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1.
Med. clín (Ed. impr.) ; 160(11): 501-516, jun. 2023. tab
Artigo em Espanhol | IBECS | ID: ibc-221514

RESUMO

La enfermedad inflamatoria intestinal incluye 2 enfermedades crónicas inflamatorias, la colitis ulcerosa y la enfermedad de Crohn. Su carga de enfermedad está aumentando en el mundo. Se han publicado algunas revisiones que evalúan el uso pediátrico de los antagonistas del factor de necrosis tumoral (TNF), aunque incluyen mayoritariamente estudios observacionales y no consideran las evaluaciones económicas. En esta revisión sistemática se evalúa la evidencia disponible en cuanto a eficacia, seguridad y coste-efectividad de los antagonistas del TNF en el tratamiento de la enfermedad inflamatoria intestinal pediátrica. Se realizaron búsquedas en PubMed/MEDLINE, Embase y Cochrane Central (hasta mayo de 2022). Se incluyeron 9 ensayos clínicos aleatorizados y 4 evaluaciones económicas que estudiaran alguno de los fármacos anti-TNF (infliximab, adalimumab, golimumab, certolizumab) frente a diferentes alternativas. En los estudios que evaluaron la eficacia del tratamiento anti-TNF en enfermedad de Crohn, la mayoría valoraron la pauta de mantenimiento en pacientes que previamente habían respondido a la inducción (respuesta=28-63%, y remisión clínica=17-83% dependiendo de la dosis, fármaco y seguimiento). En colitis ulcerosa, el tratamiento de mantenimiento con anti-TNF presentó tasas de remisión clínica entre 17-44%. Nueve estudios mostraron información sobre acontecimientos adversos. No se encontraron ensayos clínicos que compararan diferentes fármacos anti-TNF. Los resultados de esta revisión indican que el tratamiento de mantenimiento con fármacos anti-TNF (como infliximab y adalimumab) en la enfermedad inflamatoria intestinal pediátrica es probablemente eficaz y seguro. Sin embargo, las evaluaciones económicas incluidas presentaron resultados contradictorios sobre las razones coste-efectividad (AU)


Inflammatory bowel disease includes two chronic inflammatory diseases, ulcerative colitis and Crohn's disease. The burden of disease is increasing worldwide. A few reviews evaluating the paediatric use of tumour necrosis factor (TNF) antagonists have been published, although these mostly include observational studies and do not consider economic evaluations. This systematic review evaluated the available evidence regarding the efficacy, safety, and cost-effectiveness of TNF antagonist therapy for paediatric inflammatory bowel disease. We searched PubMed/MEDLINE, Embase, and Cochrane Central (up to May 2022). Nine randomized clinical trials and four economic evaluations that examined any anti-TNF drugs (e.g., infliximab, adalimumab, golimumab, and certolizumab) against different alternatives were included. In studies evaluating the efficacy of anti-TNF drugs in Crohn's disease, most assessed the efficacy of maintenance regimen in patients who had previously responded to induction (response=28%–63%, and clinical remission=17%–83% depending on dose, drug, and follow-up). In ulcerative colitis, maintenance treatment with anti-TNF drugs reported clinical remission rates between 17% and 44%. Nine studies reported information on adverse events. No clinical trials comparing different anti-TNF drugs were found. The findings from this review suggest that maintenance treatment with anti-TNF drugs (such as infliximab and adalimumab) in paediatric inflammatory bowel disease is probably effective and safe. However, the economic evaluations reported contradictory results of the cost-effectiveness ratios (AU)


Assuntos
Humanos , Criança , Adalimumab/uso terapêutico , Anti-Inflamatórios/uso terapêutico , Colite Ulcerativa/tratamento farmacológico , Doença de Crohn/tratamento farmacológico , Doenças Inflamatórias Intestinais/tratamento farmacológico , Fatores de Necrose Tumoral/antagonistas & inibidores , Infliximab/uso terapêutico , Fármacos Gastrointestinais/uso terapêutico
2.
Med. clín (Ed. impr.) ; 160(3): 107-112, febrero 2023. tab
Artigo em Inglês | IBECS | ID: ibc-215518

