Ameliorative Effects of Thymoquinone on Sperm Parameters and Testosterone Level of Nicotine-Treated Sprague Dawley Rats

Abstract Thymoquinone (TQ), the main constituent of the volatile oil derived from Nigella sativa has shown pharmacological benefits against various diseases while nicotine is an active component in cigarette that is known to be detrimental. This study was conducted to assess the ameliorating effects of TQ on sperm count, membrane, mitochondria and testosterone of nicotine-treated rats. Rats were randomized into four groups: control, nicotine, TQ, and nicotine with TQ. Nicotine (5 mg/kg bwt/day) was subcutaneously injected for 30 days to induce damaging effects on sperm and testosterone level. Rats were force-fed with TQ (5 mg/kg bwt/day) for the following 30 days. Sperm count was reduced in the nicotine group (26.72 ± 1.64 106/mL) but showed a significantly higher number in the nicotine+TQ group (30.97 ± 0.88 106/mL; p<0.05). Results of sperm membrane integrity test and number of MitoTracker positive sperm also showed a significantly lower percentage in the nicotine group (47.34 ± 0.69 % and 75.68 ± 0.90 %, respectively) but a notable improvement in the nicotine+TQ group (52.58 ± 1.14 % and 79.08 ± 0.74 %, respectively). Testosterone concentration showed elevation in the nicotine+TQ group (7.61 ± 0.51 ng/mL) compared to the nicotine group (5.71 ± 0.15 ng/mL). TQ demonstrated ameliorative potential against the detrimental effects of nicotine towards sperm count, membrane, mitochondria and testosterone level.

Guías de Práctica Clínica para el Tratamiento del Tabaquismo, Chile 2017 / Clinical Practice Guidelines for Smoking Cessation

RESUMEN Considerando que la población chilena tiene una historia de alto consumo de tabaco la Sociedad Chilena de Enfermedades Respiratorias en colaboración con las Sociedades Chilenas de Cardiología; Endocrinología y Diabetes formó un grupo interdisciplinario que emitió un conjunto de recomendaciones para el enfrentamiento del paciente fumador, asesorado metodológicamente por expertos. Estas intervenciones deben priorizarse en grupos de alto riesgo. Métodos: El panel elaboró y graduó las recomendaciones siguiendo la metodología GRADE. Para estimar el efecto de cada intervención, se identificó revisiones sistemáticas y estudios clínicos aleatorizados. Además, se realizó una búsqueda de estudios realizados con población chilena. Para cada una de las preguntas, el panel determinó la dirección y fuerza de la recomendación mediante una tabla de la Evidencia a la Decisión. Recomendaciones: Para todos los fumadores, el panel recomienda usar consejería breve sobre no intervención, consejería vía telefonía móvil sobre no intervención, y mensajes de texto sobre no intervención (recomendación fuerte; certeza moderada en la evidencia de los efectos). Para los individuos motivados, con indicación de fármacos para dejar de fumar el panel recomienda terapia de reemplazo de nicotina sobre no intervención, bupropión sobre no intervención, vareniclina sobre no intervención (recomendación fuerte; certeza moderada en la evidencia de los efectos). Discusión: Se emiten recomendaciones basadas en la evidencia para el tratamiento del tabaquismo.

Considering that Chilean population has a high tobacco consumption history, the Chilean Society of Respiratory Diseases in collaboration with the Chilean Societies of Cardiology and, Endocrinology and Diabetes, formed an interdisciplinary group, who issued a set of recommendations for the treatment of the smoker, methodologically advised by experts. These interventions should be prioritized in high-risk groups. Methods: The panel elaborated and graded the recommendations following the GRADE methodology. To assess the effect of each intervention, systematic reviews and randomized clinical trials were identified. In addition, a search of studies done with the Chilean population was carried out. For each of the questions, the panel determined the direction and strength of the recommendation through a decision evidence table. Recommendations: For all smokers, the panel recommends using brief counseling ABC on non-intervention, using mobile telephone interventions on non-intervention, using text message on non-intervention, (strong recommendation; moderate certainty in the evidence of the effects). For motivated individuals, with indication for quitting drugs the panel recommends using nicotine replacement therapy on non-intervention, using bupropion on non-intervention, using varenicline on non-intervention. (strong recommendation; moderate certainty in the evidence of the effects). Discussion: This clinical practice guide provides recommendations based on the evidence for smoking cessation.

