Efectos adversos cardíacos de la domperidona en pacientes adultos: revisión sistemática / Cardiac adverse effects of domperidone in adult patients: a systematic review

Background: Domperidone is widely prescribed in patients with gastrointestinal disorders but some cardiac adverse effects have been recently reported. Aim: To evaluate the risk of QT prolongation, ventricular arrhythmias and sudden cardiac death associated with the use of oral domperidone in adults without cancer. Material and Methods: Systematic searches in MEDLINE, LILACS, SciELO, the Cochrane Library and regulatory agencies websites were performed, followed by a manual search of cited references. The search strategy consisted of combining free and indexed text words without any date or language restriction. Results: Three case-control studies met the inclusion criteria; none of them evaluated QT interval prolongation. With low risk of bias, each study quantified the risk of ventricular arrhythmia or sudden cardiac death (VA/SCD). The odds ratios for these events in these studies were 4.7 (95% confidence interval (CI): 1.4-16), 1.59 (95% CI: 1.28-1.98) and 11.02 (95% CI: 2.02-62.3) respectively. A significantly increased risk was observed in patients older than 60 years of age or receiving doses > 30 mg/day. Conclusions: Heterogeneity between selected studies did not allow the computation of a summary measure. However, evidence was found that an increased risk of VA/SCD is associated with the use of oral domperidone in adults.

Evaluation of resistance in a selected field strain of Haemonchus contortus to ivermectin and moxidectin using the Larval Migration on Agar Test / Avaliação da resistência em um isolado de campo selecionado de Haemonchus contortus à ivermectina e moxidectina usando o Teste de Migração de Larvas em Ágar

Haemonchus contortus is one of the most common and economically significant causes of disease in small ruminants worldwide, and the control programs of parasitic nematodes - including H. contortus - rely mostly on the use of anthelmintic drugs. The consequence of the use of this, as the sole sanitary strategy to avoid parasite infections, was the reduction of the efficacy of all chemotherapeutic products with a heavy selection for resistance. The widespread of anthelmintic resistance and the difficulty of its early diagnosis has been a major concern for the sustainable parasite management on farms. The objective of this research was to determine and compare the ivermectin (IVM) and moxidectin (MOX) effect in a selected field strain of H. contortus with a known resistance status, using the in vitro larval migration on agar test (LMAT). Third stage larvae of the selected isolate were obtained from faecal cultures of experimentally infected sheep and incubated in eleven increasing diluted concentrations of IVM and MOX (6, 12, 24, 48, 96, 192, 384, 768, 1536, 3072 and 6144µg/mL). The dose-response sigmoidal curves were obtained using the R² value of >0.90 and the lethal concentration (LC50) dose for the tested anthelmintic drugs using a four-parameter logistic model. The LC50 value for MOX was significantly lower than IVM (1.253µg/mL and 91.06µg/mL), identifying the H. contortus isolate as considerably less susceptible to IVM compared to MOX. Furthermore, the LMAT showed a high consistency (p<0.0001) and provided to be a useful diagnostic tool for monitoring the resistance status of IVM and MOX in H. contortus field isolate, as well as it may be used for official routine drug monitoring programs under the Ministry of Agriculture (MAPA) guidance.

Haemonchus contortus é uma das causas mais comuns e economicamente significativas de doença em produções de pequenos ruminantes em todo o mundo, e os programas de controle de parasitas nematoides - incluindo H. contortus - baseiam-se principalmente no uso de drogas anti-helmínticas. A consequência da utilização desses compostos, como sendo a única estratégia sanitária para evitar infecções por parasitas, tem sido a redução da eficácia de todos os produtos quimioterápicos, selecionando fortemente para resistência. O desenvolvimento generalizado da resistência anti-helmíntica e a dificuldade de seu diagnóstico precoce têm sido uma grande preocupação para o manejo sustentável de parasitas no campo. O objetivo desta pesquisa foi determinar e comparar o efeito da ivermectina (IVM) e da moxidectina (MOX) em um isolado de campo selecionado de H. contortus com um estado de resistência conhecido, utilizando o teste in vitro de migração de larvas em ágar (LMTA). Larvas de terceiro estágio de um isolado de H. contortus selecionado foram obtidas a partir de culturas de fezes de ovinos infectados experimentalmente e incubadas em onze concentrações diluídas crescentes de IVM e MOX (6, 12, 24, 48, 96, 192, 384, 768, 1536, 3072 e 6144µg/mL). As curvas sigmoides de dose-resposta foram obtidas utilizando o valor de R² >0,90 e a dose de concentração letal (CL50) para as drogas anti-helmínticas testadas, utilizando um modelo logístico de quatro parâmetros. O valor de CL50 para MOX foi significativamente menor do que para IVM (1,253µg/mL e 91,06µg/mL), identificando o isolado de H. contortus como consideravelmente menos suscetível à IVM em comparação à MOX. Além disso, o LMTA mostrou uma alta consistência (p<0,0001) e pode ser uma ferramenta útil de diagnóstico para monitorar o status de resistência de IVM e MOX em isolado de campo de H. contortus, assim como ser utilizado de forma oficial e em rotina para programas de monitoramento das drogas sob a demanda do Ministério da Agricultura (MAPA).

