ABSTRACT
OBJECTIVE@#To investigate the effect of pirfenidone for reducing urethral stricture following urethral injury in rats and explore the possible mechanism.@*METHODS@#Thirty male SD rats were randomly assigned into negative control group, positive control group and pirfenidone group (n=10). In pirfenidone and positive control groups, the rats were subjected to incision of the posterior urethral cavernous body followed by daily intraperitoneal injection of pirfenidone (100 mg/kg) and an equivalent volume of solvent, respectively. The rats in the negative control group were given intraperitoneal injections of solvent without urethral injury. At two weeks after modeling, retrograde urethrography was performed for observing urethral stricture, and the injured urethral tissues were harvested for HE staining, Masson staining, immunohistochemical staining and Western blotting for detecting the protein expressions of α-SMA and TGF-β1. The mRNA expressions of the inflammatory factors TNF-α, IL-6, and IL-1β were detected using qRT-PCR.@*RESULTS@#The body weight of the rats in pirfenidone group was significantly decreased compared with that in the other two groups (P < 0.05). Retrograde urethrography showed significant narrowing of the urethra in the positive control group but not in the pirfenidone group. HE staining of the injured urethral tissues showed obvious proliferation of urethral epithelial cells with narrow urethral cavity and increased inflammatory cells in positive control group. The pathological findings of the urethra were similar between pirfenidone group and the negative control group. Masson staining revealed obviously reduced collagen fibers and regular arrangement of the fibers in pirfenidone group as compared to the positive control group. Compared with those in the negative control group, the expressions of α-SMA and TGF-β1 were significantly increased in the positive control group, and pirfenidone treatment significantly inhibited their expressions (P < 0.05 or 0.01). Pirfenidone also significantly inhibited the mRNA expressions of TNF-α, IL-6, and IL-1β in the injured urethral tissue (P < 0.05 or 0.01).@*CONCLUSION@#Pirfenidone can prevent urethral fibrosis and stricture after urethral injury possibly by inhibiting the TGF-β1 pathway and inflammatory response.
Subject(s)
Animals , Female , Humans , Male , Rats , Interleukin-6/metabolism , Pyridones/pharmacology , RNA, Messenger/metabolism , Rats, Sprague-Dawley , Solvents , Transforming Growth Factor beta1/metabolism , Tumor Necrosis Factor-alpha/metabolism , Urethral Stricture/pathologyABSTRACT
We report a 68-year-old woman with a history of idiopathic pulmonary fibrosis, who had immediate skin reactions associated with the use of pirfenidone in two opportunities. In the evaluation by immunology, an allergy to pirfenidone was diagnosed. Given the urgent need for the drug, a desensitization procedure was started. The dose of the medication was increased progressively, previous premedication with cetirizine, ranitidine and montelukast. After this procedure the patient was able to tolerate the treatment with pirfenidone without cutaneous reactions.
Subject(s)
Humans , Female , Aged , Anti-Inflammatory Agents, Non-Steroidal/therapeutic use , Idiopathic Pulmonary Fibrosis , Pyridones/adverse effectsABSTRACT
SUMMARY Anaplastic thyroid carcinoma is the rarest tumor of the thyroid gland, representing less than 2% of clinically recognized thyroid cancers. Typically, it has an extremely rapid onset, fatal outcomes in most cases, and a median overall survival of 3 to 10 months despite aggressive multidisciplinary management. The presence of targetable mutations in anaplastic thyroid carcinoma patients is an opportunity for treatment when conventional therapeutics approaches are not effective, a frequent situation in the majority of patients. We present our experience in the management of a patient with unresectable anaplastic thyroid cancer who had a remarkable and rapid response to treatment with dabrafenib and trametinib during the COVID-19 pandemic. After four weeks of dabrafenib 150 mg twice daily plus trametinib 2 mg daily, he showed a dramatic reduction of the cervical mass around 90%. Nearly eight weeks under treatment with dabrafenib plus trametinib, the patient remains with minimal locoregional disease without distant metastases.
Subject(s)
Humans , Male , Thyroid Neoplasms/drug therapy , Thyroid Carcinoma, Anaplastic/genetics , Thyroid Carcinoma, Anaplastic/drug therapy , COVID-19 , Oximes , Pyridones , Pyrimidinones , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Proto-Oncogene Proteins B-raf/genetics , Pandemics , SARS-CoV-2 , Imidazoles , MutationABSTRACT
ABSTRACT Dolutegravir (DTG) is amongst the most prescribed antiretrovirals worldwide and is recommended as first line regimen in most HIV treatment guidelines. Its use, although infrequently, had been associated to an increased chance of neural tube defects (NTD) in Botswana, Africa. Herein we describe two cases of NTD in women who conceived while taking DTG as part of their antiretroviral treatment in the city of Porto Alegre, Brazil.
Subject(s)
Humans , Female , HIV Infections/drug therapy , Neural Tube Defects , Oxazines , Piperazines , Pyridones , Brazil , Africa , Heterocyclic Compounds, 3-RingABSTRACT
ABSTRACT MEK- and BRAF-inhibitors trametinib and dabrafenib are successfully used for BRAF-mutated, metastasizing melanoma, but these compounds may induce side effects. We report a 50 years old female with BRAF-mutated metastasizing melanoma who received trametinib (2 mg/d) and dabrafenib (200 mg/d) after using interferon without benefit. Shortly after starting trametinib/dabrafenib, she experienced an inability to abduct the left eye. Eight days after starting this therapy the patient experienced loss of appetite, vomiting, diarrhea, vertigo, and fever of 40°C. Two days later she experienced visual loss, requiring permanent support for her daily activities. Two further days later myoglobinuria appeared in the absence of myalgias or muscle weakness but accompanied by marked tiredness and inactivity. She could not eat or drink during four days prior to admission. The patient suspected an adverse effect of trametinib/dabrafenib and discontinued it 2 days prior to admission. Thereafter, she experienced an almost complete remission of the deficits except for ocular muscle weakness and visual impairment.
