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1.
Arch. argent. pediatr ; 116(3): 451-454, jun. 2018. tab
Article in Spanish | LILACS, BINACIS | ID: biblio-950025

ABSTRACT

La información sobre el uso de posaconazol en niños es escasa. Se realizó este estudio descriptivo retrospectivo entre agosto de 2010 y marzo de 2017 para evaluar las características clínicas, microbiológicas y la evolución de los pacientes tratados con posaconazol. Se incluyeron 16 niños. Mediana de edad: 161 meses (rango intercuartílico -RIC- 69-173 m). Todos tenían enfermedad subyacente y presentaban infección fúngica invasiva probada. Los aislamientos más frecuentes fueron Mucor spp. y Aspergillus spp. La dosis media de posaconazol fue 600 mg/día (400-800 mg/día) y la mediana de duración del tratamiento, 223 días (RIC 48-632). Diez pacientes presentaron efectos adversos, pero solo uno requirió suspensión del antifúngico debido a alteraciones hidroelectrolíticas.


There is limited information on the use of posaconazole in children. This retrospective and descriptive study was conducted to evaluate the clinical, microbiological characteristics and evolution of patients treated with posaconazole between August 2010 and March 2017. We included 16 children. Median age: 161 months (interquartile range -IQR-69-173m). All had underlying disease and a proven invasive fungal infection. The most frequent isolated were Mucor spp. and Aspergillus spp. The mean posaconazole dose was 600 mg /day (400-800 mg/day) and the median duration of treatment was 223 days (IQR 48-632). Ten patients had adverse effects, but only one required suspension of the antifungal treatment due to hydroelectrolytic disorders.


Subject(s)
Humans , Child, Preschool , Child , Adolescent , Triazoles/therapeutic use , Invasive Fungal Infections/drug therapy , Antifungal Agents/therapeutic use , Time Factors , Triazoles/administration & dosage , Triazoles/adverse effects , Retrospective Studies , Dose-Response Relationship, Drug , Tertiary Care Centers , Invasive Fungal Infections/microbiology , Hospitals, Pediatric , Antifungal Agents/administration & dosage , Antifungal Agents/adverse effects
2.
Rev. Soc. Bras. Med. Trop ; 50(5): 712-714, Sept.-Oct. 2017. tab, graf
Article in English | LILACS | ID: biblio-897020

ABSTRACT

Abstract Basidiobolomycosis is an unusual fungal skin infection that rarely involves the gastrointestinal tract. This study reported a 5-year-old boy with gastrointestinal basidiobolomycosis that had been misdiagnosed as gastrointestinal lymphoma. He was treated by surgical resection and a combination of posaconazole and amphotericin B deoxycholate with an acceptable response and no recurrence.


Subject(s)
Humans , Male , Child, Preschool , Colonic Diseases/microbiology , Zygomycosis/pathology , Zygomycosis/drug therapy , Zygomycosis/diagnostic imaging , Gastrointestinal Neoplasms/diagnosis , Liver Diseases/microbiology , Lymphoma/diagnosis , Triazoles/therapeutic use , Tomography, X-Ray Computed , Amphotericin B/therapeutic use , Treatment Outcome , Colonic Diseases/pathology , Colonic Diseases/diagnostic imaging , Deoxycholic Acid/therapeutic use , Diagnosis, Differential , Drug Combinations , Gastrointestinal Neoplasms/pathology , Liver Diseases/pathology , Liver Diseases/diagnostic imaging , Lymphoma/pathology , Antifungal Agents/therapeutic use
3.
Rev. Assoc. Med. Bras. (1992) ; 63(4): 371-378, Apr. 2017. graf
Article in English | LILACS | ID: biblio-842545

ABSTRACT

Summary Aromatase inhibitors have emerged as an alternative endocrine therapy for the treatment of hormone sensitive breast cancer in postmenopausal women. The use of third-generation inhibitors represented by exemestane, letrozol and anastrozole is currently indicated. Anastrozole is a nonsteroidal compound and a potent selective inhibitor of the aromatase enzyme. Although a few studies have shown that its pharmacodynamic and pharmacokinetic properties may be affected by interindividual variability, this drug has been recently used in all configurations of breast cancer treatment. In metastatic disease, it is currently considered the first-line treatment for postmenopausal women with estrogen receptor-positive breast tumors. Anastrozole has shown promising results in the adjuvant treatment of early-stage breast cancer in postmenopausal women. It has also achieved interesting results in the chemoprevention of the disease. Therefore, due to the importance of anastrozole both for endocrine treatment and chemoprevention of hormone-sensitive breast cancer in postmenopausal women, we proposed the current literature review in the SciELO and PubMed database of articles published in the last 10 years.


