. Método: Realizou-se um levantamento nas bases de dados PubMed, MEDLINE e LILACS de acordo com os descritores DeCS/MeSH ((hepatocellular carcinoma) AND recurrence) AND Direct-acting antiviral. A revisão obedeceu ao protocolo PRISMA e está cadastrada na plataforma PROSPERO. A análise estatística dos dados foi realizada no software RStudio. Resultados: Sete artigos foram selecionados resultando em 847 pacientes. Entre os tratados com AAD, a taxa de recorrência variou entre 11,1% e 42,1% e, no grupo controle, ocorreu em 5% a 65,6% dos pacientes. O risco relativo (RR) de recorrência do CHC no grupo de pacientes que recebeu AAD foi menor do que o risco evidenciado no grupo controle, apesar de não haver significância estatística (RR 0,71 95% IC [0,55;0,93] I²=38%, p=0,14). O tempo até o diagnóstico da recorrência teve uma média de 9,35 meses no grupo exposto à terapia e 13,42 meses no grupo controle. Conclusão: Sugere-se que a terapia com AAD não aumenta o risco de recorrência do CHC em comparação com grupos controle. Nos pacientes que desenvolveram recorrência, ocorreu com maior frequência dentro do primeiro ano após introdução dos AAD.


Introduction: Hepatitis C is associated with the development of hepatocellular carcinoma (HCC). The interferon-based therapeutic regimen has been replaced by direct-acting antivirals (AAD) to treat HCV virus infection. However, recent studies have shown an unexpected increase in HCC recurrence in patients treated with AAD to resolve hepatitis C. Objective: To assess the risk of hepatocarcinoma recurrence after using AAD in patients with HCV infection. Method: A survey was carried out in PubMed, MEDLINE, and LILACS databases according to the descriptors DeCS/MeSH ((hepatocellular carcinoma) AND recurrence) AND Direct-acting antiviral. The review followed the PRISMA protocol and is registered on the PROSPERO platform. The data statistical analysis was performed through RStudio software. Results: Seven articles were selected resulting in 847 patients. Among those treated with AAD, the recurrence rate varied between 11.1% to 42.1% and, in the control group, it occurred in 5% to 65.6% of the patients. The relative risk (RR) of recurrence of HCC in the group of patients who received AAD was less than the risk evidenced in the control group, although there is no statistical significance (RR 0.71 95% CI [0.55; 0.93] I²=38%, p=0.14). The mean time until the diagnosis of recurrence was 9.35 months in the group exposed to therapy and 13.42 months in the control group. Conclusion: It is suggested that therapy with AAD does not increase the risk of HCC recurrence compared to control groups. In patients who developed recurrence, it occurred more frequently within the first year after the introduction of AAD.


Introducción: La hepatitis C está asociada con el desarrollo de carcinoma hepatocelular (CHC). El régimen terapéutico basado en interferón ha sido reemplazado por antivirales de acción directa (AAD) para tratar la infección por VHC. Sin embargo, estudios recientes han mostrado un incremento inesperado en la recurrencia del CHC en pacientes tratados con AAD para resolución de la hepatitis C. Objetivo: Evaluar el riesgo de recurrencia del hepatocarcinoma después de usar AAD en pacientes con infección por VHC. Método: Se realizó una pesquisa en las bases de datos PubMed, MEDLINE y LILACS según los descriptores DeCS/MeSH ((carcinoma hepatocelular) AND recurrencia) AND antiviral de acción directa. La revisión siguió el protocolo PRISMA y está registrada en la plataforma PROSPERO. El análisis estadístico de los datos se realizó mediante el software RStudio. Resultados: Fueron seleccionados 7 artículos resultando en 847 pacientes. Entre los tratados con AAD, la tasa de recurrencia varió entre el 11,1% y el 42,1% y, en el grupo de control, ocurrió entre el 5% y el 65,6% de los pacientes. El riesgo relativo (RR) de recurrencia del CHC en el grupo de pacientes que recibieron AAD fue inferior que el riesgo evidenciado en el grupo control, aunque no hay significación estadística (RR 0,71; IC del 95% [0,55; 0,93] I²=38%, p=0,14). El tiempo hasta el diagnóstico de recidiva fue de 9,35 meses en el grupo expuesto a terapia y de 13,42 meses en el grupo control. Conclusión: Se sugiere que la terapia con AAD no aumenta el riesgo de recurrencia del CHC en comparación con los grupos control. En los pacientes que desarrollaron recurrencia, esta ocurrió con mayor frecuencia durante el primer año después de la introducción de los AAD.


Subject(s)
Antiviral Agents/therapeutic use , Hepatitis C/complications , Carcinoma, Hepatocellular/etiology , Liver Neoplasms/etiology , Neoplasm Recurrence, Local
17.
Rev. Hosp. Clin. Univ. Chile ; 32(2): 159-167, 2021.
Article in Spanish | LILACS | ID: biblio-1283537

ABSTRACT

The main treatment for patients with severe Covid-19 is to maintain adequate ventilatory support and monitor the possible progression of the disease. Therapeutic strategies such as High Flow Nasal Cannula, awake prone position, antithrombotic prophylaxis and the use of dexamethasone. There have improved the probability of not presenting complications and not requiring invasive mechanical ventilation. The use of convalescent plasma is still under investigation and is currently only recommended in clinical trials. Finding antivirals that allow treating the infection and clinically improving patients has led to mounting studies with different methodologies, and currently there are specific and limited indications for their routine use, as in the case of Remdesivir, which has been approved by the FDA as emergency treatment in severe cases. Immunomodulatory treatments are still under study. An example of this is Tocilizumab and Anakinra, which have shown promising results for the management of seriously ill patients. It should be noted that there are many therapies that are being tested and that every day the information about the results obtained is changing. (AU)


