RESUMO
OBJECTIVES: The management of hepatitis C has progressed from interferon-based therapy to oral direct acting antiviral therapy. Deranged lipid levels (total cholesterol, triglyceride) after treatment with interferon-based therapy are well known. There is a paucity of data on changes in lipid profile, glycemic parameters and alteration in quality of life with the newer regimen. This study was designed to assess the changes in lipid profile, glycemic parameters, quality of life in chronic hepatitis C patients with genotype 3 after treatment with sofosbuvir and daclatasvir. METHODS: The study was a single-centre, prospective study, conducted at tertiary care hospital from January 2017 to December 2017. Fifty patients, who received sofosbuvir (400 mg) and daclatasvir (60 mg) orally once daily for a period of 12 weeks for chronic hepatitis C and genotype 3, were recruited. RESULTS: Total cholesterol levels (166.9 ± 23.8 to 192.4 ± 34.5 mg/dL, p-value < 0.0001) and low-density cholesterol (LDL) levels (100.9 ± 22.8 to 121.6 ± 37.2, p-value < 0.0001) were elevated after the treatment. A significant decrease in median levels of glycated hemoglobin (HbA1c) was observed (5.57% to 5.41%, p-value < 0.002). Quality of life markedly improved in all domains, i.e. physical, physiological, environmental, and social relationships according to an abbreviated form of World Health Organization quality of life assessment named WHOQOL-BREF questionnaire. Treatment was found to be effective with sustained virological response (SVR) achieved in 94% patients. CONCLUSIONS: Our study reports a substantial increment in total cholesterol, and low-density lipoprotein with sofosbuvir and daclatasvir treatment though it achieved SVR in 94% of patients and improved their quality of life.
Assuntos
Antivirais/administração & dosagem , Colesterol/sangue , Dexametasona/administração & dosagem , Dislipidemias/induzido quimicamente , Framicetina/administração & dosagem , Genótipo , Gramicidina/administração & dosagem , Hepacivirus/genética , Hepatite C Crônica/tratamento farmacológico , Hepatite C Crônica/virologia , Imidazóis/administração & dosagem , Qualidade de Vida , Administração Oral , Adolescente , Adulto , Antivirais/efeitos adversos , Carbamatos , Dexametasona/efeitos adversos , Combinação de Medicamentos , Dislipidemias/sangue , Feminino , Framicetina/efeitos adversos , Hemoglobinas Glicadas , Gramicidina/efeitos adversos , Humanos , Imidazóis/efeitos adversos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Pirrolidinas , Valina/análogos & derivados , Adulto JovemAssuntos
Antibacterianos/administração & dosagem , Antibacterianos/efeitos adversos , Córnea/cirurgia , Framicetina/administração & dosagem , Framicetina/efeitos adversos , Facoemulsificação/efeitos adversos , Facoemulsificação/métodos , Cuidados Pós-Operatórios , Olho , Migração de Corpo Estranho/patologia , Migração de Corpo Estranho/fisiopatologia , Migração de Corpo Estranho/cirurgia , Humanos , Implante de Lente Intraocular , Pomadas , Remissão Espontânea , Técnicas de SuturaRESUMO
PURPOSE: To perform a comprehensive, multifactorial analysis of potential risk factors (demographic and clinical) for contact allergy to neomycin sulfate, a common adverse reaction resulting from the topical use of this drug; especially in some subgroups of the population. METHODS: Retrospective analysis of allergy test data of the Information Network of Departments of Dermatology (IVDK, www.ivdk.org) between 1998 and 2003, including all patients patch tested with a standard screening series because of suspected allergic contact dermatitis (ACD). As one outcome, a positive (allergic) test reaction to neomycin sulfate was considered. An alternative outcome included only those patients with a positive test to neomycin sulfate and a final diagnosis of ACD. The association between outcome and potential risk factors was analyzed with Poisson regression analysis, deriving prevalence ratios (PR) as risk estimates. RESULTS: Of the 47,559 patients tested, 2.5% had positive reactions to neomycin sulfate, while in 1.1% ACD was additionally diagnosed. The results of the multifactorial analysis indicated that the risk of both outcomes decreased slightly during the period covered; was higher among patients with leg dermatitis; varied significantly with age and increased progressively with the number of additional positive reactions to other standard series allergens. Cross-reactivity to other, selectively tested, aminoglycoside antibiotics was substantial (kappa = 0.67; 95%CI: 0.63-0.71) for framycetin sulfate, to low (kappa = 0.33; 95%CI: 0.27-0.37) for gentamicin sulfate. CONCLUSIONS: The prevalence of contact sensitization to neomycin sulfate was noteworthy among patients patch tested in the IVDK centers. Supplementing clinical epidemiology, neomycin contact allergy has been estimated to be relatively common even on the level of the unselected population (prevalence approx. 1%). Hence, the topical use of neomycin sulfate by patients should be carefully monitored, considering its potential to induce ACD, with emphasis on subgroups at risk.