RESUMO

Introduction: Monitoring plasma levels of Infliximab plays an important role in optimising treatment in patients with inflammatory bowel disease (IBD). The aim of the following study has been to determine the predictive potential of monitoring infliximab plasma levels for sustained clinical response and evaluate its usefulness to improve treatment efficacy and symptom control, in patients with IBD.MethodsThis single-centre retrospective study (2017–2019) included patients diagnosed with IBD treated with infliximab. Serum levels and the occurrence of drug-associated immunogenicity were analysed at Week 8 post-induction and 6, 12 and 24 months. Clinical parameters and inflammatory markers were recorded such as subjective global assessment (SGA), C-reactive protein (CRP) and faecal calprotectin (FC). Factors associated with early discontinuation and dose intensification of infliximab were determined.ResultsMultivariate analysis determined that IFX concentrations>7μg/mL at week 8, and at 6 months, are associated with inflammatory remission (p=0.046, 0.045). IFX>7μg/mL at 12 months predicted remission at 18 months of treatment (p=0.006). IFX values>3μg/mL at 12 months are associated with stable SGA at 18 months (p=0.001). Such values at 18 months are associated with stable SGA at 24 months (p=0.044).Conclusions and relevanceThe predictive potential of monitoring IFX plasma levels as a strategy to evaluate sustained long-term clinical response was confirmed. Our results highlight the importance of its introduction into routine clinical practice to enable early identification of non-responders, treatment optimisation, relapse prevention and improve long-term therapy maintenance. (AU)


Introducción: La monitorización de infliximab (IFX) juega un papel importante en la optimización del tratamiento en pacientes con enfermedad inflamatoria intestinal (EII). El objetivo del estudio fue determinar el potencial predictivo de la monitorización de IFX para la respuesta clínica sostenida, y evaluar su utilidad en la eficacia del tratamiento y del control de los síntomas.MétodosEstudio retrospectivo unicéntrico (2017-2019) que incluyó pacientes con EII tratados con IFX. Se analizaron los niveles séricos y la inmunogenicidad asociada al fármaco en la semana 8 postinducción, y a los 6, 12 y 24 meses. Se registraron los parámetros clínicos y los marcadores inflamatorios correspondientes a la evaluación global subjetiva (SGA), proteína C reactiva (PCR) y calprotectina fecal (CF). Se determinaron los factores asociados a la interrupción precoz y a la intensificación de la dosis de IFX.ResultadosEl análisis multivariante determinó que las concentraciones de IFX>7μg/ml en la semana 8, y a los 6 meses, se asocian a la remisión inflamatoria (p=0,046-0,045). El IFX>7μg/ml a los 12 meses predijo la remisión a los 18 meses de tratamiento (p=0,006). Los valores de IFX>3μg/ml a los 12 meses se asocian a una SGA estable a los 18 meses (p=0,001). Dichos valores a los 18 meses se asocian a SGA estable a los 24 meses (p=0,044).Conclusiones y relevanciaSe confirma el potencial predictivo de la monitorización de los niveles plasmáticos de IFX como estrategia para evaluar la respuesta clínica sostenida a largo plazo. Nuestros resultados destacan la importancia de su introducción en la práctica clínica habitual para permitir la identificación temprana de los no respondedores, la optimización del tratamiento, la prevención de recaídas y mejorar el mantenimiento de la terapia a largo plazo. (AU)


Assuntos
Humanos , Colite Ulcerativa/diagnóstico , Doença de Crohn/diagnóstico , Fármacos Gastrointestinais/uso terapêutico , Infliximab/uso terapêutico , Doenças Inflamatórias Intestinais/tratamento farmacológico , Estudos Retrospectivos
4.
Rev. esp. enferm. dig ; 115(8): 435-443, 2023. tab, graf
Artigo em Inglês | IBECS | ID: ibc-223637

RESUMO

Background and objectives: there is increasing evidence that proactive therapeutic drug monitoring in induction is useful to improve the control of inflammatory bowel disease (IBD), although it remains controversial. The primary objective of the study was to assess the short-term outcomes of proactive Bayesian therapeutic drug monitoring (TDM) during induction, to optimize infliximab (IFX) maintenance dose. Methods: retrospective observational cohort of IBD patients > 18 years. They were divided into two cohorts, standard therapy group (ST-group), with clinically based dose adjustment, and monitoring group (iTDM-group), with pharmacokinetic parameters calculated by Bayesian prediction at week 6 and individualized dosage regimens thereafter. In patients with an infliximab trough level (ITL) at week 6 below the optimal therapeutic range, the dose adjustment was performed at the first maintenance dose. Results: a total of 153 patients were included, 40 in the iTDM-group. Median ITL at week 6 during the induction period was 12.8 µg/ml (IRQ: 12.7) in this group. Only 16 patients (40.0 %) had ITL ≥ 15 µg/ml. Half of the patients (50.3 %) received intensified maintenance therapy during the study period (57.5 % iTDM vs 47.8 % ST, p = 0.291). The proportion of patients achieving primary response at week 14 was 51.8 %. When comparing the two groups, this proportion was higher in the iTDM group (74.3 % vs 44.2 %, p = 0.002). With regards to the variable “poor clinical outcomes” at week 26, this proportion was lower in the iTDM group (3.3 % iTDM vs 21.1 % ST, p = 0.024). Conclusions: proactive therapeutic drug monitoring using Bayesian approach is associated with higher primary response rates and fewer short-term complications (AU)