Los inhibidores de MEX and BRAF como trametinib y dabrafenib se usan en el melanoma metastásico con mutación BRAF, pero pueden tener efectos secundarios. Informamos una paciente de 50 años con un melanoma metastásico con la mutación BRAF que recibió trametinib (2 mg/día) y dabrafenib (200 mg/día) después de usar interferón sin beneficio. Después de iniciar esta terapia la paciente notó una incapacidad de abducir el ojo izquierdo. Ocho días después de iniciar el tratamiento, tuvo falta de apetito, vómitos, diarrea, vértigo y fiebre de 40°C. Dos días después notó pérdida de su agudeza visual, requiriendo asistencia para efectuar sus actividades de vida diaria. Dos días después apareció coluria, en ausencia de mialgias o debilidad muscular, pero acompañadas de fatiga. Ella no pudo comer o tomar líquidos por cuatro días antes de ingresar al hospital. La paciente sospechó que estaba experimentando efectos secundarios de los medicamentos y los suspendió dos días antes del ingreso, experimentando una casi completa remisión de sus síntomas, con excepción de la debilidad de musculatura ocular y déficit visual.
Subject(s)
Female , Humans , Middle Aged , Rhabdomyolysis , Skin Neoplasms , Renal Insufficiency , Oximes , Pyridones/adverse effects , Pyrimidinones , Rhabdomyolysis/chemically induced , Skin Neoplasms/drug therapy , Vision Disorders/chemically induced , Antineoplastic Combined Chemotherapy Protocols , Proto-Oncogene Proteins B-raf/genetics , Imidazoles , MutationABSTRACT
Las terapias target constituyen hoy en día una alternativa terapéutica cada vez más utilizada para el manejo de pacientes con melanoma metastásico. Sin embargo, se han descrito múltiples efectos farmacológicos adversos asociados a su uso, siendo los cutáneos los de mayor prevalencia. Se presenta el caso de un hombre de 55 años con diagnóstico de melanoma cutáneo metastásico etapa IV, BRAFV600E mutado, en tratamiento con dabrafenib/trametinib que consultó por desarrollo de lesiones nodulares eritematosas sensibles en extremidades superiores e inferiores, asociadas a sensación febril durante el curso del tratamiento. Se descartó alguna infección sobreagregada. Se realizó una biopsia de las lesiones cutáneas, con confirmación diagnóstica histopatológica de una paniculitis mixta de predominio septal, granulomatosa y con vasculitis leucocitoclástica. La paniculitis asociada a esta terapia ha sido descrita en la literatura y se ha considerado un efecto farmacológico inmunomediado adverso, relacionándose a un mejor pronóstico para el melanoma metastásico en tratamiento. Por lo tanto, así como en el caso presentado, se evita la suspensión del fármaco y se asocia terapia sintomática en caso de mayores molestias del paciente. Es de alta relevancia para el dermatólogo conocer e interpretar adecuadamente este efecto adverso farmacológico, y así indicar el manejo más adecuado para el paciente.
Target therapies are currently a therapeutic option increasingly used for the management of patients with metastatic melanoma. However, there are multiple adverse pharmacological effects associated with their use that have been described. Cutaneous adverse reactions are the most frequent. We report the case of a 55-year-old man with a diagnosis of stage IV BRAFV600E-mutated metastatic cutaneous melanoma undergoing treatment with dabrafenib/trametinib, who consulted due to the development of erythematous nodular lesions in the upper and lower limbs associated with febrile sensation during the course of treatment. Infection was ruled out and a biopsy of the skin lesions was done, which provided the histopathological confirmation of a predominantly septal, granulomatous with leukocytoclastic vasculitis, mixed panniculitis. Panniculitis associated with this therapy has been described in the literature and has been considered an immune-mediated pharmacological adverse effect. It is considered to be related to a better prognosis in the treatment of metastatic melanoma. Consequently, as shown in this case report, target therapy should not be discontinued and symptomatic medication should be given to alleviate patient discomfort. The dermatologist should know and properly interpret this adverse effect and prescribe the most appropriate management for the patient.
Subject(s)
Humans , Male , Middle Aged , Panniculitis/chemically induced , Antineoplastic Combined Chemotherapy Protocols/adverse effects , Molecular Targeted Therapy/methods , Oximes/administration & dosage , Pyridones/administration & dosage , Pyrimidinones/administration & dosage , Skin Neoplasms/drug therapy , Panniculitis/diagnosis , Panniculitis/therapy , Antineoplastic Combined Chemotherapy Protocols/administration & dosage , Molecular Targeted Therapy/adverse effects , Dermatologists , Imidazoles/administration & dosage , Melanoma/drug therapyABSTRACT
ABSTRACT Idiopathic pulmonary fibrosis (IPF) is a form of chronic interstitial lung disease of unknown cause, which predominantly affects elderly men who are current or former smokers. Even though it is an uncommon disease, it is of great importance because of its severity and poor prognosis. In recent decades, several pharmacological treatment modalities have been investigated for the treatment of this disease, and the classic concepts have therefore been revised. The purpose of these guidelines was to define evidence-based recommendations regarding the use of pharmacological agents in the treatment of IPF in Brazil. We sought to provide guidance on the practical issues faced by clinicians in their daily lives. Patients of interest, Intervention to be studied, Comparison of intervention and Outcome of interest (PICO)-style questions were formulated to address aspects related to the use of corticosteroids, N-acetylcysteine, gastroesophageal reflux medications, endothelin-receptor antagonists, phosphodiesterase-5 inhibitors, pirfenidone, and nintedanib. To formulate the PICO questions, a group of Brazilian specialists working in the area was assembled and an extensive review of the literature on the subject was carried out. Previously published systematic reviews with meta-analyses were analyzed for the strength of the compiled evidence, and, on that basis, recommendations were developed by employing the Grading of Recommendations Assessment, Development and Evaluation approach. The authors believe that the present document represents an important advance to be incorporated in the approach to patients with IPF, aiming mainly to improve its management, and can become an auxiliary tool for defining public policies related to IPF.