Análisis crítico de un artículo: terapia de reemplazo de la nicotina, efectividad en un escenario real / Critically appraised article: A prospective cohort study challenging the effectiveness of population-based medical intervention for smoking cessation

Objective: To examine the population effectiveness of nicotine replacement therapies (NRTs), either with or without professional counselling, and provide evidence needed to better inform healthcare coverage decisions. Methods: A prospective cohort study was conducted in three waves on a probability sample of 787 Massachusetts adult smokers who had recently quit smoking. The baseline response rate was 46%; follow-up was completed by 56% of the designated cohort at wave 2 and 68% at wave 3. The relationship between relapse to smoking at follow-up interviews and assistance used, including NRT with or without professional help, was examined. Results: Almost one-third of recent quitters at each wave reported to have relapsed by the subsequent interview. Odds of relapse were unaffected by use of NRT for > 6 weeks either with (p = 0.117) or without (p = 0.159) professional counseling and were highest among prior heavily dependent persons who reported NRT use for any length of time without professional counselling (OR 2.68). Conclusions: This study finds that persons who have quit smoking relapsed at equivalent rates, whether or not they used NRT to help them in their quit attempts. Cessation medication policy should be made in the larger context of public health, and increasing individual treatment coverage should not be at the expense of population evidence-based programmes and policies.

A real-life study of the effectiveness of different pharmacological approaches to the treatment of smoking cessation: re-discussing the predictors of success

OBJECTIVE: To evaluate the effectiveness of nicotine replacement therapy (NRT), bupropion, nortriptyline and combination therapy and describe factors associated with treatment success. INTRODUCTION: Clinical trials clearly demonstrate the efficacy of pharmacotherapy in smoking cessation. However, it is only after its use in real-life settings that clinical effectiveness and limitations of a treatment are fully known. METHODS: Patients attended a four-session cognitive-behavioral program and received medicines free of charge. Abstinence from smoking was assessed at each visit. RESULTS: A total of 868 smokers (68.8 percent women) were included. Their mean age was 49.6 years; the amount smoked was 25 cigarettes/day and the Fagerströ m Score was 6.6. Abstinence rates after 6 months and 1 year were 36.5 percent and 33.6 percent. In univariate analysis, male gender, age (>50), higher number of cigarettes smoked, cardiovascular comorbidities, longer interval from the last cigarette and combined treatment of nortriptyline plus NRT were predictive of abstinence, while neuropsychiatric comorbidities and the answer ''yes'' to the question ''Do you smoke more often during the first hours after waking'' were correlated with failure. In a multivariate model, predictors of abstinence were neuropsychiatric comorbidities, the answer ''yes'' to the question ''Do you smoke more often during the first hours after waking'' and combined treatment of nortriptyline plus NRT. Male gender and a longer period from the last cigarette were correlated with lower abstinence rate. CONCLUSION: Satisfactory success rates were obtained in a teaching hospital. Factors such as age, daily cigarette consumption, number of pack-years and dependency score were not reliable markers of abstinence. The combination nortriptyline+NRT was independently associated with higher abstinence rates.