Resumo Os inibidores de aromatase têm emergido como uma endocrinoterapia alternativa para o tratamento de câncer de mama sensível a hormônios em mulheres pós-menopáusicas. A utilização de inibidores de terceira geração, representados por exemestano, letrozol e anastrozol, é atualmente indicada. Anastrozol é um composto não esteroide e um inibidor potente e seletivo da enzima aromatase. Embora alguns estudos tenham demonstrado que as suas propriedades farmacodinâmicas e farmacocinéticas podem ser afetadas pela variabilidade interindividual, esse fármaco tem sido recentemente utilizado em todas as configurações de tratamento do câncer de mama. Na doença metastática, é atualmente considerado o tratamento de primeira linha em mulheres pós-menopáusicas com tumores de mama e receptor de estrogênio positivo. O anastrozol tem mostrado resultados promissores no tratamento adjuvante do câncer de mama em estágio inicial em mulheres na pós-menopausa. Ele também conseguiu resultados interessantes na quimioprevenção da doença. Portanto, em virtude da importância do anastrozol tanto no tratamento endócrino quanto na quimioprevenção do câncer de mama hormoniossensível em mulheres na pós-menopausa, propusemos a atual revisão da literatura na base de dados SciELO e PubMed de artigos publicados nos últimos 10 anos.


Subject(s)
Humans , Female , Triazoles/therapeutic use , Breast Neoplasms/prevention & control , Breast Neoplasms/drug therapy , Chemoprevention/methods , Aromatase Inhibitors/therapeutic use , Nitriles/therapeutic use , Tamoxifen/therapeutic use , Tamoxifen/pharmacokinetics , Triazoles/pharmacokinetics , Reproducibility of Results , Treatment Outcome , Chemotherapy, Adjuvant , Postmenopause , Antineoplastic Agents, Hormonal/therapeutic use , Antineoplastic Agents, Hormonal/pharmacokinetics , Aromatase Inhibitors/pharmacokinetics , Anastrozole , Nitriles/pharmacokinetics
4.
Braz. j. infect. dis ; 21(1): 79-87, Jan.-Feb. 2017. tab, graf
Article in English | LILACS | ID: biblio-839188

ABSTRACT

Abstract The current increment of invasive fungal infections and the availability of new broad-spectrum antifungal agents has increased the use of these agents by non-expert practitioners, without an impact on mortality. To improve efficacy while minimizing prescription errors and to reduce the high monetary cost to the health systems, the principles of pharmacokinetics (PK) and pharmacodynamics (PD) are necessary. A systematic review of the PD of antifungals agents was performed aiming at the practicing physician without expertise in this field. The initial section of this review focuses on the general concepts of antimicrobial PD. In vitro studies, fungal susceptibility and antifungal serum concentrations are related with different doses and dosing schedules, determining the PD indices and the magnitude required to obtain a specific outcome. Herein the PD of the most used antifungal drug classes in Latin America (polyenes, azoles, and echinocandins) is discussed.


Subject(s)
Humans , Antifungal Agents/pharmacokinetics , Polyenes/therapeutic use , Polyenes/pharmacokinetics , Aspergillosis/metabolism , Aspergillosis/drug therapy , Azoles/therapeutic use , Azoles/pharmacokinetics , Triazoles/therapeutic use , Triazoles/pharmacokinetics , Candidiasis/metabolism , Candidiasis/drug therapy , Microbial Sensitivity Tests , Area Under Curve , Dose-Response Relationship, Drug , Echinocandins/therapeutic use , Echinocandins/pharmacokinetics , Latin America , Antifungal Agents/therapeutic use
5.
Rev. bras. ginecol. obstet ; 39(1): 14-20, Jan. 2017. tab, graf
Article in English | LILACS | ID: biblio-843905

ABSTRACT

ABSTRACT Objective: Obesity is associated with an increased risk for breast cancer. Recent studies have shown that aromatase inhibitors may be less effective in women with a high body mass index (BMI). The aim of this study was to establish the relationship between the BMI and plasma estrone and estradiol levels in postmenopausal women with hormone receptor-positive breast cancer using anastrozole. Methods: In this cohort study, the patients were divided into three groups according to BMI (normal weight, overweight and obese) to compare and correlate plasma hormone levels before starting anastrozole hormone therapy and three months after treatment. Plasma hormone levels were compared for age and use of chemotherapy. Results: A statistically significant reduction in estrone and estradiol levels was observed between baseline and three months after starting the anastrozole treatment (p < 0.05). There was no statistically significant difference in plasma estrone and estradiol levels among the BMI groups (p > 0.05), but a significant reduction in plasma estrone levels was observed after three-months' treatment relative to baseline in all groups, as well as a reduction in estradiol in the obese group (p < 0.05). The use of chemotherapy and age > 65 years had no influence on plasma steroid levels. Conclusion: Changes in estrone and estradiol levels in the studied groups were not associated with BMI, chemotherapy or age.