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Infliximab/uso terapêutico , Fármacos Gastrointestinais/uso terapêutico , Doenças Inflamatórias Intestinais/tratamento farmacológico , Monitoramento de Medicamentos , Estudos Retrospectivos , Estudos de Coortes , Teorema de Bayes , Índice de Gravidade de Doença , Resultado do Tratamento
5.
Rev. esp. enferm. dig ; 115(3): 121-127, 2023. ilus, tab, graf
Artigo em Inglês | IBECS | ID: ibc-217235

RESUMO

Background and aim: prokinetics could eradicate small intestinal bacterial overgrowth. This study aimed to evaluate the efficacy of mosapride, rifaximin and a combination of mosapride and rifaximin for the treatment of small intestinal bacterial overgrowth. Methods: we randomly assigned patients with functional dyspepsia diagnosed with small intestinal bacterial overgrowth in a 1:1:1 ratio to receive mosapride, rifaximin or a combination of both for two weeks. The hydrogen-methane glucose breath test and symptom questionnaire were surveyed before and after the treatment. Primary outcome was eradication rate of small intestinal bacterial overgrowth. Secondary outcomes were changes in the gas concentration, symptoms and safety. Results: the eradication rates were 17.2 % (5/29) for mosapride, 32.1 % (9/28) for rifaximin, and 34.6 % (9/26) for the combined groups, with no significant differences among the three groups. Total hydrogen concentration during the glucose breath test significantly decreased in the rifaximin group (p = 0.001). Total methane concentration significantly decreased in the rifaximin and combined groups (p = 0.005). Significant symptomatic improvements were observed in chest and abdominal discomfort with mosapride, in flatulence with rifaximin, and in chest discomfort with the combined groups. Adverse events were similar between the groups. Conclusions: rifaximin has an advantage of reducing gas, whereas mosapride can help to decrease breath hydrogen concentration. Certain intestinal symptoms improved with mosapride alone or combined with rifaximin (AU)


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Rifaximina/uso terapêutico , Dispepsia/diagnóstico , Dispepsia/tratamento farmacológico , Fármacos Gastrointestinais/uso terapêutico , Testes Respiratórios , Estudos Prospectivos
6.
Gastroenterol. hepatol. (Ed. impr.) ; 45(2): 155-163, Feb. 2022. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-204148

RESUMO

El síndrome de rumiación es un trastorno funcional caracterizado por la regurgitación involuntaria de los alimentos recientemente ingeridos desde el estómago hacia la boca, donde puede ser remasticados o expulsados. Desde el punto de vista clínico, se caracteriza por episodios repetidos de regurgitación de alimentos sin esfuerzo, con vómitos frecuentes como queja habitual. El mecanismo físico que genera los eventos de regurgitación depende de un proceso involuntario que altera las presiones abdominal y torácica, acompañado de una unión esofagogástrica permisiva. El diagnóstico del síndrome de rumiación es clínico: destaca la importancia de realizar una anamnesis exhaustiva sobre las características de los síntomas. Las pruebas complementarias se utilizan para corroborar el diagnóstico o descartar otra enfermedad orgánica. El tratamiento está enfocado a terapias conductuales como primera línea, reservando las terapias farmacológicas y quirúrgicas para casos refractarios.


Rumination syndrome is a functional disorder characterized by the involuntary regurgitation of recently swallowed food from the stomach into the mouth, from where it can be re-chewed or expelled. Clinically, it is characterized by repeated episodes of effortless food regurgitation. The most usual complaint is frequent vomiting. The physical mechanism that generates regurgitation events is dependent on an involuntary process that alters abdominal and thoracic pressures accompanied by a permissive oesophageal-gastric junction. The diagnosis of rumination syndrome is clinical, highlighting the importance of performing an exhaustive anamnesis on the characteristics of the symptoms. Complementary tests are used to corroborate the diagnosis or rule out organic pathology. Treatment is focused on behavioural therapies as the first line, reserving pharmacological and surgical therapies for refractory cases.