Factores determinantes en el éxito de un tratamiento antitabaco / Factors associated with abstinence in a smoking cessation program

Smoking cessation programs have an efficacy of approximately 30 percent. Different factors related to the patients may influence this figure. Aim To identify determinant factors for smoking cessation after one year of treatment and to determine if bupropion and nicotine substitutes are effective in smoking cessation treatments. Material and methods: Follow up of 68 patients that attended a smokers clinic at a General Hospital. The patients filled up a questionnaire which included demographic, morbid and smoking habits data. They were subjected to a psychiatric interview to determine their treatment. One year later, patients were contacted by telephone and were asked if they remained without smoking. Results: After one year, 41 percent of patients responded that they were abstinent. On univariate analysis, male gender appeared as a protective factor associated to abstinence. On multivariate analysis, the use of bupropion appeared as a protective factor. A high score on the automatic item of the smoking motivation questionnaire appeared as a risk factor. The presence of respiratory diseases and the male gender were borderline significant protective factors. Nicotine substitutes were not associated with better abstinence rates. Conclusions: In this sample of smokers, the use of bupropion was associated with better abstinence rates and a high motivation to smoke appeared as a risk factor to continue smoking.

Terapias farmacológicas para dejar de fumar: metaanálisis de estudios aleatorizados controlados / Pharmacotherapies for smoking cessation: a meta-analysis of randomised controlled trials

Objetivo. Comparar los efectos del tratamiento de 7 formas farmacológicas aprobadas para dejar de fumar. Materiales y métodos. Fuente y selección de datos: Búsqueda realizada en Enero de 2008 en la base de datos del Centro para Control y Prevención de Enfermedades relacionadas con el tabaco de Estados Unidos, MEDLINE, EMBASE y la Biblioteca Cochrane. Restringido a idioma inglés solamente. Se contemplaron para este trabajo todos los estudios aleatoririzados controlados (EAC) que reportaran medidas bioquímicas de abstinencia a 6 y 12 meses (p.ej., cotinina en orina). _De los 622 trabajos potencialmente relevantes, 69 (32.908 pacientes totales) cumplieron los criterios de inclusión (EAC con placebo, ciegos, medición de abstinencia 6 y/o 12 meses con confirmación bioquímica). Lois datos fueron obtenidos por dos revisores en forma independiente. Los desacuerdos fueron arreglados por consenso o por un tercer revisor. Cuando fue necesario, se contactó a los autores para mayor información. Resultados. Encontraron las siguientes chamces (odds ratio [OR] para abandono del hábito tabáquico, en orden de efectividad decreciente: vareniclina (OR=2,55), spray nasal de nicotina (2,37), inhalador bronquial de nicotina (2.18), bupropión (2.12), parche de nicotina (1.88) y chicle de nicotina (1.65). Todas las diferencias entre el placebo y el tratamiento fueron estadísticamente significativas. Seis estudios que incluían 1.881 pacientes compararon directamente vareniclina con bupropión y arrojaron resultados a favor de vareniclina (OR= 2.18; INTERVALO DE CONFIANZA DEL 95% [IC95%]: 1,09-4,08). Conclusiones. Vareniclina, bupropión y 5 formas de reemplazo nicotínico estudiadas (chicle, parche, spray nasal, tabletas e inhaladores) fueron más efectivos que placebo al promover una terapia para dejar de fumar. A pesar de la eficacia documentada, el número absoluto de pacientes abstinentes a 12 meses es bajo.

Ambulatório de apoio ao tabagista no Ceará: perfil dos pacientes e fatores associados ao sucesso terapêutico / Outpatient smoking cessation program in the state of Ceará, Brazil: patient profiles and factors associated with treatment success

OBJETIVO: Avaliar o perfil dos pacientes e fatores associados ao sucesso do tratamento do fumante. MÉTODOS: Estudo retrospectivo dos pacientes que foram atendidos no ambulatório de apoio ao tabagista do Hospital de Messejana, no Ceará, durante o período de outubro de 2002 a abril de 2005. O tratamento foi avaliado considerando-se o perfil do tabagista, tipo de medicação e período de utilização da mesma. RESULTADOS: Do total de 320 pacientes atendidos, 65,6 por cento eram mulheres. A média de idade do início do tratamento foi de 48 anos, sendo 33 anos o tempo médio de uso do tabaco. Acima de 90 por cento deles iniciaram o tabagismo antes dos vinte anos de idade. Daqueles que se encontravam no programa havia pelo menos um ano (258 pessoas), 50,8 por cento atingiram o sucesso terapêutico, 17,8 por cento recaíram e 31,4 por cento não pararam de fumar. Sucesso parcial foi atingido, em média, na quinta semana do tratamento e a recaída foi predominante no quarto mês. Cerca de 60 por cento dos pacientes utilizaram terapia medicamentosa. CONCLUSÃO: A chance de parar de fumar foi associada significativamente ao uso de medicação, independentemente do perfil tabágico avaliado. No segundo ano do programa, observou-se maior associação da bupropiona à terapia de reposição nicotínica, com conseqüente elevação da taxa de sucesso e tendência à redução da recaída.