RESUMO Objetivo: A obesidade está associada com risco aumentado de câncer de mama. Estudos recentes têm mostrado que os inibidores de aromatase podem ser menos eficazes em mulheres com alto índice de massa corporal (IMC). O objetivo deste estudo foi estabelecer a relação entre o IMC e os níveis plasmáticos de estrona e estradiol em mulheres no período pós-menopausa com câncer de mama receptor hormonal positivo, em tratamento com anastrozol. Métodos: Este estudo de coorte acompanhou três grupos de pacientes de acordo com o seu IMC (peso normal, sobrepeso e obesidade), a fim de comparar e correlacionar as dosagens dos hormônios estrona e estradiol antes e após três meses do uso do anastrozol. Os níveis plasmáticos dos hormônios foram também relacionados à idade do paciente e ao uso da quimioterapia. Resultados: Redução estatisticamente significativa de estrona e estradiol foi observada entre os níveis basais e três meses após o início do tratamento com anastrozol (p < 0,05). Não houve diferença estatisticamente significativa entre os níveis plasmáticos de estrona e estradiol em relação ao IMC (p > 0,05), mas houve redução significativa entre os níveis plasmáticos basais de estrona após o tratamento em todos os grupos, e redução de estradiol no grupo de pacientes obesas (p < 0,05). A condução da quimioterapia e da idade acima de 65 anos não interfere com os níveis plasmáticos de esteroides. Conclusão: Os níveis plasmáticos de estrona e estradiol nos grupos estudados não foram alterados em termos de IMC, quimioterapia e idade.


Subject(s)
Humans , Female , Middle Aged , Antineoplastic Agents, Hormonal/therapeutic use , Aromatase Inhibitors/therapeutic use , Body Mass Index , Breast Neoplasms/blood , Breast Neoplasms/drug therapy , Estradiol/blood , Estrone/blood , Nitriles/therapeutic use , Triazoles/therapeutic use , Cohort Studies
6.
Braz. j. microbiol ; 47(4): 793-799, Oct.-Dec. 2016. tab
Article in English | LILACS | ID: biblio-828190

ABSTRACT

Abstract Triazole fungicides are used broadly for the control of infectious diseases of both humans and plants. The surge in resistance to triazoles among pathogenic populations is an emergent issue both in agriculture and medicine. The non-rational use of fungicides with site-specific modes of action, such as the triazoles, may increase the risk of antifungal resistance development. In the medical field, the surge of resistant fungal isolates has been related to the intensive and recurrent therapeutic use of a limited number of triazoles for the treatment and prophylaxis of many mycoses. Similarities in the mode of action of triazole fungicides used in these two fields may lead to cross-resistance, thus expanding the spectrum of resistance to multiple fungicides and contributing to the perpetuation of resistant strains in the environment. The emergence of fungicide-resistant isolates of human pathogens has been related to the exposure to fungicides used in agroecosystems. Examples include species of cosmopolitan occurrence, such as Fusarium and Aspergillus, which cause diseases in both plants and humans. This review summarizes the information about the most important triazole fungicides that are largely used in human clinical therapy and agriculture. We aim to discuss the issues related to fungicide resistance and the recommended strategies for preventing the emergence of triazole-resistant fungal populations capable of spreading across environments.


Subject(s)
Humans , Triazoles/poisoning , Ecosystem , Drug Resistance, Fungal , Agriculture , Fungi/drug effects , Antifungal Agents/pharmacology , Plant Diseases/microbiology , Triazoles/therapeutic use , Fungi/physiology , Fungicides, Industrial , Mycoses/microbiology , Mycoses/drug therapy , Antifungal Agents/therapeutic use
7.
Rev. chil. infectol ; 33(2): 222-225, abr. 2016. ilus, graf, tab
Article in Spanish | LILACS | ID: lil-784871

ABSTRACT

Fungal peritonitis is a major complication of peritoneal dialysis associated with high mortality. Most survivors have a high rate of abandonment of peritoneal dialysis. We report a case of fungal peritonitis due to an unusual agent. An 83 year-old woman, with a history of type 2 diabetes mellitus and multiple episodes of bacterial peritonitis associated to technical flaws in the implementation of automated peritoneal dialysis, was admitted due to abdominal pain and cloudy peritoneal fluid. Rhodotorula mucilaginosa was identified in the peritoneal fluid by MALDI-TOF. She was treated with catheter removal and oral posaconazole for 14 days showing clinical resolution and non-recurrence.


