Your browser doesn't support javascript.
loading
Show: 20 | 50 | 100
Results 1 - 20 de 207
Filter
1.
Rev. Hosp. Ital. B. Aires (2004) ; 41(4): 187-192, dic. 2021. ilus
Article in Spanish | LILACS, BINACIS, UNISALUD | ID: biblio-1366967

ABSTRACT

La sinusitis micótica alérgica es una enfermedad inflamatoria de la mucosa rinosinusal producida por hongos que pueden aislarse de la cavidad de nasal de individuos sanos. Se produce indirectamente por los hongos que actúan como antígeno y desencadenan una reacción inmunológica mediada por IgE que origina pólipos y una secreción mucosa espesa con detritus e hifas denominada mucina. Su presentación clínica más frecuente es una sinusitis crónica unilateral o bilateral con pólipos. Con menos frecuencia, las sustancias originadas por la desgranulación de los eosinófilos producen remodelación o destrucción ósea y la sinusitis puede simular una neoplasia. Se describe el caso clínico de un paciente que padeció una sinusitis micótica alérgica con destrucción ósea masiva de la base del cráneo y que tuvo extensión intracraneal extradural e intraorbitaria de la enfermedad. Fue tratado con éxito mediante cirugía y corticoides. (AU)


Allergic fungal sinusitis is an inflammatory disease of the rhinosinusal mucosa caused by fungi that can be isolated from the nasal cavity of healthy individuals. The pathology is produced indirectly by the fungus that acts as an antigen and triggers an IgE-mediated allergic reaction that causes polyps and a thick mucous discharge with detritus and hyphae called mucin. Its most common clinical presentation is unilateral or bilateral chronic sinusitis with polyps. Less commonly, substances originated by the degranulation of eosinophils cause bone remodeling or destruction, and sinusitis can simulate a neoplasia. We describe the clinical case of a patient who suffered from allergic fungal sinusitis with massive bone destruction of the skull base and who had intracranial, extradural and intraorbital extension of the disease. He was successfully treated with surgery and corticosteroids.Key words: allergic fungal sinusitis, intracranial extension, endoscopic surgery, transorbital transpalpebral approach. (AU)


Subject(s)
Humans , Male , Middle Aged , Sinusitis/diagnostic imaging , Skull Base/physiopathology , Rhinitis, Allergic/diagnostic imaging , Invasive Fungal Infections/diagnostic imaging , Curvularia/pathogenicity , Sinusitis/surgery , Sinusitis/drug therapy , Prednisone/administration & dosage , Skull Base/surgery , Budesonide/administration & dosage , Rhinitis, Allergic/surgery , Rhinitis, Allergic/drug therapy , Invasive Fungal Infections/surgery , Invasive Fungal Infections/drug therapy
2.
s.l; CONETEC; 13 mayo 2021.
Non-conventional in Spanish | LILACS, BRISA | ID: biblio-1224494

ABSTRACT

INTRODUCCIÓN: En los primeros informes de China, Italia y Estados Unidos que describen a los pacientes con COVID-19 ingresados en el hospital, los pacientes con asma y enfermedad pulmonar obstructiva crónica (EPOC) estaban significativamente sub-representados.3-6 Surgió entonces la hipótesis que esta subrepresentación de las primeras cohortes, podría deberse al uso generalizado de glucocorticoides inhalados en esta población. 7 El uso de glucocorticoides inhalados en pacientes con asma y EPOC tiene la finalidad de disminuir la inflamación de las vías aéreas y de este modo contribuir a reducir las exacerbaciones, que a menudo se deben a infecciones de origen viral. 8 Los estudios in vitro han demostrado que los glucocorticoides inhalados reducen la replicación de SARS-CoV-2 en las células epiteliales de las vías respiratorias, además de la regulación en menos de la expresión de los genera ACE2 y TMPRSS2, que son críticos para la entrada de células virales en este epitelio.9 Budesonide inhalado se encuentran ampliamente disponible en Argentina y está aprobada por la Administración Nacional de Medicamentos, Alimentos y Tecnología Médica (ANMAT) para la prevención de los síntomas respiratorios relacionados con la inflamación bronquial aguda o crónica. 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. OBJETIVO: El objetivo del presente informe es evaluar parámetros de eficacia, seguridad, conveniencia y recomendaciones disponibles acerca del uso de esteroides inhalados para el tratamiento de pacientes con COVID-19. MÉTODOS: Efectos en la Salud: Se desarrolló un protocolo sustentado en proyectos que resume activamente la evidencia científica a medida que la misma se hace disponible. Con este fin se utilizó la plataforma Love de Epistemonikos para identificar revisiones sistemáticas "vivas". Se seleccionaron aquellas con una calidad metodológica apropiada evaluada a través de la herramienta AMSTAR-2, y que a su vez llevaran un proceso de actualización frecuente.10 De cada una de las revisiones sistemáticas identificadas se extractaron los efectos de la intervención sobre los desenlaces priorizados como importantes o críticos separando los efectos del tratamiento sobre pacientes con COVID-19 (mortalidad, ingreso en asistencia ventilatoria mecánica, duración de estadía hospitalaria, tiempo a la resolución de síntomas o mejoría clínica al día 7-28 y eventos adversos graves) y la certeza en dichos efectos. Adicionalmente se extractaron datos relacionados a efectos de subgrupo potencialmente relevantes para la toma de decisión, con especial énfasis en el tiempo de evolución y la severidad de la enfermedad. Implementación: Este domino contempla dos subdominios: la existencia de barreras y facilitadores para la implementación de la tecnología evaluada no consideradas en los otros dominios analizados, y los costos comparativos en relación con otras intervenciones similares. Recomendaciones: se utilizó la plataforma COVID recmap. Se seleccionaron aquellas guías con rigor metodológico apropiado según la herramienta AGREE II (> 70%) y se incorporaron sus recomendaciones al informe. RESULTADOS: Efectos en la Salud: Se identificaron dos revisiones sistemáticas que cumplen con los criterios de inclusión del presente informe y que reportan sobre budesonide inhalado para pacientes con COVID-19. Se identificaron 2 ECA que incluyeron 1929 participantes en los que budesonide inhalado se comparó con la atención estándar u otros tratamientos. CONCLUSIONES: El cuerpo de evidencia disponible hasta el momento sugiere que budesonide inhalado podría mejorar el tiempo de resolución de los síntomas y disminuir las hospitalizaciones. Existe incertidumbre en el efecto de budesonide inhalado sobre la mortalidad, los efectos advsersos severos o el ingreso en asistencia ventilatoria mecánica. Budesonide inhalado se encuentran ampliamente disponible en Argentina y está aprobada por ANMAT para el tratamiento de síntomas respiratorios relacionados con la inflamación bronquial aguda o crónica. Su costo comparativo es bajo y no se identificaron recomendaciones que aborden el uso de esteroides inhalados para el tratamiento de COVID-19.