OBJECTIVE: To evaluate patient profiles and factors associated with successful treatment. METHODS: A retrospective study of patients enrolled in the smoking cessation program at the Hospital de Messejana, located in the state of Ceará, Brazil, from October of 2002 to April of 2005. The treatment was evaluated based on patient profile, type of medication prescribed and time on that medication. RESULTS: Of the 320 patients enrolled, 65.5 percent were women. The mean age at the outset of treatment was 48 years, and the mean duration of the smoking habit was 33 years. More than 90 percent of the patients had started smoking before the age of 20. Of the 258 individuals who had enrolled in the program at least one year prior, 50.8 percent had achieved treatment success; 17.8 percent had relapsed, and 31.4 percent had not quit smoking. On average, partial success was achieved in the fifth week of the treatment, and relapse occurred predominantly in the fourth month. Approximately 60 percent of the patients were treated with medication. CONCLUSION: Quitting smoking was significantly associated with the use of medication, regardless of the profile of the smoker evaluated. In the second year of the program, quitting smoking was more strongly associated with the use of bupropion and nicotine replacement, resulting in a higher success rate and a trend toward a reduction in the relapse rate.

Ensaio clínico randomizado: efetividade da abordagem cognitivo-comportamental e uso de adesivos transdérmicos de reposicão de nicotina, na cessacão de fumar, em adultos residentes no Município do Rio de Janeiro, Brasil / Randomized clinical trial: effectiveness of the cognitive-behavioral approach and the use of nicotine replacement transdermal patches for smoking cessation among adults in Rio de Janeiro, Brazil

Ensaio clínico randomizado conduzido para avaliar efetividades dos métodos de abordagem cognitivo-comportamental e terapia de reposicão de nicotina com adesivos para cessacão de fumar. Participaram 1.199 voluntários, adultos, do Município do Rio de Janeiro, Brasil, alocados aleatoriamente em dez grupos: aconselhamento breve (GB) intensivo de 1 ou 2 sessões (G1-G2) e de 3 ou 4 sessões (G3-G4), com/sem terapia de reposicão de nicotina. Proporcões de abstinência foram estimadas durante os 12 meses. Essas proporcões nos grupos sem adesivo foram 20 por cento (GB), 17 por cento (G1-G2) e 23 por cento (G3-G4). Nos grupos com adesivo foram aproximadamente 30 por cento (GBA), 34 por cento (G1A-G2A) e 33 por cento (G3A-G4A). Após ajuste múltiplo, as razões de proporcão de abstinência parecem seguir padrão consistente com efeito "dose-resposta": comparadas com GB foram 0,85 (G1-G2); 1,13 (G3-G4); 1,51 (GBA); 1,66 (G1A-G2A) e 1,75 (G3A-G4A) (p < 0,05). Os resultados sugerem que acrescer terapia de reposicão de nicotina aumenta a proporcão de abstinência na cessacão. Padrões tipo "dose-resposta" encontrados nas razões de proporcão de abstinência sugerem que a abordagem cognitivo-comportamental pode ser uma opcão razoável no tratamento do fumante.