Eficácia das lactonas macrocíclicas sistêmicas ( ivermectina e moxidectina ) na terapia da demodicidose canina generalizada / Efficacy of systemics macrocyclic lactones ( ivermectin and moxidectin ) for the treatment of generalized canine demodicosis

Avaliou-se a eficácia de lactonas macrocíclicas (ivermectina e moxidectina) sobre a eventual ocorrência de efeitos colaterais e acompanharam-se, após a alta parasitológica, por 12 meses, os cães tratados, visando detectar a recidiva do quadro dermatopático. Dos 63 animais, 59 por cento eram fêmeas, 76 por cento apresentavam precisa definição racial e 67 por cento tinham pelame curto. A ivermectina (0,6mg/kg/dia) foi administrada por via oral a 31 cães, e a moxidectina (0,5mg/kg/cada 72 horas), pela mesma via, a 32 animais. Os tempos médios para a obtenção da primeira negativação do exame parasitológico do raspado cutâneo e para a consecução da alta foram, respectivamente, de 90 e 130 dias para a ivermectina e de 108 e 147 dias para a moxidectina. A ivermectina acarretou menos (16,1 por cento) efeitos colaterais em relação à moxidectina (37,5 por cento) (P=0,03). As recidivas foram, respectivamente, 10,3 por cento e 13 por cento para ivermectina e moxidectina. Não houve diferença entre os dois protocolos de terapia quanto aos percentuais de recidiva (P=0,67) e eficácia (P=0,61). Ambas as lactonas macrocíclicas mostraram-se eficazes: ivermectina 89,7 por cento e moxidectina 87 por cento.

The efficacy of ivermectin and moxidectin for treatment of generalized canine demodicosis, was evaluated to detect the eventual occurrence of side effects caused by the use of these drugs, and to follow the treated dogs for 12 months after obtaining parasitologic cure. Of 63 dogs, 59 percent were females, 76 percent were defined as purebred and 67 percent had short hair. Ivermectin (0.6mg/kg/daily) was orally administered to 31 dogs and moxidectin (0.5mg/kg/every 72 hours) to 32 dogs. The average number of days to obtain the first negative skin scraping results and the parasitologic cure were, respectively, 90 and 130 days for ivermectin, and 108 and 147 days for moxidectin. Ivermectin caused fewer side effects (16.1 percent) than moxidectin (37.5 percent) (P<0.05). The percentages of relapse were, respectively, 10.3 percent and 13.0 percent when ivermectin and moxidectin were administered. No difference between protocols of therapy was found for percentage of relapse (P> or =0.67) and efficacy (P> or =0.61). Both drugs were effective and safe to treat generalized canine demodicosis: ivermectin 89.7 percent and moxidectin 87.0 percent.

A Case of Complete Regression of Hepatocellular Carcinoma during Administration of COX-2 Inhibitor / 대한간학회지

Overexpression of cyclooxygenase-2 (COX-2) has been associated with hepatocarcinogenesis. Inhibitors of COX-2 have proapoptotic and antiproliferative effects on malignant tumors and inhibit tumor invasion to the surrounding tissues. We report here a case of complete regression of advanced hepatocellular carcinoma (HCC) during COX-2 inhibitor administration. An eighty-year-old female was diagnosed as an advanced HCC, which was associated with HCV infection. She received COX-2 inhibitor for 3 months due to degenerative arthritis of both knees. Tumor enhancement on arterial phase CT completely disappeared without specific treatment for the HCC, and the tumor size decreased on the follow-up CT scan.

Efficacy of omega-3 fatty acids, atorvastatin and orlistat in non-alcoholic fatty liver disease with dyslipidemia.

AIM: To evaluate the efficacy and safety of three hypolipidemic agents in patients with non-alcoholic fatty liver disease associated with hyperlipidemia. METHODS: Patients with dyslipidemia (Fredrickson type IIb), asymptomatic persistent transaminasemia lasting 24 weeks, and evidence of hepatic fat infiltration on ultrasonography and liver biopsy were studied. Those with predominant hypertriglyceridemia received omega-3 fatty acids (5 mL thrice daily) (Group A), those with predominant hypercholesterolemia received atorvastatin 20 mg/daily (Group B), and overweight patients received orlistat 120 mg thrice daily before meals (Group C). After 24 weeks of treatment, serum transaminase and lipid levels and liver ultrasonography were repeated. RESULTS: Serum transaminase levels decreased significantly (p< 0.001) in all groups but the decrease was more marked in Group C (AST 75 [16] to 31 [7] IU/L; ALT 120 [38] to 41 [10] IU/L) than in Group A (AST 70 [14] to 41 [6]; ALT 110 [20] to 68 [12]) or Group B (AST 68 [13] to 46 [9]; ALT 115 [22] to 76.6 [13]). After treatment, ultrasonography showed resolution of fatty liver in 35% of patients in Group A, 61% in Group B, and in 86% in Group C (p< 0.001, Group C vs. A). CONCLUSIONS: A decline in transaminase levels and normalization of ultrasonographic evidence of fatty liver were observed on treatment with omega-3 fatty acids in patients with hypertriglyceridemia, with atorvastatin in those with hypercholesterolemia, and orlistat in overweight patients with hyperlipidemia.