RESUMO A fibrose pulmonar idiopática (FPI) é uma forma de pneumopatia intersticial crônica fibrosante de causa desconhecida, que acomete preferencialmente homens idosos, com história atual ou pregressa de tabagismo. Mesmo sendo uma doença incomum, ela assume grande importância devido a sua gravidade e prognóstico reservado. Nas últimas décadas, diversas modalidades terapêuticas farmacológicas foram investigadas para o tratamento dessa doença, de tal modo que conceitos clássicos vêm sendo revisados. O objetivo destas diretrizes foi definir recomendações brasileiras baseadas em evidências em relação ao emprego de agentes farmacológicos no tratamento da FPI. Procurou-se fornecer orientações a questões de ordem prática, enfrentadas pelos clínicos no seu cotidiano. As perguntas PICO (acrônimo baseado em perguntas referentes aos Pacientes de interesse, Intervenção a ser estudada, Comparação da intervenção e Outcome [desfecho] de interesse) abordaram aspectos relativos ao uso de corticosteroides, N-acetilcisteína, tratamento medicamentoso do refluxo gastroesofágico, inibidores dos receptores da endotelina, inibidores da fosfodiesterase-5, pirfenidona e nintedanibe. Para a formulação das perguntas PICO, um grupo de especialistas brasileiros atuantes na área foi reunido, sendo realizada uma extensa revisão bibliográfica sobre o tema. As revisões sistemáticas com meta-análises previamente publicadas foram analisadas quanto à força das evidências compiladas e, a partir daí, foram concebidas recomendações seguindo a metodologia Grading of Recommendations Assessment, Development and Evaluation. Os autores acreditam que o presente documento represente um importante avanço a ser incorporado na abordagem de pacientes com FPI, objetivando principalmente favorecer seu manejo, e pode se tornar uma ferramenta auxiliar na definição de políticas públicas relacionadas à FPI.
Subject(s)
Humans , Male , Aged , Practice Guidelines as Topic , Idiopathic Pulmonary Fibrosis/drug therapy , Acetylcysteine/therapeutic use , Pyridones/therapeutic use , Brazil , Indoles/therapeutic use , Anti-Inflammatory Agents/therapeutic useABSTRACT
La historia natural de la fibrosis pulmonar idiopática (FPI) es heterogénea e impredecible. Aunque el curso de la enfermedad, sin tratamiento, es inevitablemente progresiva y de mal pronóstico. Los tratamientos históricos han variado desde corticosteroides e inmunosupresores (azatioprina, ciclofosfamida), hasta colchicina y N-acetilcisteína. En las últimas décadas se han realizado múltiples ensayos terapéuticos fallidos. Sin embargo, desde el año 2014 en los Estados Unidos, Europa y otros países, dos drogas, denominadas terapia antifibrótica o modificadoras de la enfermedad, están aprobadas para el tratamiento de la FPI: nintedanib y pirfenidona. La terapia antifibrótica, tiene como objetivo enlentecer en hasta 50% la declinación de la función pulmonar en pacientes con FPI.
The natural history of idiopathic pulmonary fibrosis (IPF) is heterogeneous and unpredictable. The course of the disease without treatment, is inevitably progressive, with a poor prognosis. Historical treatments have varied from corticosteroids and immunosuppressants (azathioprine, cyclophosphamide), to colchicine and N-acetylcysteine. In the last decades, multiple failed therapeutic trials have been carried out. However, since 2014 in the United States, Europe and other countries, two drugs, called antifibrotic therapy or disease modifiers, are approved for the treatment of IPF: nintedanib and pirfenidone. The purpose of antifibrotic therapy is to slow down the decline in lung function in patients with IPF up to 50%.
Subject(s)
Humans , Pyridones/therapeutic use , Idiopathic Pulmonary Fibrosis/drug therapy , Immunosuppressive Agents/therapeutic use , Indoles/therapeutic useABSTRACT
Abstract Bidens pilosa L. is a heterocarpic weed species with two cypselae types that present morpho-physiological differences, being the peripheral type smaller and slower to germinate than the central one. We aimed to verify how the germination mechanism varied between types. We focused on two mechanisms: (1) pericarp constraints (physical and chemical) and (2) hormonal stimulation (Abcisic acid [ABA] and Gibberellin [GA]). Both cypselae types are physically constrained by the pericarp, for when it is excised both seed types increase their germination, but behavioral differences still remain. The pericarp of the peripheral type also has chemical inhibitors that effectively inhibited germination of the intact central cypsela. To test the hormonal effects, we focused on the ABA:GA control. Both cypselae responded to an exogenous ABA concentration gradient, however there is no variation between types on the sensitivity to it. Also, both cypselae types were indifferent to Fluridone (ABA inhibitor), which indicates that the dormancy is not maintained by de novo ABA synthesis. Cypselae types had different sensitivity to an exogenous GA3 gradient, the central type being more sensitive to the treatment than the peripheral one. But when the endogenous GA synthesis was blocked by Paclobutrazol, both types responded equally to same GA3 concentrations. This indicates that endogenous GA synthesis may be related to differences observed on germination of cypselae types. To conclude, seed types differ on their growth potential to overcome the pericarp resistance: while the inhibitor in the peripheral pericarp reduces growth potential, GA increases it.