La peritonitis fúngica es una complicación mayor de la diálisis peritoneal, con una alta mortalidad asociada y la mayoría de los sobrevivientes presentan una alta tasa de abandono de diálisis peritoneal como terapia de reemplazo renal. Se presenta un caso de peritonitis fúngica por un agente infrecuente. Mujer de 83 años, diabética con múltiples episodios de peritonitis bacteriana asociada a fallas técnicas en la ejecución de diálisis peritoneal automatizada, ingresa por cuadro clínico de dolor abdominal y líquido peritoneal turbio. Se confirmó la presencia de Rhodotorula mucilaginosa en líquido peritoneal mediante MALDI-TOF. Fue tratada con retiro del catéter y posaconazol oral por 14 días, presentando una evolución favorable.


Subject(s)
Humans , Female , Aged, 80 and over , Peritonitis/microbiology , Rhodotorula/isolation & purification , Peritoneal Dialysis/adverse effects , Familial Mediterranean Fever/therapy , Time Factors , Triazoles/therapeutic use , Peritoneal Dialysis/methods , Catheter-Related Infections/microbiology , Catheter-Related Infections/therapy , Antifungal Agents/therapeutic use
8.
Acta cir. bras ; 31(4): 286-293, Apr. 2016. tab, graf
Article in English | LILACS | ID: lil-781334

ABSTRACT

PURPOSE: To evaluate the effects of letrozole (Ltz) in carcinogen+estrogen-induced endometrial hyperplasia. METHODS: BALB/c female mice were divided into four groups of 12 animals each receiving an intrauterine dose of N-ethyl-N-nitrosourea (ENU) and weekly subcutaneous injections of estradiol hexaidrobenzoate (EHB), except for group I(control). The groups were divided in I (control), II (ENU+EHB), III (ENU+EHB+MPA) and IV (ENU+EHB+Ltz). Group III also received intramuscular injections of MPA (medroxy progesterone acetate) every four weeks, while group IV received oral doses of Ltz daily. At the end of 16 weeks, the animals were sacrificed, and blood samples were collected for the measurement of serum estradiol and progesterone levels. Uterine histological sections were made to evaluate the presence of endometrial proliferative lesions. Differences between groups were evaluated with student's t test, ANOVA and chi-square test. RESULTS: Groups ENU+EHB, ENU+EHB+MPA and ENU+EHB+Ltz showed varying degrees of endometrial hyperplasia. The incidence of hyperplasia in groups ENU+EHB and ENU+EHB+Ltz was higher and more severe than in group ENU+EHB+MPA. Control group showed lower levels of serum estradiol than the other groups. CONCLUSION: There was no evidence that letrozole could act as an antiestrogenic drug in the development of endometrial proliferative lesions.


Subject(s)
Animals , Female , Triazoles/pharmacology , Aromatase Inhibitors/pharmacology , Endometrial Hyperplasia/drug therapy , Carcinogenesis/drug effects , Nitriles/pharmacology , Progesterone/blood , Time Factors , Triazoles/therapeutic use , Adenocarcinoma/etiology , Adenocarcinoma/drug therapy , Reproducibility of Results , Treatment Outcome , Endometrial Neoplasms/etiology , Endometrial Neoplasms/drug therapy , Medroxyprogesterone Acetate/pharmacology , Antineoplastic Agents, Hormonal/pharmacology , Aromatase Inhibitors/therapeutic use , Endometrial Hyperplasia/chemically induced , Endometrial Hyperplasia/pathology , Endometrium/drug effects , Endometrium/pathology , Estradiol/blood , Ethylnitrosourea , Carcinogenesis/pathology , Mice, Inbred BALB C , Nitriles/therapeutic use
9.
Rev. chil. infectol ; 32(4): 472-475, ago. 2015. ilus
Article in Spanish | LILACS | ID: lil-762648

ABSTRACT

We reported a case of non-invasive pulmonary infection by Scedosporium apiospermum in 67 years old female with bronchiectasis and caverns secondary to tuberculosis. Diagnosis was made with lung CT and bronchial lavage cultures. The patient was initially treated with itraconazole for six weeks without success and then voriconazole for 16 weeks, with good clinical response.


Reportamos el caso clínico de una infección pulmonar no invasora por Scedosporium apiospermum en una mujer de 67 años de edad, con bronquiectasias y cavernas pulmonares secundarias a una tuberculosis. El diagnóstico se realizó con la TAC pulmonar y cultivos de lavado bronquial. La paciente fue tratada inicialmente con itraconazol oral por seis semanas sin respuesta y luego voriconazol vía oral por 16 semanas, con una buena respuesta clínica.