Subject(s)
Humans , Budesonide/administration & dosage , COVID-19/drug therapy , Severity of Illness Index , Administration, Inhalation , Cost-Benefit Analysis , Budesonide/economics , Therapeutic Index
3.
Ciudad Autónoma de Buenos Aires; Comisión Nacional de Evaluación de Tecnologías de Salud; 13 de Mayo 2021. 15 p. (Informe de Evaluación de Tecnologías Sanitarias COVID N°05, 5).
Monography in Spanish | LILACS, BINACIS, ARGMSAL | ID: biblio-1254667

ABSTRACT

La enfermedad por el Coronavirus 2019 (COVID-19 - Coronavirus Disease 2019) es una patología respiratoria de humanos producida por la infección por un nuevo coronavirus identificado con la sigla SARS-CoV-2.1 El 11 de marzo de 2020 la Organización Mundial de la Salud (OMS) declaró al COVID-19 como una pandemia, y desde ese momento hasta el 13 mayo del 2021 se ha reportado aproximadamente para Argentina con más de 3.000.000 casos confirmados y 68.807 muertes.1,2 Al no existir un tratamiento farmacológico específico contra el virus hasta el momento (aunque esteroides sistémicos han demostrado reducir la mortalidad en pacientes hospitalizados por COVID-19 con complicaciones respiratorias graves y que las heparinas son efectivas en la prevención de la trombosis venosa profunda también en casos graves), la comunidad científica se ha enfocado en la búsqueda y desarrollo de intervenciones antivirales, y en resignificar diferentes tipos de fármacos que se utilizan en otras indicaciones. El presente informe pretende evaluar si el empleo de budesonide inhalado es eficaz, seguro y resulta conveniente para el tratamiento de pacientes con COVID-19 en Argentina


Subject(s)
Therapeutics , Budesonide , COVID-19
4.
Rev. Assoc. Med. Bras. (1992) ; 67(2): 168-172, Feb. 2021. tab, graf
Article in English | LILACS | ID: biblio-1287807

ABSTRACT

SUMMARY Refractory celiac disease is an uncommon condition which might be associated to poor prognosis. It is often treated with immunosuppressive medications, with poor results. It is divided in type 1 and type 2, the latter carrying a high risk for lymphoma and mortality. A case of a 41 year old female patient with refractory celiac disease type 2 is reported. She was treated with oral budesonide for six months, achieving histological remission.


Subject(s)
Humans , Male , Female , Celiac Disease/diagnosis , Budesonide
5.
Article in Chinese | WPRIM | ID: wpr-826665

ABSTRACT

OBJECTIVE@#To observe the therapeutic effect of herb-separated moxibustion combined with budesonide nasal spray (rhinocort) on moderate to severe persistent allergic rhinitis (AR) of kidney- deficiency type, and to explore the correlation between nasal temperature and condition of allergic rhinitis.@*METHODS@#A total of 70 patients with moderate to severe persistent AR were randomized into an observation group (35 cases) and a control group (35 cases, 3 cases dropped off). Both groups were treated with rhinocort, one spray on each side of the nostril (approximately 64 μg each spray), once in the morning and once in the evening, for 4 weeks. On the basis of the above treatment, the observation group was treated with herb-separated moxibustion at Shenshu (BL 23), Feishu (BL 13), Zhiyang (GV 9), Dazhui (GV 14), 3 moxibustions per acupoint, a single treatment lasting about 30 min. This treatment was given once every other day, 3 times every week, and totally continuous 4 weeks. The changes of AR symptom visual analogue scale (VAS) scores were observed before and after treatment and at 3 months follow-up after treatment. The heat variation (temperature, range) on projection areas of the nose, lungs, large intestine and kidneys of the two groups' patients before and after treatment were detected by the infrared thermal imaging diagnostic system, and the correlation between the VAS scores and nasal temperature before and after treatment was analyzed. The clinical effects of both groups were evaluated according to the VAS score.@*RESULTS@#The total effective rate in the observation group after treatment was 85.7% (30/35), which was higher than 71.9% in the control group (23/32, <0.05). After treatment and at follow-up, the VAS scores of both groups were lower than those before treatment (<0.05), and the VAS score of the observation group was lower than that of the control group at follow-up (<0.05). After treatment, the nasal temperature, pulmonary range, large intestinal range and renal range of the observation group were all lower than those before treatment (<0.05), the nasal temperature and nasal range of the control group were lower than before treatment (<0.05), and the reduction of nasal temperature, nasal range and renal range in the observation group was greater than that of the control group (<0.05). Before and after treatment, there was a correlation between VAS score and nasal temperature (<0.05).@*CONCLUSION@#The herb-separated moxibustion combining western medication has a better effect and long-term effect than western medication alone for moderate to severe persistent AR, which can improve heat variation on projected areas of the nose, lung, large intestine and kidney of patients. In addition, nasal temperature can reflect the severity of the symptoms of patients with moderate to severe persistent AR, or it can be used as a secondary indicator to evaluate condition of AR.