Resumo Bidens pilosa L. é uma espécie de planta daninha heterocarpica com dois tipos de cipselas que possuem diferenças morfofisiológicas, sendo o tipo periférico de menor tamanho e com germinação lenta se comparado com o central. Nosso objetivo foi verificar como o mecanismo de germinação varia entre os tipos. Focamos em dois mecanismos: (1) restrição causada pelo pericarpo (física e química) e (2) estímulo hormonal (Ácido abscísico [ABA] e Giberelina [GA]). Os tipos de cipselas são fisicamente limitados pelo pericarpo, pois quando ambos os tipos de sementes são excisados há um aumento na germinação, contudo as diferenças no processo se mantém. O pericarpo do tipo periférico ainda possui inibidores que efetivamente retardam a germinação das cipselas centrais intactas. Para testar os efeitos hormonais, nós focamos no controle pelo ABA:GA. Ambas cipselas responderam ao gradiente de concentração de ABA exógeno, contudo não houve variação na sensibilidade entre os tipos. Ainda, ambos tipos de cipselas foram indiferentes à Fluoridona (inibidor de ABA), que indica que a dormência não é mantida pela nova síntese de ABA. Tipos de cipselas apresentam diferentes sensibilidades ao gradiente exógeno de GA3, com o tipo central sendo mais sensível ao tratamento que o periférico. Mas quando a síntese endógena de GA foi bloqueada pelo Paclobutrazol, ambos os tipos responderam de forma similar às concentrações de GA 3. Isso indica que a síntese de GA endógena pode estar relacionada com a diferença observada na germinação dos dois tipos de cipselas. Para concluir, os tipos de sementes diferem no potencial para superar a resistência do pericarpo, sendo o inibidor no pericarpo da cipsela periférica o redutor do potencial de crescimento, enquanto a GA aumenta esse potencial.
Subject(s)
Plant Growth Regulators/pharmacology , Pyridones/pharmacology , Abscisic Acid/pharmacology , Germination/physiology , Bidens/physiology , Herbicides/pharmacology , Seeds/growth & development , Seeds/drug effects , Germination/drug effects , Bidens/drug effectsABSTRACT
This study aimed to investigate the mechanism of fluorofenidone (AKF-PD) in treating renal interstitial fibrosis in rats with unilateral urinary obstruction (UUO). Thirty-two male Sprague-Dawley rats were randomly divided into sham, UUO, UUO + enalapril, and UUO + AKF-PD groups. All rats, except sham, underwent left urethral obstruction surgery to establish the animal model. Rats were sacrificed 14 days after surgery, and serum was collected for renal function examination. Kidneys were collected to observe pathological changes. Immunohistochemistry was performed to assess collagen I (Col I) protein expression, and terminal deoxynucleotidyl transferase-mediated nick end-labeling staining to observe the apoptosis of renal tubular epithelial cells. The expression of Fas-associated death domain (FADD), apoptotic protease activating factor-1 (Apaf-1), and C/EBP homologous protein (CHOP) proteins was evaluated by immunohistochemistry and western blot analysis. AKF-PD showed no significant effect on renal function in UUO rats. The pathological changes were alleviated significantly after enalapril or AKF-PD treatment, but with no significant differences between the two groups. Col I protein was overexpressed in the UUO group, which was inhibited by both enalapril and AKF-PD. The number of apoptotic renal tubular epithelial cells was much higher in the UUO group, and AKF-PD significantly inhibited epithelial cells apoptosis. The expression of FADD, Apaf-1, and CHOP proteins was significantly upregulated in the UUO group and downregulated by enalapril and AKF-PD. In conclusion, AKF-PD improved renal interstitial fibrosis by inhibiting apoptosis of renal tubular epithelial cells in rats with UUO.
Subject(s)
Animals , Male , Pyridones/pharmacology , Ureteral Obstruction/pathology , Apoptosis/drug effects , Epithelial Cells/drug effects , Kidney Diseases/pathology , Pyridones/metabolism , Blood Urea Nitrogen , Fibrosis , Angiotensin-Converting Enzyme Inhibitors/metabolism , Angiotensin-Converting Enzyme Inhibitors/pharmacology , Enalapril/metabolism , Enalapril/pharmacology , Random Allocation , Rats, Sprague-Dawley , Creatinine/blood , Collagen Type I/drug effects , Collagen Type I/metabolism , Disease Models, Animal , Transcription Factor CHOP/drug effects , Apoptotic Protease-Activating Factor 1/drug effects , Apoptotic Protease-Activating Factor 1/metabolism , Fas-Associated Death Domain Protein/drug effects , Fas-Associated Death Domain Protein/metabolismABSTRACT
Abstract: We evaluated adherence to highly active antiretroviral therapy (HAART) and its associated factors according to the type of regimen in patients initiating treatment in Belo Horizonte, Minas Gerais State, Brazil. We measured adherence using the eight items Morisky Therapeutic Adhesion Scale (MMAS-8) and compared the use of "backbone" tenofovir/lamivudine plus efavirenz one tablet once-daily (STR) or dolutegravir in multi-tablet once-daily (MTR-DTG), or other multi-tablet regimens (MTR-other). We conducted a multivariate logistic regression analysis to address factors associated with adherence. A total of 393 patients were included, 254 used STR, 106 MTR-DTG, and 33 MTR-other. The overall adhesion rate was 44.8% (95%CI: 39.4; 50.1), 50% for MTR-DTG, 43.3% for STR and 39.4% for MTR-other. Multivariate analysis showed a higher chance of adherence among patients using MTR-DTG, those who received and understood counseling about their treatment and with a higher quality of life. Prior use of illicit drugs in the lifetime was associated with poorer adherence. Overall adherence was low, highlighting the need for strategies focusing on counseling about medicines and substance use. Pill burden was not an issue for patients using MTR-DTG once-daily, who achieved better results.