Assuntos
Antibacterianos/efeitos adversos , Dermatite Alérgica de Contato/etiologia , Neomicina/efeitos adversos , Administração Tópica , Corticosteroides/efeitos adversos , Adulto , Antibacterianos/administração & dosagem , Áustria/epidemiologia , Dermatite Alérgica de Contato/epidemiologia , Análise Fatorial , Feminino , Framicetina/efeitos adversos , Alemanha/epidemiologia , Humanos , Perna (Membro) , Masculino , Neomicina/administração & dosagem , Testes do Emplastro , Prevalência , Fatores de Risco , Suíça/epidemiologiaAssuntos
Anestésicos Locais/efeitos adversos , Doenças do Ânus/induzido quimicamente , Dermatite Alérgica de Contato/diagnóstico , Dermatite Alérgica de Contato/etiologia , Dibucaína/efeitos adversos , Esculina/efeitos adversos , Framicetina/efeitos adversos , Hidrocortisona/efeitos adversos , Adulto , Reações Cruzadas , Diagnóstico Diferencial , Combinação de Medicamentos , Feminino , Hemorroidas/tratamento farmacológico , Humanos , Pomadas , Testes do EmplastroAssuntos
Antibacterianos/efeitos adversos , Gentamicinas/efeitos adversos , Otite Média com Derrame/tratamento farmacológico , Administração Tópica , Adolescente , Antibacterianos/uso terapêutico , Anti-Inflamatórios/efeitos adversos , Anti-Inflamatórios/uso terapêutico , Audiometria de Tons Puros , Dexametasona/efeitos adversos , Dexametasona/uso terapêutico , Quimioterapia Combinada , Framicetina/efeitos adversos , Framicetina/uso terapêutico , Gentamicinas/administração & dosagem , Gentamicinas/uso terapêutico , Gramicidina/efeitos adversos , Gramicidina/uso terapêutico , Perda Auditiva Condutiva/diagnóstico , Perda Auditiva Condutiva/etiologia , Humanos , Masculino , Otite Média com Derrame/complicações , Perfuração da Membrana Timpânica/etiologiaAssuntos
Anafilaxia/induzido quimicamente , Antibacterianos/efeitos adversos , Framicetina/efeitos adversos , Administração Tópica , Idoso , Anafilaxia/imunologia , Antibacterianos/imunologia , Ensaio de Imunoadsorção Enzimática , Feminino , Framicetina/imunologia , Humanos , Imunoglobulina G/análise , Imunoglobulina G/imunologia , Testes Cutâneos , Fatores de Tempo , Úlcera Varicosa/tratamento farmacológicoRESUMO
Although experimental data confirm the presence of ototoxicity due to topical ear drops, the clinical relevance still remains debatable. Only few case reports document sensorineural hearing loss (SNHL) attributable to ototopical preparations in patients with chronic otitis media. A careful review of 134 patients charts evaluated between 1953 and 1995 for possible antibiotic related ototoxicity revealed two patients with bilateral profound SNHL attributable to excessive administration of framycetin- and polymyxin-containing ear drops in the presence of tympanic membrane perforation. Although ototopical preparations are widely used, they rarely induce SNHL. The authors emphasize patient education, application of topical ear drops using soaked gauze strips, and documentation of the patients hearing status at the beginning of the treatment regimen.
Assuntos
Antibacterianos/efeitos adversos , Framicetina/efeitos adversos , Perda Auditiva Neurossensorial/induzido quimicamente , Hidrocortisona/efeitos adversos , Neomicina/efeitos adversos , Otite Média/tratamento farmacológico , Polimixina B/efeitos adversos , Administração Tópica , Adulto , Idoso , Antibacterianos/administração & dosagem , Doença Crônica , Combinação de Medicamentos , Framicetina/administração & dosagem , Testes Auditivos , Humanos , Hidrocortisona/administração & dosagem , Masculino , Neomicina/administração & dosagem , Polimixina B/administração & dosagem , SoluçõesRESUMO
Thirty-four patients suffering from chronic otorrhoea were tested for delayed type contact allergy. Patch testing showed a relevant positive reaction in 19 patients (56%). The most frequent allergens were aminoglycosides with neomycin and framycetin as major offenders. Other antimicrobial agents (clioquinol, polymyxin B), cream bases (lanolin) and corticosteroids (tixocortol) were less common allergens encountered. These results indicate that it is almost obligatory to perform patch testing in any patient with long-standing otitis which does not respond to local therapy. Scoring of the patch tests has to be extended to 7 days, as notably the aminoglycosides and corticosteroids only become positive after such a long interval. Because of the high risk of sensitization, topical preparations containing neomycin and framycetin should not be used routinely. We recommend the use of either a topical antiseptic or a topical antibiotic with low allergenic potential for the initial treatment of otorrhoea.