Assuntos
Humanos , Transtornos de Alimentação na Infância , Vômito , Refluxo Laringofaríngeo , Fármacos Gastrointestinais/uso terapêutico , Tratamento Farmacológico , Gastroenterologia , Pacientes Internados
8.
Nutr. hosp ; 39(1): 230-232, ene. - feb. 2022. tab
Artigo em Inglês | IBECS | ID: ibc-209685

RESUMO

Introduction: teduglutide (TED) is indicated for the treatment of patients with short-bowel syndrome (SBS) who are dependent on parenteral support. Case report: we report the case of a 60-year-old woman with SBS treated with TED. She had previously undergone multiple surgical resections due to Crohn's disease. Her remnant bowel included only the duodenum and 50-60 centimeters of jejunum. The patient was dependent on intravenous fluids (2,320 mL/48 h) and had a high stoma output (3,000 mL/day). After four months of TED the jejunostomy output had decreased to 2,200 mL/day with a thicker consistency, and intravenous fluid therapy was reduced to 2,010 mL/48 h. TED was withdrawn due to acute pancreatitis and enlargement of two supraumbilical hernias with high strangulation risk. Discussion: pancreatitis has been reported in clinical studies, and determination of amylase and lipase is recommended in all patients receiving TED. In contrast, there are no recommendations for the surveillance of hernia enlargement in patients on TED therapy, but we suggest the need for surveillance based on this case report (AU)


Introducción: la teduglutida (TED) está indicada para el tratamiento de pacientes con síndrome de intestino corto (SBS) que precisen soporte parenteral. Caso clínico: mujer de 60 años con SBS tratada con TED. Previamente se había sometido a múltiples resecciones quirúrgicas por su enfermedad de Crohn. Su intestino remanente incluía el duodeno y 50-60 centímetros de yeyuno. La paciente era dependiente de líquidos por vía intravenosa (2320 ml/48 h) y tenía una ostomía de alto débito (3000 ml/día). Después de cuatro meses de TED, el débito de la yeyunostomía disminuyó a 2200 ml/día, con una consistencia más espesa, y la fluidoterapia intravenosa se redujo a 2010 ml/48 h. Se retiró la TED por pancreatitis aguda y agrandamiento de dos hernias supraumbilicales con alto riesgo de estrangulamiento. Discusión: se han descrito casos de pancreatitis en estudios previos, por lo que se recomienda la determinación de la amilasa y la lipasa en los pacientes tratados con TED. Sin embargo, no hay recomendaciones específicas sobre la vigilancia del agrandamiento de hernias, pero sugerimos su idoneidad basada en este caso clínico (AU)


Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Síndrome do Intestino Curto/tratamento farmacológico , Fármacos Gastrointestinais/efeitos adversos , Fármacos Gastrointestinais/uso terapêutico , Peptídeos/efeitos adversos , Peptídeos/uso terapêutico , Pancreatite/induzido quimicamente , Hérnia/induzido quimicamente , Doença Aguda
11.
Rev. esp. enferm. dig ; 112(8): 590-597, ago. 2020. tab, graf
Artigo em Inglês | IBECS | ID: ibc-199962

RESUMO

INTRODUCTION: infliximab is used in inflammatory bowel disease, which has a great inter-individual pharmacokinetic variability. Thus, it is necessary to individualize the therapy in many cases. The main objective of our study was to compare two methods of a dose adjustment strategy using therapeutic drug monitoring: a) based on an algorithm and b) based on Bayesian prediction, to achieve an optimal infliximab trough level in patients with inflammatory bowel diseases. The secondary objective was to evaluate the predictive performance of a population pharmacokinetic model of infliximab in patients with inflammatory bowel diseases and therefore, its clinical utility. Furthermore, the factors associated with a suboptimal adjustment of the model were analyzed. METHODS: a retrospective observational cohort analysis was performed of patients with inflammatory bowel disease and available serum levels of infliximab. The relationship between trough concentration and dosing strategy was compared in both groups. The external validation of a previously published population pharmacokinetic model was performed using the NONMEM software. The mean prediction error and mean absolute prediction error were calculated to evaluate the predictive performance of the model. RESULTS: a total of 94 infliximab serum samples were obtained from 47 patients. After the adjustment, a total of 30 patients (63.8 %) achieved optimal infliximab trough levels. A dosing strategy based on Bayesian was associated with optimal infliximab trough levels that were higher than the strategy based on an algorithm (OR: 8.94 [95 % CI: 2.24 - 35.6], p = 0.001). For the individual predictions, the mean prediction error was 0.118 Mug/ml (95 % CI: -0.149-0.384) and the mean absolute prediction error was 0.935 Mug/ml (95 % CI: 0.569-1.075). CONCLUSIONS: the application of a population pharmacokinetic model based on Bayesian prediction is an important advance in the optimization of infliximab dosage in the treatment of inflammatory bowel disease