Subject(s)
Aged , Female , Humans , Lung Diseases, Fungal/microbiology , Scedosporium/isolation & purification , Antifungal Agents/therapeutic use , Bronchoalveolar Lavage Fluid/microbiology , Lung Diseases, Fungal/drug therapy , Scedosporium/growth & development , Tomography, X-Ray Computed , Triazoles/therapeutic use
11.
Article in English | WPRIM | ID: wpr-138283

ABSTRACT

This study aimed to evaluate the efficacy of random-start controlled ovarian stimulation (COS) in cancer patients for emergency fertility preservation. In this retrospective comparative study, 22 patients diagnosed with cancer and 44 infertile women undergoing conventional in vitro fertilization (IVF) were included. In cancer patients, ovarian stimulation was started on the day of referral, irrespective of their menstrual cycle date. The control group was selected by age matching among women undergoing conventional IVF. COS outcomes were compared between groups. The number of total and mature oocytes retrieved and the oocyte maturity rate were higher in the random-start group than in the conventional-start group. However, duration of ovarian stimulation was longer in the random-start group (11.4 vs. 10.3 days, P = 0.004). The addition of letrozole to lower the estradiol level during COS did not adversely affect total oocytes retrieved. However, oocyte maturity rate was lower in cycles with letrozole than in cycles without letrozole (71.6% vs. 58.2%, P = 0.019). Our study confirms the feasibility and effectiveness of random-start COS in cancer patients.


Subject(s)
Cryopreservation , Estradiol/blood , Female , Fertility Preservation/methods , Fertilization in Vitro , Humans , Infertility, Female/surgery , Neoplasms , Nitriles/therapeutic use , Oocyte Retrieval/methods , Ovulation Induction/methods , Retrospective Studies , Triazoles/therapeutic use
12.
Article in English | WPRIM | ID: wpr-138282

ABSTRACT

This study aimed to evaluate the efficacy of random-start controlled ovarian stimulation (COS) in cancer patients for emergency fertility preservation. In this retrospective comparative study, 22 patients diagnosed with cancer and 44 infertile women undergoing conventional in vitro fertilization (IVF) were included. In cancer patients, ovarian stimulation was started on the day of referral, irrespective of their menstrual cycle date. The control group was selected by age matching among women undergoing conventional IVF. COS outcomes were compared between groups. The number of total and mature oocytes retrieved and the oocyte maturity rate were higher in the random-start group than in the conventional-start group. However, duration of ovarian stimulation was longer in the random-start group (11.4 vs. 10.3 days, P = 0.004). The addition of letrozole to lower the estradiol level during COS did not adversely affect total oocytes retrieved. However, oocyte maturity rate was lower in cycles with letrozole than in cycles without letrozole (71.6% vs. 58.2%, P = 0.019). Our study confirms the feasibility and effectiveness of random-start COS in cancer patients.


Subject(s)
Cryopreservation , Estradiol/blood , Female , Fertility Preservation/methods , Fertilization in Vitro , Humans , Infertility, Female/surgery , Neoplasms , Nitriles/therapeutic use , Oocyte Retrieval/methods , Ovulation Induction/methods , Retrospective Studies , Triazoles/therapeutic use
13.
Arq. bras. endocrinol. metab ; 58(4): 369-376, 06/2014. tab, graf
Article in English | LILACS | ID: lil-711627

ABSTRACT

Objective: To evaluate the effect of sitagliptin on somatosensory-evoked potentials (SEPs) and metabolic control in patients with type 2 diabetes mellitus without clinical diabetic neuropathy. Materials and methods: Interventional, prospective, and open study. Patients with less than six months from the diagnosis were included. Examinations of SEPs and laboratory tests at fasting and after food stimulation were performed before and after three months of treatment with sitagliptin (100 mg/day). Results: There was a reduction in the mean levels of HbA1c (P < 0.0001), fasting glucose (P = 0.001), total cholesterol (P = 0.019), and ALT (P = 0.022). An increase in active GLP-1 was found at the end of the study (P = 0.0025). Several SEPs showed statistically significant differences when analyzed before and after treatment with sitagliptin. Conclusion: The results give a glimpse of the possible use of sitagliptin in the treatment of some neurodegenerative conditions of the peripheral nervous system, in addition to its already established role in glycemic control. .


Objetivo: Avaliar o efeito da sitagliptina nos potenciais evocados somatossensoriais (PESS) e controle metabólico de pacientes com diabetes melito tipo 2, sem neuropatia diabética. Materiais e métodos: Estudo de intervenção, prospectivo e aberto. Os pacientes com menos de seis meses de diagnóstico foram incluídos. Exames dos PESS e testes laboratoriais em jejum e após a estimulação com alimentos foram realizados antes e depois de três meses de tratamento com sitagliptina (100 mg/dia). Resultados: Houve redução nos níveis médios de HbA1c (P < 0,0001), glicemia de jejum (P = 0,001), colesterol total (P = 0,019) e ALT (P = 0,022). Verificou-se aumento de GLP-1 ativo (P = 0,0025). Vários PESS mostraram diferenças estatisticamente significativas quando os valores foram analisados antes e após o tratamento com sitagliptina. Conclusão: Os resultados vislumbram a possível utilização de sitagliptina no tratamento de algumas condições neurodegenerativas do sistema nervoso periférico, em adição ao seu papel no controle glicêmico. .