Resumo: Avaliamos a adesão à terapia antirretroviral (TARV) e fatores associados de acordo com o tipo de esquema em pacientes no início do tratamento em Belo Horizonte, Minas Gerais, Brasil. Mensuramos a adesão com a Escala de Adesão Terapêutica de Morisky, de oito itens (MMAS-8), e comparamos o uso de tenofovir/lamivudina com efavirenz, um comprimido uma vez ao dia (STR), ou dolutegravir em múltiplos comprimidos uma vez ao dia (MTR-DTG), com outros esquemas com múltiplos comprimidos ao dia (MTR-outros). Conduzimos uma análise de regressão logística multivariada para avaliar os fatores associados à adesão. Foram incluídos 393 pacientes: 254 em uso de STR, 106 MTR-DTG e 33 MTR-outros. A taxa global de adesão foi 44,8% (IC95%: 39,4; 50,1), sendo 50% para MTR-DTG, 43,3% para STR e 39,4% para MTR-outros. A análise multivariada mostrou chances maiores de adesão em pacientes em uso de MTR-DTG, pacientes que haviam recebido e compreendido o aconselhamento sobre o tratamento e pacientes com melhor qualidade de vida. Uso anterior de drogas ilícitas em qualquer período da vida está associada à pior adesão. A adesão global foi baixa, enfatizando a necessidade de estratégias focadas no aconselhamento sobre medicamentos e uso de drogas. A quantidade de comprimidos não foi um problema para pacientes em uso de MTR-DTG uma vez ao dia, os quais alcançaram melhores taxas de adesão.
Resumen: Evaluamos la adherencia a la terapia antirretroviral altamente activa (TARAA) y sus factores asociados, según el tipo de tratamiento en pacientes que comenzaron su tratamiento en Belo Horizonte, Minas Gerais, Brasil. La adherencia se mensuró por la Escala de Adhesión Terapéutica de Morisky, de ocho ítems (MMAS-8), y se comparó el uso del "eje" tenofovir/lamivudina, además de un comprimido de efavirenz una vez al día (STR) o dolutegravir con varios comprimidos una vez al día (MTR-DTG), u otros tratamientos con múltiples comprimidos (MTR-otros). Se realizó un análisis multivariado de regresión logística para evaluar los factores asociados a la adherencia. Se incluyeron un total de 393 pacientes, 254 usaron STR, 106 MTR-DTG, y 33 MTR-Otros. La tasa de adherencia general fue de un 44,8% (95%CI: 39,4; 50,1), 50% en el MTR-DTG, 43,3% en el STR y 39,4% en el MTR-otros. El análisis multivariado mostró una probabilidad más alta de adherencia entre pacientes usando MTR-DTG, quienes recibieron y comprendieron las orientaciones acerca de sus tratamientos y los que disfrutaban de una calidad mejor de vida. El consumo previo de drogas ilícitas a lo largo de la vida estuvo asociado con una adherencia más escasa. La adherencia general fue baja y resalta la necesidad de estrategias que se enfoquen en brindar orientación sobre el uso de la medicación y de sustancias. El número de comprimidos no fue un problema para los pacientes que tomaban MTR-DTG una vez al día, que obtuvieron mejores resultados.
Subject(s)
Humans , Male , Female , Adult , HIV Infections/drug therapy , HIV Integrase Inhibitors/administration & dosage , Anti-Retroviral Agents/therapeutic use , Medication Adherence/statistics & numerical data , Heterocyclic Compounds, 3-Ring/administration & dosage , Oxazines , Piperazines , Pyridones , Quality of Life , Brazil , Viral Load , Educational Status , Self ReportABSTRACT
Direct oral anticoagulants (DOACs), including the direct thrombin inhibitor dabigatran and the direct factor Xa inhibitors rivaroxaban, apixaban and edoxaban have at least comparable efficacy as vitamin K antagonists along with a better safety profile, reflected by a lower incidence of intracranial hemorrhage. Specific reversal agents have been developed in recent years. Namely, idarucizumab, a specific antidote for dabigatran, is currently approved in most countries. Andexanet, which reverses factor Xa inhibitors, has been recently approved by the FDA, and ciraparantag, a universal antidote targeted to reverse all DOACs, is still under investigation. In this review we provide an update on the pharmacology of DOACs, the risk of hemorrhagic complications associated with their use, the measurement of their anticoagulant effect and the reversal strategies in case of DOAC-associated bleeding.