No disponible


Assuntos
Humanos , Masculino , Feminino , Adulto , Infliximab/administração & dosagem , Fármacos Gastrointestinais/administração & dosagem , Doenças Inflamatórias Intestinais/sangue , Doenças Inflamatórias Intestinais/tratamento farmacológico , Fármacos Gastrointestinais/farmacocinética , Estudos Retrospectivos , Infliximab/farmacocinética , Estudos de Coortes , Teorema de Bayes
12.
Rev. esp. enferm. dig ; 112(8): 636-641, ago. 2020. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-199969

RESUMO

INTRODUCCIÓN: los inhibidores del factor de necrosis tumoral alfa (anti-TNF) son fármacos eficaces en el tratamiento de la colitis ulcerosa (CU) moderada-grave. Sin embargo, muchos pacientes no responden o tienen una pérdida de respuesta terapéutica durante el seguimiento. OBJETIVO: analizar los factores que determinan la respuesta clínica a los anti-TNF en la CU. MÉTODOS: estudio multicéntrico retrospectivo en 79 pacientes con CU que iniciaron tratamiento con anti-TNF entre 2009 y 2015. El criterio de valoración principal fue la remisión clínica (índice pMayo ≤ 1) a los 12 meses. Asimismo, se analizaron la remisión y respuesta clínica (índice pMayo final ≤ 3) y la retirada de corticoides a los tres, seis y 12 meses. Se realizó análisis para identificar las variables predictoras de respuesta clínica. RESULTADOS: a los 12 meses, presentó remisión y respuesta clínica el 59,2 % y el 77,8 % de los pacientes, respectivamente. Se consiguió retirar los corticoides en el 82,4 % de los pacientes. A los 12 meses, la retirada de corticoides (< 3 meses) (OR 0,06; IC 95 %: 0,01-0,24) y la respuesta clínica a los seis meses (OR 0,008; IC 95 %: 0,001-0,053) fueron factores predictivos independientes de remisión clínica. CONCLUSIÓN: en pacientes con CU activa tratados con anti-TNF, la retirada de los corticoides en los primeros tres meses y la respuesta clínica a los seis meses de iniciado el tratamiento predicen la remisión clínica de la enfermedad


No disponible


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Colite Ulcerativa/tratamento farmacológico , Fator de Necrose Tumoral alfa/antagonistas & inibidores , Fármacos Gastrointestinais/uso terapêutico , Infliximab/uso terapêutico , Adalimumab/uso terapêutico , Índice de Gravidade de Doença , Resultado do Tratamento , Estudos Retrospectivos , Indução de Remissão
13.
Rev. esp. enferm. dig ; 112(5): 360-366, mayo 2020. tab, ilus
Artigo em Inglês | IBECS | ID: ibc-195589

RESUMO

INTRODUCTION: previous studies have shown that higher infliximab trough levels are associated with favorable shortterm and long-term therapeutic outcomes in inflammatory bowel disease. There is a need to determine which patients could benefit from proactive therapeutic drug monitoring in the induction phase. The aim of this study was to evaluate the pharmacokinetic variability of infliximab, determine the factors associated with achieving target infliximab trough levels in the induction phase and analyze the clinical and biochemical response at week 26 of treatment. PATIENTS AND METHODS: a retrospective observational study was performed of patients with inflammatory bowel disease and data available on serum levels of infliximab during the induction period. The percentage of patients that achieved target infliximab trough levels at week 6 was determined. Clinical remission and response and biochemical remission were evaluated at week 26. RESULTS: thirty patients were included and only 13 (43.3 %) had infliximab trough levels > 15 μg/mL at week 6. A clinical response was observed during the maintenance period in 71.4 % of patients, their infliximab levels were significantly higher than in non-responders (6.3 μg/mL [IQR: 6.7] vs 1.0 μg/mL [IQR: 5.0], respectively; p = 0.016). Likewise, 53.6 % of patients achieved biochemical remission (responders 6.2 μg/mL [IQR: 5.2] vs non-responders 3.2 μg/mL [IQR: 5.0]; p = 0.031). CONCLUSION: less than half of patients had target infliximab levels during the induction period. Therapeutic drug monitoring during this period is related to the achievement of therapeutic levels of infliximab and may lead to a better clinical response in these patients


No disponible


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Infliximab/administração & dosagem , Infliximab/farmacocinética , Fármacos Gastrointestinais/administração & dosagem , Fármacos Gastrointestinais/farmacocinética , Doenças Inflamatórias Intestinais/tratamento farmacológico , Estudos Retrospectivos , Indução de Remissão , Ensaio de Imunoadsorção Enzimática , Teorema de Bayes , Fatores de Tempo , Monitoramento de Medicamentos
14.
Rev. esp. enferm. dig ; 112(2): 90-93, feb. 2020. ^f90^l93, tab
Artigo em Espanhol | IBECS | ID: ibc-196024