Subject(s)
Adult , Female , Humans , Male , Middle Aged , /drug therapy , Evoked Potentials, Somatosensory/drug effects , Hypoglycemic Agents/therapeutic use , Pyrazines/therapeutic use , Triazoles/therapeutic use , Activation, Metabolic , Area Under Curve , Alanine Transaminase/blood , Aspartate Aminotransferases/blood , Blood Glucose/analysis , Cholesterol/blood , /metabolism , /physiopathology , Food, Formulated , Fasting/metabolism , Glucagon-Like Peptide 1/blood , Glycated Hemoglobin A/analysis , Prospective Studies , Statistics, Nonparametric , Triglycerides/blood , gamma-Glutamyltransferase/blood
15.
Braz. j. infect. dis ; 17(1): 102-105, Jan.-Feb. 2013. ilus
Article in English | LILACS | ID: lil-665782

ABSTRACT

Posaconazole Histoplasmosis Salvage therapy African histoplasmosis is a granulomatous mycosis caused by Histoplasma capsulatum var. duboisii. Treatment is usually extrapolated from guidelines for classical histoplasmosis, and includes 2-4 weeks of amphotericin B followed by a step-down maintenance therapy with itraconazole. Pediatric usage of posaconazole, an oral second-generation azole, remains off-label, but recent surveys show that it is safe and well tolerated in children. We report a case of disseminated African histoplasmosis in a 12-year-old boy from Guinea-Bissau. Therapy with amphotericin B and itraconazole led to a progressive clinical deterioration. A dramatic and lasting improvement was observed using posaconazole. He completed 12 months of therapy. No relapse was noted during or 3 months after treatment. We report that posaconazole may be a safe and efficacious drug in the salvage management of disseminated AH, either in patients with disease refractory to conventional anti-fungal therapy, or in patients whose serious adverse effects of first-line drugs preclude its use.


Subject(s)
Child , Humans , Male , Antifungal Agents/therapeutic use , Histoplasmosis/drug therapy , Salvage Therapy/methods , Triazoles/therapeutic use , Histoplasmosis/pathology , Treatment Outcome
16.
Article in English | WPRIM | ID: wpr-221307

ABSTRACT

Many Korean patients with transfusion-induced iron overload experience serious clinical sequelae, including organ damage, and require lifelong chelation therapy. However, due to a lack of compliance and/or unavailability of an appropriate chelator, most patients have not been treated effectively. Deferasirox (DFX), a once-daily oral iron chelator for both adult and pediatric patients with transfusion-induced iron overload, is now available in Korea. The effectiveness of deferasirox in reducing or maintaining body iron has been demonstrated in many studies of patients with a variety of transfusion-induced anemias such as myelodysplastic syndromes, aplastic anemia, and other chronic anemias. The recommended initial daily dose of DFX is 20 mg/kg body weight, taken on an empty stomach at least 30 min before food and serum ferritin levels should be maintained below 1000 ng/mL. To optimize the management of transfusion-induced iron overload, the Korean Society of Hematology Aplastic Anemia Working Party (KSHAAWP) reviewed the general consensus on iron overload and the Korean data on the clinical benefits of iron chelation therapy, and developed a Korean guideline for the treatment of iron overload.


Subject(s)
Anemia, Aplastic/therapy , Benzoates/therapeutic use , Blood Transfusion/adverse effects , Chelation Therapy/methods , Humans , Iron Chelating Agents/therapeutic use , Iron Overload/therapy , Myelodysplastic Syndromes/therapy , Pyridones/therapeutic use , Republic of Korea , Triazoles/therapeutic use
17.
Article in English | WPRIM | ID: wpr-159651

ABSTRACT

We investigated characteristics associated with the efficacy of dipeptidyl peptidase-4 inhibitors (DPP4i) in Korean patients with type 2 diabetes. We reviewed medical records of 477 patients who had taken sitagliptin or vildagliptin longer than 40 weeks. Response to DPP4i was evaluated with HbA1c change after therapy (DeltaHbA1c). The Student's t-test between good responders (GR: DeltaHbA1c > 1.0%) and poor responders (PR: DeltaHbA1c < 0.5%), a correlation analysis among clinical parameters, and a linear multivariate regression analysis were performed. The mean age was 60 yr, duration of diabetes 11 yr and HbA1c was 8.1%. Baseline fasting plasma glucose (FPG), HbA1c, C-peptide, and creatinine were significantly higher in the GR compared to the PR. Duration of diabetes, FPG, HbA1c, C-peptide and creatinine were significantly correlated with DeltaHbA1c. In the multivariate analysis, age (r2 = 0.006), duration of diabetes (r2 = 0.019), HbA1c (r2 = 0.296), and creatinine levels (r2 = 0.024) were independent predictors for the response to DPP4i. Body mass index and insulin resistance were not associated with the response to DPP4i. In conclusion, better response to DPP4i would be expected in Korean patients with type 2 diabetes who have higher baseline HbA1c and creatinine levels with shorter duration of diabetes.