Daño gastrointestinal inducido por celecoxib y rofecoxib, en ratas / Gastrointestinal damage induced by celecoxib and rofecoxib in rats

En diferentes grupos de ratas Wistar (n=15), se estudiaron AINEs inhibidores selectivos de la COX-2, como delecoxib y refecoxib, en cinco modelos experimentales: 1) Celecoxib y rofecoxib por vía oral y dosis dependiente durante 5 días y 24 hs. Después de indometacina oral. 2) Similar a 1, pero subcutáneo. 3) Ulcera gástrica inducida por ácido acético glacial. 4) Ulcera duodenal por cisteamina. 5) Estrés por inmovilización e inmersión en agua a 15 grados Celsius durante 6 horas. Celecoxib y rofecoxib por vía oral o SC en mucosa gastrointestinal sana no provaron lesiones necróticas en una superficie del 0 grados Celsius, presentanto histología normal; en cambio, agravaron y complicaron lesiones inducidas en forma previa por indometacina en más del 90 por ciento (p<0,001), con necrosis masiva del intestino delgado, así como ampliaron y causaron perforaciones en las úlceras gástricas y duodenales inducidas por ácido acético y cisteamina. Se produjo asimismo agravación de la zona necrótica gástrica por estrés en un 60-90 por ciento (p<0,05). Celecoxib y rofecoxib condujeron a una neutrofilia de 5000/mm3, similar a la inducida por la indometacina; en cambio, no produjeron infiltración leucocitaria en mucosa gástrica (MPO), siendo un marcador de AINE selectivo COX-2. Se concluyó que celecoxib y rofecoxib, administrados en dosis dependiente como inhibidores de COX-2 y no COX-1, no provocaron en mucosa gastrointestinal sana ninguna lesión por toxicidad, observándose un amplio margen terapéutico. En cambio, suministrados en mucosa gastrointestinal dañada agravaron y complicaron las lesiones ulcerosas gástricas y necróticas intestinales, limitando su uso en clínica.

Efectos letal y subletal de lactonas sobre la garrapata del ganado Boophilus annulatus Say / Lethal and sublethal effects of lactones on the cattle tick Boophilus annulatus Say

En este trabajo se evaluó el efecto letal y subletal de cinco lactonas obtenidas de un cultivo líquido de Streptomyces sp, sobre la garrapata del ganado (Boophilus annulatus Say) y la cantidad y calidad de su ovoposición. Los resultados se compararon con los producidos por un fármaco comercial a base de ivermectina. La lactona 3 povocó 30 por ciento de mortalidad, el más alto de las lactonas en experimentación y un descenso mayor en la eclosión de la puesta que el causado por el fármaco comercial usado, lo que le confiere un uso potencial como insecticida

Effects of Goyazensolide during in vitro cultivation of Schistosoma mansoni

Goyazensolide, a component extracted of Eremanthus goyazensis showed a significant inhibitory effect on egg-laying of Schistosoma mansoni during in vitro cultivation of this parasite. Motility of the worms was also reduced under treatment with goyazensolide and 90 per cent of mortality was reached with concentration up to 4 µg/ml. It has found that separated worms were more susceptible than worms pairing during drug exposition and female alone was significantly more susceptible than male worm in the same conditions of in vitro cultivation. Natural products isolated from plants represent potencial sources for the identification of structures useful for the design of alternative molecules to be used as new drug substances against several infectious deseases.

Experiments suggesting a role for the platelet-activating factor in hippocampal and amygdala synapses in memory in rats

Platelet-activating factor (1-O-alky1-2-acetyl-sn-glycero-3-phosphocholine, PAF) is present in brain, is released from neurons in culture and, in hippocampal slices, enhances glutamate release and long-term potentiation (LTP) through an action on membrane receptors sensitive to the antagonist, BN 52021. This led to the proposal that PAF may be a retrograde messenger in the genesis of LTP. LTP has been, in turn, proposed as a mechanism of memory. Male Wistar rats were implanted bilaterally with cannulae aimed at the amygdala and the dorsal hippocampus. After recovery from surgery, the animals were trained in step-down inhibitory avoidance using a 0.5 mA footshock, and tested for retention 24 h later. BN 52021 (0.5 mug) was amnestic when given into the hippocampus or the amygdala either before or immediately after training but not 30 min later. The findings support the idea that memory of this task depends on the generation of LTP at the time of training in hippocampus and amygdala, and further suggest that PAF is involved in the development of this LTP.