RESUMO

El megacolon es una complicación grave de la enfermedad inflamatoria intestinal que con frecuencia requiere colectomía. Infliximab sería una alternativa terapéutica cuando fracasa el tratamiento convencional, antes de la cirugía. En la actualidad, su uso se basa en la publicación de casos aislados. Presentamos nuestra serie de 12 pacientes con megacolon (cinco con signos de toxicidad sistémica) tratados con infliximab. El 75% de los pacientes evitaron la colectomía durante el episodio agudo tras la instauración precoz del tratamiento con infliximab (2,45 días desde el diagnóstico del megacolon), apreciando un mayor riesgo de cirugía entre los pacientes con colitis ulcerosa y criterios de toxicidad. Pese a mantener infliximab a largo plazo, dos pacientes más requirieron cirugía en el seguimiento. Ningún paciente sufrió efectos adversos relevantes en relación con el tratamiento ni complicaciones posquirúrgicas significativas


No disponible


Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Colite Ulcerativa/complicações , Doença de Crohn/complicações , Megacolo/tratamento farmacológico , Megacolo/etiologia , Infliximab/uso terapêutico , Fármacos Gastrointestinais/uso terapêutico , Resultado do Tratamento , Estudos Retrospectivos , Megacolo/cirurgia , Colectomia
17.
Rev. fitoter ; 14(2): 153-166, dic. 2014. tab, ilus
Artigo em Espanhol | IBECS | ID: ibc-132394

RESUMO

El presente trabajo se desarrolló dentro del marco del Proyecto: «Conservación, fortalecimiento y uso sostenible de la flora de Itá Azul y San Gervasio, Colonia Independencia, Reserva de Recursos Manejados Yvyturuzú. Paraguay», tuvo por objetivo determinar las plantas medicinales empleadas por las comunidades de Itá Azul y San Gervasio, (Colonia Independencia, Departamento de Guairá), Paraguay. Para ello se realizaron encuestas en las mencionadas comunidades, siendo encuestadas en total 81 personas, quienes reportaron un total de 68 especies de uso medicinal distribuidas en 35 familias, siendo las familias con mayor número de especies las Asteráceas (19%), Rutáceas (9%) y Fabáceas, Lamiáceas y Verbenáceas (6% cada una). El 53 % de las especies reportadas son nativas. Se prefiere el uso de las plantas en estado fresco (36%), siendo la parte de la planta más empleada la hoja (32%) y la forma de uso mayormente mencionada el tereré (infusión de las plantas conjuntamente con hoja de mate, 43%). Las afecciones reportadas se agruparon en 11 categorías, de las cuales los trastornos digestivos seguidos por las afecciones respiratorias fueron las más reportadas en el uso de plantas medicinales. Para 11 especies no se ha reportado el uso. El conocimiento etnofarmacobotánico se transmite oralmente de una generación a otra, principalmente a través de las mujeres. La investigación científica puede contribuir eficazmente a preservar este patrimonio cultural (AU)


O presente trabalho foi desenvolvido no âmbito do projeto "Conservación, Fortalecimiento y Uso Sostenible de la flora de Itá Azul y San Gervasio, Colonia Independencia, Reserva de Recursos Manejados Yvyturuzú. Paraguay", com o objetivo de determinar as plantas medicinais utilizadas pelas comunidades de Ita Azul e San Gervasio, Colonia Independencia, Departamento de Guairá, no Paraguai. Para isso foram realizados inquéritos nas comunidades acima mencionadas, tendo sido inquiridas um total de 81 pessoas, que reportaram um total de 68 espécies de uso medicinal, distribuídas em 35 famílias, sendo as famílias com maior número de espécies as Asteraceae (19%), Rutaceae (9 %), seguindo-se Fabaceae, Lamiaceae e Verbenaceae (com 6% cada uma). Cerca de 53% das espécies reportadas são nativas. Utilizamse preferencialmente plantas frescas (36%), sendo a parte da planta mais utilizada a folha (32%) e a forma de uso principalmente mencionada o tereré (43%). As afeções reportadas foram agrupadas em 11 categorias, das quais os distúrbios digestivos foram os mais relatados sobre o uso de plantas medicinais e em segundo lugar as afeções respiratórias. Para 11 espécies não foi reportado o seu uso. O conhecimento etnofarmacobotánico é transmitido oralmente de uma geração para outra, principalmente através das mulheres. A investigação científica pode contribuir de forma eficaz para preservar este património cultural