Subject(s)
Humans , Blood Coagulation Factors/therapeutic use , Antithrombins/administration & dosage , Antithrombins/adverse effects , Antibodies, Monoclonal, Humanized/therapeutic use , Hemorrhage/chemically induced , Hemorrhage/therapy , Pyrazoles/administration & dosage , Pyrazoles/adverse effects , Pyridines/administration & dosage , Pyridines/adverse effects , Pyridones/administration & dosage , Pyridones/adverse effects , Thiazoles/administration & dosage , Thiazoles/adverse effects , Administration, Oral , Risk Factors , Rivaroxaban/administration & dosage , Rivaroxaban/adverse effects , Dabigatran/administration & dosage , Dabigatran/adverse effects , Antidotes/therapeutic useABSTRACT
ABSTRACT Fifty seven soil-borne actinomycete strains were assessed for the antibiotic production. Two of the most active isolates, designed as Streptomyces ST-13 and DK-15 exhibited a broad range of antimicrobial activity and therefore they were selected for HPLC fractionation against the most suppressed bacteria Staphylococcus aureus (ST-13) and Chromobacterium violaceum (DK-15). LC/MS analysis of extracts showed the presence of polyketides factumycin (DK15) and tetrangomycin (ST13). The taxonomic position of the antibiotic-producing actinomycetes was determined using a polyphasic approach. Phenotypic characterization and 16S rRNA gene sequence analysis of the isolates matched those described for members of the genus Streptomyces. DK-15 strain exhibited the highest 16S rRNA gene sequence similarity to Streptomyces globosus DSM-40815 (T) and Streptomyces toxytricini DSM-40178 (T) and ST-13 strain to Streptomyces ederensis DSM-40741 (T) and Streptomyces phaeochromogenes DSM-40073 (T). For the proper identification, MALDI-TOF/MS profile of whole-cell proteins led to the identification of S. globosus DK-15 (accession number: KX527570) and S. ederensis ST13 (accession number: KX527568). To our knowledge, there is no report about the production of these antibiotics by S.globosus and S. ederensis, thus isolates DK15 and ST13 identified as S. globosus DK-15 and S.ederensis ST-13 can be considered as new sources of these unique antibacterial metabolites.
Subject(s)
Streptomyces/isolation & purification , Streptomyces/metabolism , Anti-Bacterial Agents/biosynthesis , Phylogeny , Pyridones/metabolism , Soil Microbiology , Streptomyces/classification , Streptomyces/genetics , Benz(a)Anthracenes/metabolism , DNA, Bacterial/genetics , Bacterial Typing TechniquesSubject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Young Adult , Pyrazoles/adverse effects , Pyridones/adverse effects , Vitamin K/antagonists & inhibitors , Venous Thromboembolism/prevention & control , Hemorrhage/epidemiology , Anticoagulants/adverse effects , Pyrazoles/therapeutic use , Pyridones/therapeutic use , Randomized Controlled Trials as Topic , Global Health , Incidence , Risk Factors , Factor Xa Inhibitors/adverse effects , Factor Xa Inhibitors/therapeutic use , Hemorrhage/chemically induced , Anticoagulants/therapeutic useABSTRACT
OBJECTIVES: Chronic thromboembolic pulmonary hypertension is one of the most prevalent forms of pulmonary hypertension and is a major complication of acute pulmonary embolism. One mainstay of chronic thromboembolic pulmonary hypertension treatment is lifelong anticoagulation. The recent advent of direct oral anticoagulants for acute pulmonary embolism treatment has provided a viable and effective alternative for treating this condition. However, little is known about the efficacy of this new class of drugs for treating chronic thromboembolic pulmonary hypertension. We aimed to evaluate the safety and efficacy of direct oral anticoagulants in the treatment of chronic thromboembolic pulmonary hypertension. METHODS: A cohort of chronic thromboembolic pulmonary hypertension patients who initiated treatment with direct oral anticoagulants between June 2015 and November 2016 were enrolled in this study. RESULTS: Sixteen patients used rivaroxaban, three used dabigatran and one used apixaban for a mean follow-up of 20.9 months. The mean age was 51 years, and eighteen patients were classified as functional class II/III. Eight patients underwent a pulmonary endarterectomy and exhibited clinical, hemodynamic and functional improvement and currently continue to use direct oral anticoagulants. No episode of venous thromboembolism recurrence was identified during the follow-up period, but there was one episode of major bleeding after a traumatic fall. CONCLUSIONS: Although direct oral anticoagulants appear to be a safe and effective alternative for treating chronic thromboembolic pulmonary hypertension, larger studies are needed to support their routine use.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Pulmonary Embolism/drug therapy , Pyrazoles/administration & dosage , Pyridones/administration & dosage , Antithrombins/administration & dosage , Dabigatran/administration & dosage , Hypertension, Pulmonary/drug therapy , Vitamin K/antagonists & inhibitors , Chronic Disease , Administration, Oral , Reproducibility of Results , Treatment OutcomeABSTRACT
<p><b>OBJECTIVE</b>To explore the therapeutic effect of enhancer of Zeste homolog 2 (EZH2) inhibitor GSK343 on periodontitis by regulating microphage differentiation.</p><p><b>METHODS</b>Macrophage RAW264.7 cells were divided into the blank (A group), control (B group), lipopolysaccharide (LPS) stimulation (C group), and LPS+GSK343 (D group) groups. Phenotype transformations was determined through Western blot analysis and enzyme-linked immunosorbent assay by detecting the differentiation of phenotypic biological markers, including tumor necrosis factor-α (TNF-α), inducible nitric oxide synthase (iNOS), interleukin-10 (IL-10), and Arginase-1 (Arg-1). Metergasis was identified by performing a phagocytosis test on Escherichia coli (E. coli).</p><p><b>RESULTS</b>Macrophage RAW264.7 cells produced classical phenotypic biomarkers (M1) TNF-α and iNOS under LPS stimulation. The expression levels of IL-10 and Arg-1 increased after adding GSK343 into the culture medium. GSK343 also induced the conversion of M1 macrophages into M2 macrophages. Macrophage RAW264.7 cells exerted a phagocytic effect on E. coli, and this effect was enhanced after adding LPS into the culture medium. GSK343 regulated the macrophage RAW264.7 phagocytosis of E. coli.</p><p><b>CONCLUSIONS</b>GSK343 possibly participates in the regulation of macrophage differentiation and, consequently, in the latent treatment of periodontitis.</p>