Assuntos
Aminoglicosídeos/efeitos adversos , Aminoglicosídeos/uso terapêutico , Dermatite Alérgica de Contato/etiologia , Framicetina/efeitos adversos , Framicetina/uso terapêutico , Neomicina/efeitos adversos , Neomicina/uso terapêutico , Otite Média/tratamento farmacológico , Administração Tópica , Adolescente , Adulto , Idoso , Doença Crônica , Dermatite Alérgica de Contato/diagnóstico , Orelha Média/fisiopatologia , Feminino , Framicetina/administração & dosagem , Humanos , Masculino , Pessoa de Meia-Idade , Neomicina/administração & dosagem , Otite Média/fisiopatologia , Testes do EmplastroAssuntos
Dermatite Alérgica de Contato/etiologia , Hipersensibilidade a Drogas/etiologia , Framicetina/efeitos adversos , Idoso , Idoso de 80 Anos ou mais , Extração de Catarata , Túnica Conjuntiva , Dermatite Alérgica de Contato/diagnóstico , Hipersensibilidade a Drogas/diagnóstico , Feminino , Framicetina/administração & dosagem , Humanos , InjeçõesRESUMO
Thirty-seven patients with chronic otitis externa were investigated for contact hypersensitivity to 49 agents using standardized patch testing. Positive reactions were found in 22 (58%) patients. This incidence is higher than the 40% found in the only previous similar study and is within the range of 32-72% found in patients with contact dermatitis. The average age of subjects showing sensitivity was 56.7 years compared with 34.9 years for those with negative tests. This significant age difference suggests that contact hypersensitivity is not an aetiological factor in the younger patient. There was no significant difference in the duration of otitis externa between those with positive and negative tests. This feature has not been previously examined or reported. Neomycin was the commonest sensitizing agent, sensitization occurring in 12 (32%) patients.
Assuntos
Dermatite de Contato/imunologia , Otite Externa/imunologia , Adolescente , Adulto , Idoso , Dermatite de Contato/epidemiologia , Feminino , Framicetina/efeitos adversos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Neomicina/efeitos adversos , Testes CutâneosRESUMO
In an open, multi-centre study in general practice, a comparison was made of the efficacy, tolerability and acceptability of a neomycin/dexamethasone preparation administered by metered-dose spray ('Otomize') and a framycetin/gramicidin/dexamethasone preparation ('Sofradex') administered as drops in 60 patients with otitis externa. Patients were allocated at random to receive one or other preparations 3-times daily for 10 days and were followed-up again 14 days after cessation of therapy. Clinical assessments were carried out under observer blind conditions on entry (Day 0) and on Days 10 and 24 of the severity of erythema, swelling and debris in the affected ear(s). A global assessment of clinical outcome was made by the doctor on Day 10. There were no significant differences in the two groups at the start of treatment. Significant improvement occurred in both groups from Day 0 to Day 10 and from Day 10 to Day 24 in all symptoms, with the proportion symptom-free in the 'Otomize' group significantly greater than in the 'Sofradex' group at 24 days, and approaching significance at 10 days. Significantly more patients in the 'Otomize' group were rated as having a good clinical outcome by the physician, and fewer patients experienced discomfort on application. Few side-effects were reported by either treatment group, none necessitating discontinuation of therapy.