Subject(s)
Acupuncture Points , Acupuncture Therapy , Budesonide , Therapeutic Uses , Humans , Moxibustion , Rhinitis, Allergic , Therapeutics , Yang Deficiency
6.
Article in English | WPRIM | ID: wpr-762183

ABSTRACT

PURPOSE: The effect of air pollution-related particulate matter (PM) on epithelial barrier function and tight junction (TJ) expression in human nasal mucosa has not been studied to date. This study therefore aimed to assess the direct impact of PM with an aerodynamic diameter less than 2.5 μm (PM2.5) on the barrier function and TJ molecular expression of human nasal epithelial cells. METHODS: Air-liquid interface cultures were established with epithelial cells derived from noninflammatory nasal mucosal tissue collected from patients undergoing paranasal sinus surgery. Confluent cultures were exposed to 50 or 100 µg/mL PM2.5 for up to 72 hours, and assessed for 1) epithelial barrier integrity as measured by transepithelial resistance (TER) and permeability of fluorescein isothiocyanate (FITC) 4 kDa; 2) expression of TJs using real-time quantitative polymerase chain reaction and immunofluorescence staining, and 3) proinflammatory cytokines by luminometric bead array or enzyme-linked immunosorbent assay. RESULTS: Compared to control medium, 50 and/or 100 µg/mL PM2.5-treatment 1) significantly decreased TER and increased FITC permeability, which could not be restored by budesonide pretreatment; 2) significantly decreased the expression of claudin-1 messenger RNA, claudin-1, occludin and ZO-1 protein; and 3) significantly increased production of the cytokines interleukin-8, TIMP metallopeptidase inhibitor 1 and thymic stromal lymphopoietin. CONCLUSIONS: Exposure to PM2.5 may lead to loss of barrier function in human nasal epithelium through decreased expression of TJ proteins and increased release of proinflammatory cytokines. These results suggest an important mechanism of susceptibility to rhinitis and rhinosinusitis in highly PM2.5-polluted areas.


Subject(s)
Asthma , Budesonide , Claudin-1 , Cytokines , Enzyme-Linked Immunosorbent Assay , Epithelial Cells , Fluorescein , Fluorescein-5-isothiocyanate , Fluorescent Antibody Technique , Humans , Interleukin-8 , Mucous Membrane , Nasal Mucosa , Occludin , Particulate Matter , Permeability , Polymerase Chain Reaction , Rhinitis , RNA, Messenger , Tight Junctions
7.
Article in English | WPRIM | ID: wpr-762179

ABSTRACT

PURPOSE: We evaluated the severity of olfactory disturbance (OD) in the murine model of allergic rhinitis (AR) and local allergic rhinitis (LAR) in mice. We also investigated the therapeutic effect of an intranasal steroid on OD. METHODS: Forty BALB/c mice were divided into 5 groups (n = 8 for each). The control group was sensitized intraperitoneally (i.p.) and challenged intranasally (i.n.) with saline. Mice in the AR group got i.p. and i.n. ovalbumin (OVA) administration for AR induction. The LAR group was challenged i.n. with 1% OVA for inducing local nasal allergic inflammation, without inducing the systemic allergy. The OD group got an i.p. methimazole administration (75 mg/kg) to induce total destruction of olfactory mucosa. Mice in the intranasal budesonide group received i.n. budesonide (12.8 μg per time, 30 minutes after the i.n. OVA challenge) while using OVA to cause systemic allergies. We conducted a buried-food pellet test to functionally assess the degree of OD in each group by measuring the time taken until finding hidden food. We evaluated the damage to olfactory epithelium using histopathologic evaluation and compared the degree of olfactory marker protein (OMP) expression in olfactory epithelium using immunofluorescent staining. RESULTS: Mice of the AR (81.3 ± 19.8 seconds) and LAR groups (66.2 ± 12.7 seconds) spent significantly more time to detect the pellets than the control group (35.6 ± 12.2 seconds, P < 0.01). After treatment, the intranasal budesonide group exhibited significantly better results (35.8 ± 11.9 seconds) compared with the AR and LAR groups (P < 0.01). The AR and LAR groups showed considerable olfactory epithelial damage and suppression of OMP expression compared with the control group. In the intranasal budesonide group, the olfactory lesions and OMP expression had improved substantially. CONCLUSIONS: OD may be caused by olfactory epithelial damage and suppression of OMP expression in nasal allergic inflammation and could be reversed using an intranasal steroid.


Subject(s)
Animals , Budesonide , Hypersensitivity , Inflammation , Methimazole , Mice , Olfaction Disorders , Olfactory Marker Protein , Olfactory Mucosa , Ovalbumin , Ovum , Quality of Life , Rhinitis, Allergic , Steroids
8.
J. bras. pneumol ; 46(3): e20180341, 2020. tab, graf
Article in English, Portuguese | LILACS | ID: biblio-1090809