The present work was developed within the framework of the project «Conservation, strengthening and sustainable use of the flora of Ita Azul and San Gervasio, Colonia In dependencia, Managed Resources Reserve Yvyturuzú. Paraguay», aimed to determine the medicinal plants used by the communities of Ita Azul and San Gervasio, Colonia Independencia, Guairá Department, Paraguay. Surveys were conducted in the aforementioned communities to 81 people, who reported the use of 68 species of medicinal plants belonging to 35 families, mainly to Asteraceae (19%), Rutaceae (9 %), as well as Fabaceae, Lamiaceae and Verbenaceae (6% each). 53% of the species reported were native. The use of fresh plants (36%) was preferred, being the leaf the part of the plant most frequently used (32%). The plants were mainly prepared as infusion, mixed with mate leaf, in a preparation which is known as «tereré» (43%). The conditions for which the medicinal plants were used were grouped in 11 categories, being digestive disorders followed by respiratory conditions the most reported. For 11 species, no use was reported. The ethnofarmacological and ethnobotanical knowledge is transmitted orally from one generation to another, mainly by women. Scientific research can contribute efficiently to preserve this cultural heritage (AU)


Assuntos
Humanos , Masculino , Feminino , Plantas Medicinais/química , Plantas Medicinais/classificação , Plantas Medicinais/imunologia , Asteraceae/classificação , Asteraceae/imunologia , Rutaceae/química , Rutaceae/imunologia , Etnobotânica/métodos , Etnobotânica/tendências , Paraguai/epidemiologia , 24419 , Lamiaceae/química , Lamiaceae/imunologia , Fármacos Gastrointestinais/uso terapêutico
18.
Rev. fitoter ; 14(1): 67-81, jun. 2014. ilus
Artigo em Espanhol | IBECS | ID: ibc-125884

RESUMO

En la actualidad son muy pocos los usos vigentes. Aunque los dátiles son la materia utilizada con mayor frecuencia, también se han empleado la savia, el polen y el cogollo tierno o palmito. Los dátiles de Phoenix dactylifera se utilizaron como analgésico y para tratar la anemia y trastornos digestivos, o para fortalecer las encías, en el tratamiento de la disfunción eréctil y como afrodisiacos, para facilitar el parto y calmar los dolores postparto, y tratar el prolapso de la matriz o para el exceso de flujo menstrual. También se utilizaron como diuréticos, para la disuria y en trastornos de la vejiga. El uso que más claramente ha persistido es el tratamiento de diversos problemas respiratorios. En uso externo se utilizaron para tratar problemas de la piel, heridas, hemorragias y hemorroides. De la palmera de Canarias (Phoenix canariensis), especialmente en la isla de la Gomera, la savia cruda o guarapo, su concentrado o miel de palma y los resultantes de su fermentación (vino de palma) se consumen como alimento y también se utilizan como diurético, remedio de trastornos génitourinarios, digestivo, para infecciones de la cavidad bucal, expectorante, antitusígeno y para las irritaciones de garganta. En el Toledo de Al-Andalus las espatas de P. dactylifera se utilizaron, hace casi mil años, en el tratamiento de la debilidad, los dolores, nefritis, las enfermedades de la vejiga, trastornos hepáticos (también como preventivo), diarrea, trastornos digestivos, dolores en el abdomen y en el estómago, excesivo sangrado menstrual, úlceras en la piel y sarna, dolores articulares y trastornos cardiacos. La fitoterapia racional debería prestar atención a este recurso, considerar la evidencia científica disponible (farmacológica e incluso clínica) e incorporarlo a nuestro repertorio terapéutico (AU)