Subject(s)
Humans , Male , Female , COVID-19/therapy , Antiviral Agents/therapeutic use , Protease Inhibitors/therapeutic use , Antibodies, Monoclonal/therapeutic use
18.
Article in English | WPRIM | ID: wpr-881088

ABSTRACT

Huashi Baidu prescription (HSBDF), recommended in the Guideline for the Diagnosis and Treatment of Novel Coronavirus (2019-nCoV) Pneumonia (On Trials, the Seventh Edition), was clinically used to treat severe corona virus disease 2019 (COVID-19) with cough, blood-stained sputum, inhibited defecation, red tongue etc. symptoms. This study was aimed to elucidate and profile the knowledge on its chemical constituents and the potential anti-inflammatory effect in vitro. In the study, the chemical constituents in extract of HSBDF were characterized by UPLC-Q-TOF/MS in both negative and positive modes, and the pro-inflammatory cytokines were measured by enzyme-linked immunosorbent assays (ELISA) to determine the effects of HSBDF in lipopolysaccharide (LPS)-stimulated RAW264.7 cells. The results showed that a total of 217 chemical constituents were tentativedly characterized in HSBDF. Moreover, HSBDF could alleviate the expression levels of IL-6 and TNF-α in the cell models, indicating that the antiviral effects of HSBDF might be associated with regulation of the inflammatory cytokines production in RAW264.7 cells. We hope that the results could be served as the basic data for further study of HSBDF on anti-COVID-19 effect.


Subject(s)
Anti-Inflammatory Agents/therapeutic use , Antiviral Agents/therapeutic use , COVID-19/drug therapy , Drugs, Chinese Herbal/therapeutic use , Humans , Plant Extracts/therapeutic use , SARS-CoV-2/drug effects
19.
Article in English | WPRIM | ID: wpr-880988

ABSTRACT

OBJECTIVE@#Traditional Chinese medicine plays a significant role in the treatment of the pandemic of coronavirus disease 2019 (COVID-19). Tanreqing Capsule (TRQC) was used in the treatment of COVID-19 patients in the Shanghai Public Health Clinical Center. This study aimed to investigate the clinical efficacy of TRQC in the treatment of COVID-19.@*METHODS@#A retrospective cohort study was conducted on 82 patients who had laboratory-confirmed mild and moderate COVID-19; patients were treated with TRQC in one designated hospital. The treatment and control groups consisted of 25 and 57 cases, respectively. The treatment group was given TRQC orally three times a day, three pills each time, in addition to conventional Western medicine treatments which were also administered to the control group. The clinical efficacy indicators, such as the negative conversion time of pharyngeal swab nucleic acid, the negative conversion time of fecal nucleic acid, the duration of negative conversion of pharyngeal-fecal nucleic acid, and the improvement in the level of immune indicators such as T-cell subsets (CD3, CD4 and CD45) were monitored.@*RESULTS@#COVID-19 patients in the treatment group, compared to the control group, had a shorter negative conversion time of fecal nucleic acid (4 vs. 9 days, P = 0.047) and a shorter interval of negative conversion of pharyngeal-fecal nucleic acid (0 vs. 2 days, P = 0.042). The level of CD3@*CONCLUSION@#Significant reductions in the negative conversion time of fecal nucleic acid and the duration of negative conversion of pharyngeal-fecal nucleic acid were identified in the treatment group as compared to the control group, illustrating the potential therapeutic benefits of using TRQC as a complement to conventional medicine in patients with mild and moderate COVID-19. The underlying mechanism may be related to the improved levels of the immune indicator CD3


Subject(s)
Adult , Antiviral Agents/therapeutic use , COVID-19/pathology , Capsules , DNA, Viral/analysis , Drugs, Chinese Herbal/therapeutic use , Feces/virology , Female , Humans , Length of Stay , Lymphocyte Count , Male , Medicine, Chinese Traditional/methods , Middle Aged , Retrospective Studies , SARS-CoV-2/genetics , Severity of Illness Index , Treatment Outcome , Young Adult
20.
Article in English | WPRIM | ID: wpr-880560

ABSTRACT

Covid-19 pandemic has caused hundreds of thousands deaths and millions of infections and continued spreading violently. Although researchers are racing to find or develop effective drugs or vaccines, no drugs from modern medical system have been proven effective and the high mutant rates of the virus may lead it resistant to whatever drugs or vaccines developed following modern drug development procedure. Current evidence has demonstrated impressive healing effects of several Chinese medicines (CMs) for Covid-19, which urges us to reflect on the role of CM in the era of modern medicine. Undoubtedly, CM could be promising resources for developing drug candidates for the treatment of Covid-19 in a way similar to the development of artemisinin. But the theory that builds CM, like the emphasis of driving away exogenous pathogen (virus, etc.) by restoring self-healing capacity rather than killing the pathogen directly from the inside and the 'black-box' mode of diagnosing and treating patients, is as important, yet often ignored, an treasure as CM herbs and should be incorporated into modern medicine for future advancement and innovation of medical science.


Subject(s)
Antiviral Agents/therapeutic use , COVID-19/therapy , Disease Outbreaks , Drug Development/standards , Drug Resistance, Viral/genetics , Drug Therapy, Combination , Drugs, Chinese Herbal/therapeutic use , Humans , Medicine, Chinese Traditional/trends , Mutation Rate , Pandemics , Phytotherapy/methods , SARS-CoV-2/physiology
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