ABSTRACT

RESUMO Objetivo Descrever características clínicas e identificar fatores associados a maior gravidade da asma, em uma amostra de pacientes acompanhados em um centro de referência em Salvador. Métodos Estudo transversal de 473 adultos, acompanhados regularmente no Programa para Controle da Asma na Bahia (ProAR), reavaliados de forma sistemática entre 2013 e 2015. Os pacientes foram admitidos por preencher critérios anteriores de asma grave e reclassificados de acordo com a definição mais atual, proposta por um documento conjunto da European Respiratory Society/American Thoracic Society (ERS/ATS 2014). Resultados Foram reclassificados como portadores de asma grave pelos critérios da ATS/ERS (AG-ERS/ATS) 88/473 (18%). Destes, 87% eram mulheres, 48% obesos, com mediana do índice de massa corporal (IMC) de 29 kg/m2 (IQ 26-34), 99% tinham sintomas de rinite crônica e 83%, sintomas de doença do refluxo gastroesofágico (DRGE). Nenhum se declarou fumante atual. Os principais corticosteroides inalatórios utilizados foram beclometasona (88%) e budesonida (69%). A maioria relatou adequada adesão (77%) e a minoria das avaliações (0,6%) revelou erros graves na técnica inalatória. A mediana do volume expiratório forçado no primeiro segundo pós-broncodilatador (VEF1pós-BD) foi 67% do predito (IQ 55-80). A mediana do número de eosinófilos no sangue periférico foi menor nos pacientes com AG-ERS/ATS [209 células/mm3 (IQ 116-321)] do que nos demais pacientes estudados [258 células/mm3 (IQ 154-403)]. Sintomas de doença do refluxo gastroesofágico (DRGE) foram associados a mais gravidade [OR = 2,2; IC95% (1,2-4,2)]. Conclusões Neste grupo de pacientes, sintomas de RGE foram associados a AG-ERS/ATS e contagem de eosinófilos > 260 células/mm3 esteve associada a 42% menos chance de AG-ERS/ATS.


ABSTRACT Objective To describe the clinical features and to identify factors associated with significant severe asthma in samples of patients followed in a reference center in Salvador. Methods A cross-sectional study of 473 adults, regularly followed in the "Asthma Control Program" in Bahia (Programa de Controle da Asma e da Rinite Alérgica na Bahia (ProAR)), reassessed systematically between 2013 and 2015. The patients were admitted for meeting previous criteria of severe asthma and were reclassified according to the most current definition proposed by a joint document of the "European Respiratory Society/American Thoracic Society" (ERS/ATS) (ERS/ATS 2014). Results Only 88/473 (18%) were reclassified as having severe asthma by ERS/ATS criteria (SA-ERS/ATS). Among these patients, 87% were women, 48% obese, with a median Body Mass Index (BMI) of 29 kg·m2 (IQ 26-34), furthermore, 99% had symptoms of chronic rhinitis and 83% had symptoms of Gastroesophageal Reflux Disease (GERD). None of the 88 patients claimed to be current smokers. The most frequently corticosteroids were beclomethasone dipropionate (BDP) (88%) and budesonide (BUD) (69%). The majority of the evaluations reported adequate adherence (77%), however, the minority (0,6%) detected serious errors in inhalation techniques. The median Forced Expiratory Volume (FEV1) associated with post-bronchodilator test (post-BD) was 67% predicted (IQ 55-80). The median number of eosinophils in the peripheral blood was lower in patients with SA-ERS/ATS (258 cells/mm3 (IQ 116-321) than in the other patients studied [258 cells/mm3 (IQ 154-403)]. Gastroesophageal reflux symptoms were associated with a higher severity [OR = 2.2 95% CI (1.2-4.2)]. Conclusion In this group of patients, symptoms of GERD were associated with SA-ERS/ATS and eosinophil count > 260 cells/mm3 were associated 42% with less chance SA-ERS/ATS


Subject(s)
Humans , Male , Female , Adult , Asthma/diagnosis , Asthma/drug therapy , Asthma/epidemiology , Brazil/epidemiology , Bronchodilator Agents/therapeutic use , Beclomethasone/therapeutic use , Gastroesophageal Reflux/epidemiology , Rhinitis/epidemiology , Forced Expiratory Volume , Cross-Sectional Studies , Anti-Asthmatic Agents/therapeutic use , Budesonide/therapeutic use , Obesity/epidemiology
9.
Article in Chinese | WPRIM | ID: wpr-828658

ABSTRACT

OBJECTIVE@#To study the effect of intermittent versus daily inhalation of budesonide on pulmonary function and fractional exhaled nitric oxide (FeNO) in children with mild persistent asthma.@*METHODS@#A total of 120 children, aged 6-14 years, with mild persistent asthma who attended the hospital from January 2016 to January 2018 were enrolled. The children were divided into an intermittent inhalation group with 60 children (inhalation of budesonide 200 μg/day for 6 weeks when symptoms of asthma appeared) and a daily inhalation group with 60 children (continuous inhalation of budesonide 200 μg/day) by stratified randomization. The children were followed up at months 3, 6, 9, and 12 of treatment. The two groups were compared in terms of baseline data, changes in FeNO and pulmonary function parameters, amount of glucocorticoid used, number of asthma attacks, and asthma control.@*RESULTS@#At the start of treatment, there were no significant differences in baseline data, FeNO, and pulmonary function between the two groups (P>0.05). Over the time of treatment, FeNO gradually decreased and pulmonary function parameters were gradually improved in both groups (P0.05). Compared with the daily inhalation group, the intermittent inhalation group had a significantly lower amount of budesonide inhaled (P<0.05) and a significantly higher number of asthma attacks (P<0.05).@*CONCLUSIONS@#Intermittent inhalation and daily inhalation of budesonide can achieve the same level of asthma control in children with mild persistent asthma and both have no influence on the increases in body height and body weight. Daily inhalation of budesonide can produce a better efficiency in reduing FeNO and increasing FEV1%pred. Although intermittent inhalation can reduce the amount of glucocorticoid used, it may lead to a higher risk of asthma attacks.