Subject(s)
Arginase , Cell Differentiation , Enhancer of Zeste Homolog 2 Protein , Enzyme Inhibitors , Pharmacology , Enzyme-Linked Immunosorbent Assay , Escherichia coli , Indazoles , Pharmacology , Interleukin-10 , Lipopolysaccharides , Macrophages , Nitric Oxide Synthase Type II , Periodontitis , Phagocytosis , Pyridones , Pharmacology , Tumor Necrosis Factor-alphaABSTRACT
ABSTRACT CONTEXT AND OBJECTIVE: Randomized clinical trials have shown that the new oral anticoagulants have at least similar impact regarding reduction of thromboembolic events, compared with warfarin, with similar or improved safety profiles. There is little data on real costs within clinical practice. Our aim here was to perform economic analysis on these strategies from the perspective of Brazilian society and the public healthcare system. DESIGN AND SETTING: Cost-minimization analysis; anticoagulation clinic of Hospital Municipal Odilon Behrens, Belo Horizonte, MG, Brazil. METHODS: Patients at the anticoagulation clinic were recruited between August and October 2011, with minimum follow-up of four weeks. Operational and non-operational costs were calculated and corrected to 2015. RESULTS: This study included 633 patients (59% women) of median age 62 years (interquartile range 49-73). The mean length of follow-up was 64 ± 28 days. The average cost per patient per month was $ 54.26 (US dollars). Direct costs accounted for 32.5% of the total cost. Of these, 69.5% were related to healthcare professionals. With regards to indirect costs, 52.4% were related to absence from work and 47.6% to transportation. Apixaban, dabigatran and rivaroxaban were being sold to Brazilian public institutions, on average, for $ 49.87, $ 51.40 and $ 52.16 per patient per month, respectively, which was lower than the costs relating to warfarin treatment. CONCLUSION: In the Brazilian context, from the perspective of society and the public healthcare system, the cumulative costs per patient using warfarin with follow-up in anticoagulation clinics is currently higher than the strategy of prescribing the new oral anticoagulants.
RESUMO CONTEXTO E OBJETIVO: Estudos clínicos randomizados demonstraram que novos anticoagulantes orais têm pelo menos impacto semelhante em reduzir eventos tromboembólicos quando comparados à varfarina, com perfil de segurança similar ou superior. Há pouca evidência acerca de custos reais na prática clínica. Nosso objetivo é realizar análise econômica dessas estratégias, na perspectiva do sistema de saúde pública e da sociedade brasileiros. TIPO DE ESTUDO E LOCAL: Análise de custo-minimização; Clínica de Anticoagulação do Hospital Municipal Odilon Behrens, Belo Horizonte, MG, Brasil. MÉTODOS: Os pacientes da clínica de anticoagulação foram recrutados de agosto a outubro de 2011, com tempo mínimo de acompanhamento de quatro semanas. Custos operacionais e não operacionais foram computados e corrigidos para 2015. RESULTADOS: Este estudo incluiu 633 pacientes, com idade mediana de 62 (intervalo interquartil 49-73) anos, sendo 59% mulheres. O tempo médio de acompanhamento foi de 64 ± 28 dias. O custo médio por paciente por mês foi de $ 54.26 (dólares). Custos diretos foram responsáveis por 32,5% do custo total. Destes, 69,5% foram relacionados aos profissionais de saúde. Em relação aos custos indiretos, 52,4% estavam relacionados ao absenteísmo ao trabalho e 47,6% ao transporte. Apixaban, dabigatran e rivaroxaban são vendidos a órgãos públicos brasileiros, respectivamente, a um preço médio mensal de $ 49.87, $ 51.40 e $ 52.26 por paciente por mês, valores inferiores aos custos relacionados ao tratamento com varfarina. CONCLUSÃO: No contexto brasileiro, na perspectiva do sistema de saúde pública e da sociedade, os custos cumulativos por paciente em uso de varfarina acompanhados em clínica de anticoagulação são atualmente superiores à estratégia de prescrever novos anticoagulantes orais.
Subject(s)
Humans , Male , Female , Middle Aged , Aged , Thromboembolism/prevention & control , Drug Costs/statistics & numerical data , Anticoagulants/economics , Anticoagulants/therapeutic use , Pyrazoles/economics , Pyrazoles/therapeutic use , Pyridones/economics , Pyridones/therapeutic use , Reference Values , Atrial Fibrillation/economics , Atrial Fibrillation/prevention & control , Warfarin/therapeutic use , Brazil , Administration, Oral , Reproducibility of Results , Age Factors , Treatment Outcome , Costs and Cost Analysis , Delivery of Health Care/economics , Dabigatran/economics , Dabigatran/therapeutic useABSTRACT
Worldwide, venous thromboembolism (VTE) is among the leading causes of death from cardiovascular disease, surpassed only by acute myocardial infarction and stroke. The spectrum of VTE presentations ranges, by degree of severity, from deep vein thrombosis to acute pulmonary thromboembolism. Treatment is based on full anticoagulation of the patients. For many decades, it has been known that anticoagulation directly affects the mortality associated with VTE. Until the beginning of this century, anticoagulant therapy was based on the use of unfractionated or low-molecular-weight heparin and vitamin K antagonists, warfarin in particular. Over the past decades, new classes of anticoagulants have been developed, such as factor Xa inhibitors and direct thrombin inhibitors, which significantly changed the therapeutic arsenal against VTE, due to their efficacy and safety when compared with the conventional treatment. The focus of this review was on evaluating the role of these new anticoagulants in this clinical context.