Subject(s)
Adamantane/analogs & derivatives , Blood Glucose/analysis , Body Mass Index , C-Peptide/analysis , Creatinine/blood , Diabetes Mellitus, Type 2/drug therapy , Dipeptidyl-Peptidase IV Inhibitors/therapeutic use , Glycated Hemoglobin A/analysis , Humans , Insulin Resistance , Male , Middle Aged , Multivariate Analysis , Nitriles/therapeutic use , Pyrazines/therapeutic use , Pyrrolidines/therapeutic use , Retrospective Studies , Triazoles/therapeutic use
18.
Rev. chil. obstet. ginecol ; 78(1): 44-47, 2013. ilus
Article in Spanish | LILACS | ID: lil-677307

ABSTRACT

La quimioterapia neoadjuvante aparece como una opción terapéutica interesante en determinados casos de cáncer de mama. En éstos, el momento de la realización de la biopsia del ganglio centinela supone un tema de controversia actual. Los tumores Her-2-neu y receptores estrogénicos positivos presentan cierta resistencia a la terapia hormonal especialmente con tamoxifeno. Se presenta un caso con co-expresión de Her-2-neu y receptores estrogénicos que se trata con quimioterapia neoadjuvante y biopsia de ganglio centinela previa. En un segundo tiempo, se realiza cirugía conservadora sobre la mama con linfadenectomía axilar, radioterapia y hormonoterapia con letrozol, complementada con goserelina y trastuzumab. La evolución posterior ha sido muy favorable.


Neoadjuvant chemotherapy is an interesting option in the therapy of some breast cancer cases. Cases in which the timing for sentinel lymph node biopsy is controversial. Co-expression of estrogen receptors and Her2/neu (c-erbB-2) in breast cancer may imply hormone resistance, especially to tamoxifen. We present a clinic case with co-expression of estrogen receptors and Her2/neu that was treated with neoadjuvant chemotherapy and previous sentinel lymph node biopsy followed by breast tumorectomy with axillar lymphadenectomy, radiotherapy and hormonotherapy with letrozol, geserelina and trastuzumab. A good treatment response was found.


Subject(s)
Humans , Adult , Female , Antineoplastic Agents, Hormonal/therapeutic use , Breast Neoplasms/drug therapy , Nitriles/therapeutic use , Triazoles/therapeutic use , Axilla , Antibodies, Monoclonal, Humanized/therapeutic use , Chemotherapy, Adjuvant , Goserelin , Lymph Node Excision , Lymphatic Metastasis , Breast Neoplasms/surgery , Sentinel Lymph Node Biopsy , Treatment Outcome
19.
West Indian med. j ; 61(9): 932-936, Dec. 2012. ilus
Article in English | LILACS | ID: lil-694370

ABSTRACT

The use of new antiretroviral drugs in HIV infection is particularly important in patients with intolerance or resistance to other antiretroviral agents. Raltegravir and maraviroc represent new, important resources in salvage regimens. A reduced grade of liver fibro-steatosis after a combination of raltegravir and maraviroc (second-line) has not been studied and the mechanism by which these new drug classes induced a marked reduction of grade of liver diseases is currently unknown. In the present case report, nested in an ongoing multicentre observational study on the use of new antiretroviral inhibitors in heavy treatment-experienced HIV patients, we evaluated the correlation between a "short therapeutic regimen" raltegravir, maraviroc and fosamprenavir and liver diseases. The aim of this report is to describe the use of a three-drug regimen based on two novel-class antiretroviral agents (raltegravir and maraviroc) plus the protease inhibitor fosamprenavir, in an experienced HIV-infected patient with chronic progressive hepatitis C complicated by liver fibrosis; an overwhelming increased serum creatine kinase level occurred during treatment, and is probably related to integrase inhibitor administration. At present no information is available regarding this correlation.