Subject(s)
Administration, Inhalation , Adolescent , Asthma , Drug Therapy , Budesonide , Therapeutic Uses , Child , Forced Expiratory Volume , Humans , Nitric Oxide
10.
Arq. gastroenterol ; 56(4): 390-393, Oct.-Dec. 2019. tab
Article in English | LILACS | ID: biblio-1055169

ABSTRACT

ABSTRACT BACKGROUND: Drug-induced liver injury is still misunderstood in Brazil due to diagnostic difficulties or lack of reporting incidents. OBJECTIVE: To assess the frequency of adverse events related to the use of medicines in a primary healthcare unit, in a city locate southwestern of the state of Bahia, Brazil. METHODS: Prospective study conducted at the Primary Center for Specialized Health (CEMEA), February at August of 2013 in Vitoria da Conquista, Bahia, Brazil. Interviews were conducted with patients over 18 years old, and their clinical and laboratorial data were collected. The CIOMS scale was used to validate the cases. RESULTS: A total of 149 patients, mainly Afro-Brazilian women, received follow-up. Among these patients, three cases of hepatotoxicity were identified, and the medicines associated to drug-induced liver injuries were: nimesulide, budesonide and valacyclovir. CONCLUSION: Drug-induced liver injury is rare in primary healthcare units. It also allowed estimating the incidence of hepatotoxicity induced by allopathic medicines which are standardized by public healthcare authorities.


RESUMO CONTEXTO: As lesões hepáticas induzidas por drogas (DILI), ainda são mal compreendidas no Brasil devido a dificuldades diagnósticas ou à falta de relatos. OBJETIVO: Avaliar a frequência de eventos adversos relacionados ao uso de medicamentos em uma unidade básica de saúde, em uma cidade do sudoeste baiano. MÉTODOS: Estudo prospectivo realizado no período de fevereiro a agosto de 2013 em Vitória da Conquista, Bahia, Brasil. Entrevistas foram realizadas com pacientes maiores de 18 anos; os dados clínicos e laboratoriais foram coletados. A escala do CIOMS foi usada para avaliar causalidade dos casos. RESULTADOS: Um total de 149 pacientes, principalmente mulheres afro-brasileiras, receberam acompanhamento. Entre esses pacientes, três casos de hepatotoxicidade foram identificados e os medicamentos associados à DILI foram: nimesulida, budesonida e valaciclovir. CONCLUSÃO: DILI é raro em unidades básicas de saúde. Os três casos foram todos reversíveis, sem necessidade de internação hospitalar. Políticas de saúde que fomentam a prática da farmacovigilância são extremamente importantes para a prevenção e detecção de DILI.


Subject(s)
Humans , Male , Female , Adult , Sulfonamides/adverse effects , Drug Monitoring/methods , Budesonide/adverse effects , Chemical and Drug Induced Liver Injury/epidemiology , Valacyclovir/adverse effects , Primary Health Care , Brazil/epidemiology , Prospective Studies , Middle Aged
12.
Article in English | WPRIM | ID: wpr-776887

ABSTRACT

Astragalus membranaceus may be a potential therapy for childhood asthma but its driving mechanism remains elusive. The main components of A. membranaceus were identified by HPLC. The children with asthma remission were divided into two combination group (control group, the combination of budesonide and terbutaline) and A. membranaceus group (treatment group, the combination of budesonide, terbutaline and A. membranaceus). The therapeutic results were compared between two groups after 3-month therapy. Porcine peripheral blood mononuclear cells (PBMCs) were isolated from venous blood by using density gradient centrifugation on percoll. The levels of FoxP3, EGF-β, IL-17 and IL-23 from PBMCs and serum IgE were measured. The relative percentage of Treg/Th17 cells was determined using flow cytometry. The main components of A. membranaceus were calycosin-7-O-glucoside, isoquercitrin, ononin, calycosin, quercetin, genistein, kaempferol, isorhamnetin and formononetin, all of which may contribute to asthma therapy. Lung function was significantly improved in the treatment group when compared with a control group (P < 0.05). The efficacy in preventing the occurrence of childhood asthma was higher in the treatment group than the control group (P < 0.05). The levels of IgE, IL-17 and IL-23 were reduced significantly in the treatment group when compared with the control group, while the levels of FoxP3 and TGF-β were increased in the treatment group when compared with the control group (P < 0.05). A. membranaceus increased the percentage of Treg cells and reduced the percentage of Th17 cells. A. membranaceus is potential natural product for improving the therapeutic efficacy of combination therapy of budesonide and terbutaline for the children with asthma remission by modulating the balance of Treg/Th17 cells.


Subject(s)
Animals , Asthma , Drug Therapy , Allergy and Immunology , Astragalus propinquus , Chemistry , Budesonide , Cells, Cultured , Child , Child, Preschool , Cytokines , Metabolism , Drugs, Chinese Herbal , Pharmacology , Female , Humans , Immunologic Factors , Pharmacology , Leukocytes, Mononuclear , Metabolism , Lung , Physiology , Male , Swine , T-Lymphocytes, Regulatory , Cell Biology , Terbutaline , Th17 Cells , Cell Biology , Treatment Outcome
13.
Article in English | WPRIM | ID: wpr-762145

ABSTRACT

PURPOSE: Corticosteroids are regarded as the mainstay of medical treatment of eosinophilic chronic rhinosinusitis with nasal polyps (ECRSwNP). To date, a head-to-head comparison of the efficacy and safety of glucocorticoid preparations administered via different routes for the treatment of chronic rhinosinusitis with nasal polyps has not been reported. To compare the efficacy and safety of steroids administered via the oral, intranasal spray and transnasal nebulization routes in the management of ECRSwNP over a short course. METHODS: Overall, 91 patients with ECRSwNP were recruited prospectively and randomized to receive either oral methylprednisolone, budesonide inhalation suspension (BIS) via transnasal nebulization, or budesonide nasal spray (BNS) for 2 weeks. Nasal symptoms and polyp sizes were assessed before and after the treatment. Similarly, nasal polyp samples were evaluated for immunological and tissue remodeling markers. Serum cortisol levels were assessed as a safety outcome. RESULTS: Oral methylprednisolone and BIS decreased symptoms and polyp sizes to a significantly greater extent from baseline (P < 0.05) than BNS. Similarly, BIS and oral methylprednisolone significantly reduced eosinophils, T helper 2 cells, eosinophil cationic protein, interleukin (IL)-5, and expression of matrix metalloproteinases 2 and 9, and significantly increased type 1 regulatory T cells, IL-10, transforming growth factor-β, and tissue inhibitor of metalloproteinases 1 and 2 in nasal polyps to a greater extent than BNS. Post-treatment serum cortisol levels were significantly decreased by oral methylprednisolone compared to BIS or BNS, which did not significantly alter the cortisol levels. CONCLUSIONS: A short course of BIS transnasal nebulization is more efficacious compared to BNS in the management of ECRSwNP and is safer than oral methylprednisolone with respect to hypothalamic-pituitary-adrenal axis function.