Terapia neuroprotectora de la Enfermedad de Parkinson / Neuroprotective therapy in Parkinson's Disease

With the current limitations on treating Parkinsonãs disease, neuroprotection should be looked at as a possible way of slowing the varying processes involved in the onset of the disease. A review was made of the work of NINDS experts, who evaluated 59 drugs resulting from their Medline and Pub Med search. Twelve drugs, those considered the most promising, were included in the final analysis. We look at such substances as caffeine, coenzyme q10, estrogens, minocycline, nicotine, rasagiline-selegiline, and ropinirole-pramipexole. These agents acted dissimilarly, but favorably, on some of the diseaseãs processes or on its underlying pathogenesis, although the mechanisms involved and the duration of the beneficial effects were not clear. The challenge is to overcome the difficulties that make the results of the few current studies uncertain, using new methods, such as transgenic models, to maintain hope for effective future treatments.

Tratamento do tabagismo com bupropiona e reposição nicotínica / Smoking cessation with bupropion and nicotine replacement

Introdução: Aproximadamente um terço da população adulta mundial usa produtos derivados do tabaco. Devido ao novo entendimento sobre o vício tabágico e ao surgimento de novas modalidades terapêuticas, as possibilidades de sucesso nas tentativas de abandono do fumo aumentaram significativamente. Objetivos: Avaliar os percentuais de sucesso/fracasso entre os fumantes tratados no Ambulatório de Auxílio ao Abandono do Tabagismo da Pontifícia Universidade Católica do Rio Grande do Sul (AAAT-PUCRS) e analisar possíveis fatores de risco para o fracasso no abandono do tabagismo. Pacientes e métodos: Através de ensaio clínico aberto, não randomizado, avaliaram-se os fumantes que procuraram o AAAT-PUCRS entre julho de 1999 e outubro de 2000, submetidos ao programa padronizado de auxílio ao abandono do tabagismo utilizado na instituição. A análise estatística foi feita por medidas de tendência central para variáveis quantitativas, pelo cálculo do risco relativo (com intervalo de confiança de 95 por cento) para fatores associados e pela análise da curva de Kaplan-Meier para estudo do desfecho ao longo do tempo. Resultados: O estudo incluiu 169 pacientes (67,5 por cento mulheres), com idade média de 46,4 (± 10,4) anos; a maioria fumava em média 20 cigarros/dia por 30 anos. Mesmo sendo esta uma coorte muito recente, pode-se verificar que, em relação aos desfechos sucesso/fracasso pontuais, 49 por cento pararam de fumar, 14 por cento diminuíram significativamente o número de cigarros fumados e 37 por cento fracassaram. Entre as variáveis estudadas, a dependência grave à nicotina foi a única que esteve associada a maior risco de fracasso. Conclusões: Foi possível a obtenção de índices de abandono ao fumo satisfatórios utilizando metodologia padronizada, mas particularizada para cada paciente. O uso de terapêutica farmacológica aliada a técnicas cognitivo-comportamentais foi associado a maiores proporções de sucesso

Intervençäo sobre tabagismo realizada por cardiologista em rotina ambulatorial / Anti-smoking intervention performed by cardiologist during ambulatory care

OBJETIVO: Avaliar a efetividade da intervençäo sobre o tabagismo, realizada por médico cardiologista em rotina de ambulatório, utilizando a prescriçäo de adesivos de nicotina. MÉTODOS: Foram avaliados, consecutivamente, 100 pacientes (50 homens e 50 mulheres), incluindo consulta médica, aplicaçäo de escore para definiçäo do grau de dependência à nicotina, determinaçäo da concentraçäo de monóxido de carbono expirado e peso corpóreo. Os adesivos foram utilizados entre 8 e 12 semanas, com reduçäo progressiva da concentraçäo até a suspensäo (concentraçöes de 21, 14 e 7 mg). RESULTADOS: A taxa de abstinência um ano após o início do tratamento foi de 41 "por cento", confirmada pela concentraçäo do monóxido de carbono. CONCLUSÄO: A intervençäo sobre o tabagismo pode ser realizada em rotina de atendimento cardiológico com resultados satisfatórios. Os adesivos de nicotina säo seguros, bem tolerados, e devem ser utilizados, mais freqüêntemente, no auxílio aos fumantes, para deixarem de fumar.