O tromboembolismo venoso (TEV) está entre as principais causas de morte por doenças cardiovasculares no mundo, atrás apenas do infarto agudo do miocárdio e do acidente vascular cerebral. O TEV possui espectro de apresentação que vai desde a trombose venosa profunda até o tromboembolismo pulmonar agudo, de acordo com gravidade crescente de acometimento, sendo seu tratamento baseado na anticoagulação plena dos pacientes. Há muitas décadas, sabe-se que a anticoagulação interfere diretamente na mortalidade associada ao TEV. Até o início deste século a terapia anticoagulante se baseava no uso de heparina, em suas formas não fracionada ou de baixo peso molecular, e de antagonistas da vitamina K, principalmente a varfarina. Ao longo das últimas décadas, foram desenvolvidos novas classes de medicamentos anticoagulantes, inibidores do fator Xa e inibidores diretos da trombina, que mudaram significativamente o arsenal terapêutico do TEV, em função de suas características de eficácia e segurança em relação ao tratamento convencional, sendo o foco principal de esta revisão avaliar seu papel neste contexto clínico.
Subject(s)
Humans , Anticoagulants/therapeutic use , Venous Thromboembolism/drug therapy , Dabigatran/therapeutic use , Pyrazoles/therapeutic use , Pyridines/therapeutic use , Pyridones/therapeutic use , Rivaroxaban/therapeutic use , Thiazoles/therapeutic use , Time Factors , Warfarin/therapeutic useABSTRACT
Axl encodes the tyrosine-protein kinase receptor, participating in the proliferation and migration of many cells. This study examined the role of Axl in functions of endothelial progenitor cells (EPCs). Axl was detected by RT-PCR and Western blotting in both placentas and EPCs from normal pregnancy and preeclampsia patients. The Axl inhibitor, BMS777-607, was used to inhibit the Axl signalling pathway in EPCs. Cell proliferation, differentiation, migration and adhesion were measured by CCK-8 assay, cell differentiation assay, Transwell assay, and cell adhesion assay, respectively. Results showed the expression levels of Axl mRNA and protein were significantly higher in both placentas and EPCs from preeclampsia patients than from normal pregnancy (P<0.05). After treatment with BMS777-607, proliferation, differentiation, migration and adhesion capability of EPCs were all significantly decreased. Our study suggests Axl may play a role in the function of EPCs, thereby involving in the pathogenesis of preeclampsia.
Subject(s)
Adult , Female , Humans , Pregnancy , Aminopyridines , Pharmacology , Blood Pressure , Case-Control Studies , Cell Adhesion , Cell Differentiation , Cell Movement , Cell Proliferation , Fetal Blood , Cell Biology , Gene Expression Regulation , Gestational Age , Human Umbilical Vein Endothelial Cells , Pathology , Placenta , Metabolism , Pre-Eclampsia , Blood , Genetics , Primary Cell Culture , Protein Kinase Inhibitors , Pharmacology , Proto-Oncogene Proteins , Genetics , Metabolism , Pyridones , Pharmacology , RNA, Messenger , Genetics , Metabolism , Receptor Protein-Tyrosine Kinases , Genetics , Metabolism , Stem Cells , PathologyABSTRACT
To investigate the effect of a novel EZH2 inhibitor GSK126 on cell growth, apoptosis and migration of prostate cancer cells.Prostate cancer PC-3 and DU145 cells were treated with GSK126 at different doses. Cell growth was detected by sulforhodamine assay. Cell apoptosis was assayed by Annexin V-/PI kit. Transwell chamber and wound healing assays were conducted to detect cell migration. The mRNA level was detected by quantitative PCR, and protein expression was detected by Western blot analysis.GSK126 showed significant effect on cell growth and apoptosis when the dose was higher than 50 μmol/L. Wound healing assay revealed that scratch space in PC-3 cells was significantly increased in a dose-dependent manner in GSK126-treated groups[(247.2±24.4),(347.2±19.2) and (410.5±18.1) μm in low, medium and high dose (5.0, 20.0, 50.0 μmol/L), respectively] as compared with the control group[(171.3±17.8) μm](all<0.05). Transwell assay showed that migrated PC-3 cells in control group was 322.0±17.9,while those in GSK126-treated groups were 198.3±15.4 (low),82.7±6.2 (medium) and 30.2±4.1 (high), and the differences between the control group and GSK126-treated groups were significant(all<0.05). In addition, GSK126 up-regulated E-cadherin mRNA expression and down-regulated N-cadherin and Vimentin mRNA expression, whereas had no significant effect on Snail, Fibronectin and VEGF-A mRNA expression. The protein expression of E-cadherin was elevated but VEGF-A protein did not change in GSK126-treated groups. Similar results were exhibited in DU145 cell.GSK126 can significantly inhibit cell migration and invasion in prostate cancer PC-3 and DU145 cells, which may be resulted from its effect on epithelial-mesenchymal transition. GSK126 may be used as a potential anti-prostate cancer dug in clinic.