Subject(s)
Adrenal Cortex Hormones , Budesonide , Eosinophil Cationic Protein , Eosinophils , Glucocorticoids , Humans , Hydrocortisone , Inhalation , Interleukin-10 , Interleukins , Matrix Metalloproteinases , Methylprednisolone , Nasal Polyps , Polyps , Prospective Studies , Steroids , T-Lymphocytes, Regulatory , Tissue Inhibitor of Metalloproteinases
14.
Article in Spanish | LILACS | ID: biblio-1100525

ABSTRACT

Introducción. La Enfermedad Pulmonar Obstructiva Crónica (EPOC) es una patología no transmisible, caracterizada por una limitación de flujo de aire en las vías respiratorias debido a una respuesta inmunológica anormal frente a partículas. Objetivo. Conocer la eficacia que tiene la budesonida/formoterol comparado con la fluticasona/salmeterol en la mejoría de la capacidad pulmonar en personas mayores de 40 años con Enfermedad Pulmonar Obstructiva Crónica. Materiales y métodos. Se realizó una revisión sistemática de documentos producidos entre el año 2000 y 2018 en distintas bases de datos, donde se incluyeron ensayos clínicos. Se identificaron cuatro artículos para el análisis final. Resultados. Durante la evaluación comparativa de budesonida con formoterol, los artículos muestran un total de 709 personas evaluadas, con un promedio de edad de 53,5 años. El 65,4 % eran varones, el 21 % manifestaba no haber consumido tabaco, todos con diagnóstico de Enfermedad Pulmonar Obstructiva Crónica moderada-severa, según la escala GOLD (Global Initiative For Chronic Obstrutive Lung Disease). Los estudios determinaron que al administrar budesonida/formoterol de 400/12 mcg y 320/9 mcg, los pacientes tuvieron una leve mejoría en el Volumen Espiratorio Forzado del primer segundo (VEF1). Solo dos pacientes presentaron efectos adversos. No obstante, para los resultados mencionados anteriormente no se encontró diferencias significativas. Conclusiones. El uso de budesonida/formoterol es eficaz al mejorar la capacidad ventilatoria pulmonar, disminuye el número de exacerbaciones anuales y genera un adecuado control de los síntomas, sin embargo, es igual de efectivo a la fluticasona/salmeterol.


Introduction. Chronic Obstructive Pulmonary Disease (COPD) is a not transmissible disease, characterized by a limitation of airflow in the respiratory tract, due to an abnormal immune response to particles. Objective. This article aims to show that the application of budesonide / formoterol improves lung capacity in people over 40 years with Chronic Obstructive Pulmonary Disease. Materials and methods. A systematic review was conducted in the period between 2000 and 2018 in different databases where clinical trials were included. Four articles were identified for the final analysis. Results. During the comparative evaluation of budesonide with formoterol, a total of 709 people were evaluated, with an average age of 53.5 years, 65.4% were male, 21% reported not having used tobacco, all with a diagnosis of moderate-severe Chronic Obstructive Pulmonary Disease according to the GOLD scale (Global Initiative For Chronic Obstrutive Lung Disease). The studies determined that when budesonide / formoterol of 400/12 mcg and 320/9 mcg was administered, the patients had a slight improvement in the Forced Expiratory Volume of the first second (FEV1). Only two patients presented adverse effects. However, for the results mentioned above no significant differences were found. Conclusions. The use of budesonide / formoterol is effective in improving pulmonary ventilatory capacity, decreases the number of annual exacerbations and generates adequate control of symptoms, however, it is equally effective in fluticasone / salmeterol.


Introdução. A Doença Pulmonar Obstrutiva Crônica (DPOC) é uma patologia não transmissível, caraterizada por uma limitação do fluxo de ar nas vias aéreas devido a uma resposta imune anormal contra partículas. Objetivo. Conhecer a eficiência que apresenta a budesonida/formoterol comparado com fluticasona/salmeterol na melhora da capacidade pulmonar em pessoas com mais de 40 anos com Doença Pulmonar Obstrutiva Crônica. Materiais e métodos. Foi realizada uma revisão sistemática dos documentos produzidos entre 2000 e 2018 em diferentes bancos de dados, onde foram incluídos ensaios clínicos. Quatro artigos foram identificados para a análise final. Resultados. Durante a avaliação comparativa de budesonida com formoterol, os artículos mostram um total de 709 pessoas avaliadas, com uma idade média de 53,5 anos. O 65,4 % eram do sexo masculino, o 21 % disseram que não usavam tabaco, todos diagnosticados com Doença Pulmonar Obstrutiva Crônica moderada a grave, de acordo com a escala GOLD (Global Initiative For Chronic Obstrutive Lung Disease). Os estudos determinaram que administrar budesonida/formoterol de 400/12 mcg e 320/9 mcg, os pacientes apresentaram uma leve melhora no Volume Expiratório Forçado no primeiro segundo (VEF1). Apenas dois pacientes tiveram efeitos adversos. No entanto, não foram encontradas diferenças significativas para os resultados mencionados acima. Conclusões. O uso de budesonida/formoterol é eficaz na melhora da capacidade ventilatória pulmonar, diminui o numero de exacerbações anuais e gera controle adequado dos sintomas, no entanto, é igualmente eficaz para a fluticasona/salmeterol.