El uso de nuevos medicamentos antiretrovirales para la infección por VIH es particularmente importante en los pacientes con intolerancia o resistencia a otros agentes antiretrovirales. Raltegravir (RTV) y maraviroc (MRV) representan nuevos e importantes recursos en las terapias de salvamento. Un grado reducido de fibroesteatosis hepática después de una combinación de raltegravir y maraviroc (terapia de segunda línea) no ha sido estudiado, y el mecanismo por el cual estas nuevas clases de droga indujeron una marcada reducción de grado de las enfermedades hepáticas se desconoce hasta el momento. Como parte de la realización en curso de un estudio observacional multicentro acerca del uso de nuevos inhibidores antiretrovirales en pacientes de VIH altamente experimentados en el tratamiento, en el presente reporte de caso se evalúa la correlación entre un "régimen terapéutico corto" (raltegravir, maraviroc y fosamprenavir) y las enfermedades del hígado. El objetivo de este reporte es describir el uso de un régimen de tres medicamentos - basado en dos agentes antiretrovirales de nuevo tipo (raltegravir y maraviroc) además del fosamprenavir inhibidor de la proteasa - en un paciente de VIH experimentado. El paciente también sufre de hepatitis C evolutiva, progresiva, crónica, complicada por fibrosis hepática. Durante el tratamiento, se produjo un aumento extraordinario del nivel de creatina quinasa sérica, el cual probablemente esta relacionado con la administración del inhibidor de la integrasa. Actualmente no hay información disponible con respecto a esta correlación.


Subject(s)
Adult , Humans , Male , Carbamates/adverse effects , Cardiomyopathies/drug therapy , Creatine Kinase/blood , Cyclohexanes/adverse effects , Chemical and Drug Induced Liver Injury/diagnosis , Fatty Liver/chemically induced , HIV Fusion Inhibitors/adverse effects , HIV Infections/drug therapy , HIV Integrase Inhibitors/adverse effects , HIV Protease Inhibitors/adverse effects , Hepatitis C, Chronic/drug therapy , Liver Cirrhosis/chemically induced , Organophosphates/adverse effects , Pyrrolidinones/adverse effects , Sulfonamides/adverse effects , Triazoles/adverse effects , Carbamates/therapeutic use , Cyclohexanes/therapeutic use , Drug Substitution , Drug Therapy, Combination , Fatty Liver/diagnosis , HIV Fusion Inhibitors/therapeutic use , HIV Integrase Inhibitors/therapeutic use , HIV Protease Inhibitors/therapeutic use , Liver Cirrhosis/diagnosis , Organophosphates/therapeutic use , Pyrrolidinones/therapeutic use , Sulfonamides/therapeutic use , Triazoles/therapeutic use
20.
Braz. j. infect. dis ; 16(6): 531-539, Nov.-Dec. 2012. ilus, tab
Article in English | LILACS | ID: lil-658923

ABSTRACT

OBJECTIVE: To investigate the clinical features, management, and prognosis of pulmonary cryptococcosis in non-acquired immunodeficiency syndrome (AIDS) patients. METHOD: 24 cases of pulmonary cryptococcosis with accurate pathological diagnosis were retrospectively studied. RESULTS: 15 male patients and nine female patients were diagnosed at the first affiliated hospital of Sun Yat-sen University from November 1999 to November 2011. The mean age at the time of diagnosis was 44.2 ± 11.3 years (range: 24 to 65 years). Among these patients, 13 had other comorbidities. 15 were symptomatic and the other nine were asymptomatic. The most common presenting symptoms were cough, chest tightness, expectoration, and fever. None had concurrent cryptococcal meningitis. The most frequent radiologic abnormalities on chest computed tomography (CT) scans were solitary or multiple pulmonary nodules, and masses or consolidations, and most lesions were located in the lower lobes. All patients had biopsies for the accurate diagnosis. Among the 24 patients, nine patients underwent surgical resections (eight had pneumonectomy via thoracotomy and one had a pneumonectomy via thoracoscopy). Five of the patients who underwent surgery also received antifungal drug therapy (fluconazole) for one to three months after the surgery. The other 15 only received antifungal drug therapy (fluconazole or voriconazole) for three to six months (five patients are still on therapy). The follow-up observation of 19 patients who had already finished their treatments lasted from two to 11 years, and there was no relapse, dissemination, or death in any of these patients. CONCLUSION: Non-AIDS patients with pulmonary cryptococcosis have a good prognosis with appropriate management.


Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Young Adult , Cryptococcosis/diagnosis , Cryptococcus neoformans/isolation & purification , Lung Diseases, Fungal/diagnosis , Antifungal Agents/therapeutic use , Combined Modality Therapy , Cryptococcosis/therapy , Fluconazole/therapeutic use , Lung Diseases, Fungal/microbiology , Lung Diseases, Fungal/therapy , Prognosis , Pyrimidines/therapeutic use , Retrospective Studies , Thoracotomy , Tomography, X-Ray Computed , Triazoles/therapeutic use
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