Assuntos
Dexametasona/uso terapêutico , Framicetina/uso terapêutico , Gramicidina/uso terapêutico , Neomicina/uso terapêutico , Otite Externa/tratamento farmacológico , Adolescente , Adulto , Aerossóis , Idoso , Idoso de 80 Anos ou mais , Comportamento do Consumidor , Dexametasona/administração & dosagem , Dexametasona/efeitos adversos , Combinação de Medicamentos , Medicina de Família e Comunidade , Feminino , Framicetina/administração & dosagem , Framicetina/efeitos adversos , Gramicidina/administração & dosagem , Gramicidina/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Multicêntricos como Assunto , Neomicina/administração & dosagem , Neomicina/efeitos adversos , Otite Externa/patologia , Otite Externa/psicologia , Ensaios Clínicos Controlados Aleatórios como Assunto , SuspensõesRESUMO
A multi-centre general practice, open study was carried out in 89 patients with second degree haemorrhoids to compare the efficacy and tolerability of two antibiotic-corticosteroid combinations ('Uniroid' and 'Proctosedyl') in ointment and suppository formulations. Patients were allocated at random into 4 groups and received treatment with one of the trial preparations for 1, 2 or 3 weeks, as required, with weekly assessments of response. There were no significant differences between the various groups at the start of treatment. Significant improvement occurred in all groups during treatment. Both suppository and ointment formulations were broadly comparable and control of symptoms was achieved from Week 2 onwards, building up to levels in excess of 90% after 3 weeks of therapy. With regard to the symptoms of pain and itching, suppositories gave marginally greater relief in the early stages of treatment, while both ointment and suppositories were associated with similar reduction in bleeding from haemorrhoids. Whereas both suppository formulations were about equal in reducing anal discharge, 'Uniroid' ointment was clinically superior to 'Proctosedyl' ointment in controlling this symptom over the 3-week trial period. No unwanted effects were experienced attributable to treatment. No statistically significant differences between the two ointment and the two suppository formulations were identified in this study and all four preparations were found to be efficacious in the majority of patients studied.
Assuntos
Dibucaína/administração & dosagem , Esculina/administração & dosagem , Flavonoides/administração & dosagem , Framicetina/administração & dosagem , Hemorroidas/tratamento farmacológico , Hidrocortisona/administração & dosagem , Neomicina/administração & dosagem , Polimixina B/administração & dosagem , Polimixinas/administração & dosagem , Adulto , Idoso , Ensaios Clínicos como Assunto , Dibucaína/efeitos adversos , Dibucaína/uso terapêutico , Combinação de Medicamentos/administração & dosagem , Combinação de Medicamentos/efeitos adversos , Combinação de Medicamentos/uso terapêutico , Esculina/efeitos adversos , Esculina/uso terapêutico , Feminino , Framicetina/efeitos adversos , Framicetina/uso terapêutico , Humanos , Hidrocortisona/efeitos adversos , Hidrocortisona/uso terapêutico , Masculino , Pessoa de Meia-Idade , Neomicina/efeitos adversos , Neomicina/uso terapêutico , Pomadas , Polimixina B/efeitos adversos , Polimixina B/uso terapêutico , Distribuição Aleatória , SupositóriosRESUMO
Drug ototoxicity is a preoccupying iatrogenic complication. Experimental studies over recent years, in particular a pharmacokinetic study of the elimination of aminoglycosides, have enabled the authors to define rules of prescription for parenteral aminoglycosides designed to reduce to a minimum the risk associated with their use. New aminoglycosides such as Netromycin appear to be associated with reduced toxicity. The medico-legal consequences of this complication are still rare, although more precise rules of prescription tend to make the experts more rigorous. The experimental evidence of cochleovestibular toxicity of aminoglycosides applied locally in the presence of a perforated tympanum leaves no room for doubt. The principal factor seems to be the duration of treatment. The prescription of a local aminoglycoside in the presence of a perforated tympanum would only appear to be justified from a legal point of view when absolutely indicated by antibiotic sensitivity tests.
Assuntos
Antibacterianos/efeitos adversos , Surdez/induzido quimicamente , Framicetina/efeitos adversos , Doença Iatrogênica , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/administração & dosagem , Framicetina/administração & dosagem , Humanos , ImperíciaRESUMO
We describe a patient with a polyethylene tube to the middle ear who developed severe deafness and vertigo after treatment with ear drops where neomycin B was considered to be the most likely offending agent. High concentration of this antibiotic in the ear drops and access of the solution to the round window membrane in the absence of inflammatory edema and secretion may have been significant factors contributing to this serious side effect. Less ototoxic preparations should be used in patients with perforated tympanic membranes or grommets.
Assuntos
Surdez/induzido quimicamente , Dexametasona/efeitos adversos , Framicetina/efeitos adversos , Gramicidina/efeitos adversos , Combinação de Medicamentos/efeitos adversos , Feminino , Humanos , Pessoa de Meia-Idade , Vertigem/induzido quimicamenteRESUMO
Patients suffering from chronic external otitis had developed contact allergies to one or more compounds of topical preparations in 40% of 142 tested patients. Neomycin and framycetin caused most of the allergic reactions (16.2%) followed by chinoform (7.0%), chloramphenicol and polymyxin (4.2%). Preservatives of the topical otic preparations such as benzethonium chloride (8.5%), benzalkonium chloride (6.3%) and thimerosal (merthiolate) (5.6%) were also common causes of allergic reactions. An epicutaneous test (patch test) using compounds in topical preparations should be done in cases of prolonged, treatment resistant external otitis.