Subject(s)
Pulmonary Disease, Chronic Obstructive , Pulmonary Emphysema , Efficacy , Budesonide , Bronchitis, Chronic , Salmeterol Xinafoate , Formoterol Fumarate , Fluticasone
15.
Gastroenterol. latinoam ; 30(supl.1): S35-S38, 2019. tab, ilus
Article in Spanish | LILACS | ID: biblio-1116420

ABSTRACT

Microscopic colitis (MC) is a clinical condition characterized by chronic watery diarrhea, normal colonic mucosa and characteristic histological findings. It is composed of two main entities: collagenous colitis (CC) and lymphocytic colitis (LC). Its incidence has been increasing, currently accounting for between 8 to 16% of studies for chronic diarrhea. It is more frequent in elderly women and is strongly associated with other autoimmune disorders. Its pathogenesis is not very well understood, but it supposes the immune activation secondary to the exposure of the colonic mucosa to different luminal antigens, mainly drugs. Management includes suspension of the potential causative agent and the use of anti-diarrheal medications. Oral budesonide has proven to be effective in induction and maintenance of remission, but with a high rate of recurrence upon discontinuation. Immune-modulators drugs such as azatioprine and metrotrexate have been tested in patients dependent to corticoids with variable results. Antibodies against tumor necrosis factors (TNF) are under studies, with promising results.


La colitis microscópica (CM) es una condición clínica caracterizada por diarrea crónica acuosa con mucosa colónica normal y hallazgos histológicos característicos. Está compuesta por dos entidades principales: la colitis colágena (CC) y la colitis linfocítica (CL). Su incidencia ha ido en aumento, siendo en la actualidad la responsable del 8 a 16% de los casos por diarrea crónica. Es más frecuente en mujeres de edad avanzada con una fuerte asociación a otras enfermedades autoinmunes. Su etiopatogenia no es del todo conocida, pero se cree juega un rol la activación inmune secundaria a la exposición de la mucosa colónica a diferentes antígenos luminales, principalmente fármacos. Dentro del manejo se incluye la suspensión del potencial agente causal y el uso de fármacos antidiarreicos. La budesonida oral ha demostrado alta efectividad en la inducción y mantención de la remisión, pero con una alta tasa de recurrencia al suspenderla. Fármacos inmunomoduladores como azatioprina y metrotrexato se han probado en pacientes corticodependendientes con resultados variables. El uso de anticuerpos monoclonales anti factor de necrosis tumoral (TNF) se encuentra en estudio, con resultados prometedores.


Subject(s)
Humans , Colitis, Microscopic/diagnosis , Colitis, Microscopic/drug therapy , Adrenal Cortex Hormones , Mesalamine/therapeutic use , Budesonide/therapeutic use , Colitis, Collagenous/diagnosis , Colitis, Collagenous/drug therapy , Colitis, Lymphocytic/diagnosis , Colitis, Lymphocytic/drug therapy , Diarrhea/etiology , Anti-Inflammatory Agents/therapeutic use , Antibodies, Monoclonal , Antidiarrheals/therapeutic use
16.
Article in English | WPRIM | ID: wpr-739383

ABSTRACT

The aim of this study was to examine the daily practice patterns of Symbicort® Maintenance and Reliever Therapy (SMART) in Korean asthmatic patients and to analyze clinical signs related to overuse. This study used an observational, multicenter, noninterventional, prospective, uncontrolled design for examining asthmatic patients prescribed SMART to assess the frequency and pattern of Symbicort® usage as a maintenance and reliever medication. The characteristics of patients showing signs of overuse (frequency of inhalation: 8 or more times per day) were also analyzed. Among the 1,518 patients analyzed, 1,292 (85.1%) completed the trial. The number of mean inhalations per day was 2.14±1.15; the number of patients who had at least 1 as needed usage (PRN) inhalation per day was 843 (55.5%); the mean frequency of PRN use was 0.25±0.67 inhalations per day. The number of patients who overused for at least 1 day was 260 (17.1%). In particular, young patients, patients with limited physical activity, and patients with nocturnal symptoms demonstrated high frequency of overuse. The frequency of overuse during SMART was not high in Korean asthmatic patients and the asthma status of follow-up outpatients improved overall. However, there is a need for careful education targeted toward younger patients, patients with limited physical activity, and patients with nocturnal symptoms owing to their tendency to frequently overuse.


Subject(s)
Asthma , Budesonide , Education , Follow-Up Studies , Formoterol Fumarate , Humans , Inhalation , Korea , Motor Activity , Outpatients , Prescription Drug Overuse , Prospective Studies
17.
Article in English | WPRIM | ID: wpr-718070

ABSTRACT

PURPOSE: Several markers for eosinophilic inflammation have been proposed to predict response to asthma treatment. However, definitive criteria for treatment decisions have not yet been established. We investigate a potentially useful relatively non-invasive biomarker, eosinophil-derived neurotoxin (EDN), to predict favorable responses to budesonide or montelukast, common treatment for children with asthma. METHODS: Young children (1 to 6 years old) were enrolled in this randomized, parallel, 2-group, open-label trial. Criteria for eligibility included: 1) being symptomatic during the run-in period; and 2) having a serum EDN (sEDN) level ≥ 53 ng/mL, with positive specific immunoglobulin E to house dust mite. Eligible patients were randomly placed into 2 groups: the BIS group received budesonide inhalation suspension (BIS) 0.5 mg once daily; the MONT group received montelukast 4 mg once daily. Ineligible patients were invited to receive montelukast 4 mg once daily (OBS group). Treatment period was 12 weeks. RESULTS: Asthma control days increased significantly in the BIS and MONT groups (P < 0.000) over the 12-week study period. There was no significant change in sEDN in the BIS group but there was a significant decrease in the MONT group (P < 0.000). Patients in the OBS group with high EDN levels (< 53 ng/mL) showed a significant decrease due to MONT treatment (P = 0.023). Rescue medication usage significantly decreased in the BIS and MONT groups (P < 0.000). CONCLUSIONS: EDN is a useful relatively non-invasive biomarker for predicting responses to montelukast and budesonide treatment of preschool children with beta2-agonist responsive recurrent wheeze and multiple-trigger wheeze (Trial registry at UMIN Clinical Trials Registry, UMIN000008335).


Subject(s)
Asthma , Biomarkers , Budesonide , Child , Child, Preschool , Eosinophil-Derived Neurotoxin , Eosinophils , Humans , Immunoglobulin E , Immunoglobulins , Inflammation , Inhalation , Pyroglyphidae
18.
Intestinal Research ; : 522-528, 2018.
Article in English | WPRIM | ID: wpr-717953

ABSTRACT

Symptomatic ulcerative colitis (UC) can be a chronic, disabling condition. Flares in disease activity are associated with many of the negative impacts of mild-to-moderate UC. Rapid resolution of flares can provide benefits to patients and healthcare systems. i Support Therapy–Access to Rapid Treatment (iSTART) introduces patient-centered care for mild-to-moderate UC. iSTART provides patients with the ability to self-assess symptomology and self-start a short course of second-line treatment when necessary. An international panel of experts produced consensus statements and recommendations. These were informed by evidence from systematic reviews on the epidemiology, mesalazine (5-ASA) treatment, and patient use criteria for second-line therapy in UC. Optimized 5-ASA is the first-line treatment in all clinical guidelines, but may not be sufficient to induce remission in all patients. Corticosteroids should be prescribed as second-line therapy when needed, with budesonide MMX® being a preferred steroid option. Active involvement of suitable patients in management of UC flares has the potential to improve therapy, with patients able to show good accuracy for flare self-assessment using validated tools. There is a place in the UC treatment pathway for an approach such as iSTART, which has the potential to provide patient, clinical and economic benefits.


Subject(s)
Adrenal Cortex Hormones , Budesonide , Colitis, Ulcerative , Consensus , Delivery of Health Care , Epidemiology , Humans , Mesalamine , Patient-Centered Care , Self-Assessment , Ulcer
19.
Rev. cuba. pediatr ; 89(2): 165-176, abr.-jun. 2017. tab
Article in Spanish | LILACS | ID: biblio-845092

ABSTRACT

Introducción: la terapia primaria en la crisis de asma aguda, incluye administración de oxígeno, uso de ß2-agonistas por vía inhalada y la administración de esteroides sistémicos. Las ventajas que se citan sobre el uso de los esteroides inhalados serían, su rápido inicio de acción y su buen perfil de seguridad, en contraposición a los esteroides sistémicos. Objetivo: evaluar la utilidad de los corticoides inhalados en el tratamiento de la crisis de asma aguda en niños mayores de 2 años. Métodos: se realizó un estudio prospectivo, transversal, experimental, aleatorizado, de eficacia clínica; la selección se realizó por medio de una tabla de números aleatorios, y se incluyeron tres grupos: el I recibió terapia estándar, el II la sustitución del esteroide sistémico por el inhalado y el III combinó a la terapia estándar el esteroide inhalado. El análisis estadístico se realizó por medio de ANOVA y chi cuadrado con una p< 0,05 como significativa. Resultados: se estudiaron 165 pacientes, los tres grupos de tratamiento mejoraron la escala de severidad inicial. Los pacientes que recibieron esteroides inhalados adicionados a la terapia estándar, tuvieron 73 por ciento de posibilidades de no ser hospitalizados, 27 por ciento de posibilidades de reducir el riesgo de hospitalizaciones y de cada 100 pacientes tratados con la combinación, se pudieran prevenir 8 hospitalizaciones(AU)


Subject(s)
Humans , Child, Preschool , Child , Adrenal Cortex Hormones/therapeutic use , Status Asthmaticus/drug therapy , Budesonide/therapeutic use , Cross-Sectional Studies , Prospective Studies
20.
Pakistan Journal of Medical Sciences. 2017; 33 (4): 997-1001
in English | IMEMR | ID: emr-188628

ABSTRACT

Objective: To investigate the clinical effect of budesonide nebulization in the treatment of ventilator associated pneumonia of newborns and its safety


Methods: Forty-five newborns who had ventilator associated pneumonia and were admitted into the Binzhou People's Hospital between May 2014 and May 2015 were selected and included as an observation group. Moreover, another forty-five newborns who had ventilator associated pneumonia but did not undergo budesonide treatment in 2014 were randomly selected and included as a control group. Patients in the observation group were given budesonide suspension nebulization in addition to the conventional treatment. The evaluation indicators for therapeutic effect were compared between the two groups. The changes of head circumference, height and weight and death rate were observed by follow up after treatment


Results: The mechanical ventilation time, time for recovering from chest X-ray scan and hospitalization time of patients in the observation group were shorter than that of the control group, and the difference had statistical significance [P<0.05]


The oxygen index of the patients in the observation group was significantly improved compared to that of the control group, and the difference had statistical significance [P<0.05]. Patients in the two groups were followed up for six months after discharge. The head circumference, height and weight of the patients in the observation group in the 3[rd] and 6[th] month were compared to those of the control group, suggesting no significant differences [P>0.05]


The cumulative death rate of the observation group in the 6th month after treatment was significantly lower than that of the control group, and the difference had statistical significance [P<0.05]


Conclusion: Treating ventilator associated pneumonia of newborns with budesonide nebulization can effectively shorten mechanical ventilation time, time for recovering from chest X-ray scan and hospitalization time, improve pulmonary diffusion function and reduce the death rate, without affecting the growth and development of patients in the future


Subject(s)
Humans , Female , Male , Infant, Newborn , Infant , Budesonide/therapeutic use , Nebulizers and Vaporizers , Infant, Newborn , Radiography, Thoracic
SELECTION OF CITATIONS
SEARCH DETAIL