O uso medicinal da tamareira e seus produtos foi relativamente comum em Espanha, tendo alcançado o topo da diversidade e importância durante a Idade Média, tanto no Al-Andalus como nos territórios cristãos da fronteira norte, mas foram-se perdendo progressivamente. Estudou-se a evolução histórica dos usos medicinais da tamareira e da tamareira das Ilhas Canárias, tanto na Península Ibérica como nas ilhas Canárias e Baleares .Actualmente, são muito poucos os usos que se mantêm. Relativamente à parte utilizada, as tâmaras são as mais referiadas, mas também existem registos para a seiva, pólen e palmito. As tâmaras de Phoenix dactylifera foram usados como analgésicos, e para o tratamento de anemia e distúrbios digestivos, ou para fortalecer as gengivas, no tratamento da disfunção eréctil e como afrodisíacos, para facilitar o parto e acalmar as dores pós-parto, para tratamento do prolapso uterino ou do fluxo menstrual excessivo. As tâmaras também foram utilizados como diuréticos em disúria e distúrbios da bexiga e são ainda utilizados para o tratamento de vários problemas respiratórios. Externamente foram usados para tratar problemas de pele, feridas, hemorragias e hemorróidas. Da tamareira das Ilhas Canárias (Phoenix canariensis), especialmente na ilha de La Gomera, a seiva (localmente conhecida por guarapo), o seu concentrado (mel de palma), e os produtos resultantes da sua fermentação (vinho de palma) consomem-se como alimentos mas também se utilizam como diuréticos, para tratamento de problemas genito-urinários e digestivos, para infecções orais, como expectorante, antitússico e para tratar irritações da garganta. Há quase mil anos, em Toledo, usavam-se as espatas de P. dactylifera no tratamento de fraqueza, dores, nefrites, doenças da bexiga, doenças do fígado (também em prevenção), diarreia, distúrbios digestivos, dores no abdômen e estômago, fluxo menstrual excessivo, úlceras de pele e sarna, dores articulares e problemas cardíacos.A fitoterapia racional deveria prestar atenção a este recurso, considerar a evidencia científica disponível (farmacológica e mesmo clínica) e incorporá-lo no nosso repertório terapêutico


In Spain the medicinal use of date palm and its products has been relatively common, reaching the highest level of diversity and importance during the Middle Ages, both in Al Andalus and the Christian territories of the northern border. However, uses have become less common since then. Here the historical evolution of medicinal uses of date palm and Canary Island palm in both the Iberian Peninsula and the Canary and Balearic islands are reviewed. At present there are very few reported uses. The dates are the most commonly used product, but the sap, pollen and tender bud of palm (palmito) are also used. The dates of Phoenix dactylifera were used as analgesic, and to treat anaemia and digestive disorders, to strengthen the gums, and in the treatment of erectile dysfunction and as an aphrodisiac, to facilitate childbirth and soothing postpartum pains and treating matrix prolapse or excessive menstrual flow. Dates were also used as diuretics in dysuria and bladder disorders and are still used for the treatment of various respiratory problems. Externally they were used to treat skin problems, wounds, bleeding and haemorrhoids. Canary Palm (Phoenix canariensis) raw juice or sap, or concentrated palm juice, or fermented juice (palm wine) are consumed, especially on the island of La Gomera, as food and are also used as diuretic, as a remedy for genitourinary, digestive, for oral infections, as an expectorant, antitussive and to treat cavity and throat irritations disorders. Almost a thousand years ago in Al-Andalus' Toledo, spathes of P. dactylifera were used, in the treatment of weakness, pain, nephritis, bladder diseases, liver disorders, diarrhea, digestive disorders, pain in the abdomen and stomach, excessive menstrual bleeding, skin ulcers and scabies , joint pain and heart disorders. Modern rational Phytotherapy should pay closer attention to this resource and its potential, considering the available scientific evidence (pharmacological and even clinical) and incorporate it into our modern therapeutic repertoire (AU)


Assuntos
Humanos , Masculino , Feminino , Anemia/terapia , Fármacos Gastrointestinais , Manejo da Dor , Diuréticos/uso terapêutico , Cycas/metabolismo , Fitoterapia/métodos , Fitoterapia , Doenças da Gengiva/terapia , Disfunção Erétil/terapia , Doenças Respiratórias/terapia , Boca , Antitussígenos/uso terapêutico , Faringe
19.
Enferm. infecc. microbiol. clín. (Ed. impr.) ; 31(supl.2): 12-19, jun. 2013. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-179604

RESUMO

Rilpivirina (RPV) es un fármaco perteneciente a la familia de los inhibidores no nucleósidos de la transcriptasa inversa (INNTI), con potente actividad antiviral, aprobado para pacientes naïve, con perfil de efectos secundarios diferente a los INNTI de primera generación. Las interacciones farmacológicas producidas por RPV se deben a su efecto sobre el sistema CYP450, es sustrato de CYP3A4 y ligeramente inductor. Además, in vitro es inhibidor de la glucoproteína-P. RPV presenta interacciones farmacológicas clínicamente significativas, entre las que destacan los inhibidores de la proteasa, a excepción de darunavir y lopinavir potenciados, y los INNTI efavirenz y nevirapina. La toma de RPV junto con fármacos que aumentan el pH gástrico, como omeprazol, o los que inducen el CYP3A4, como rifampicina, puede causar reducciones significativas en las concentraciones de RPV y está contraindicada. El uso concomitante de RPV con un inhibidor del CYP3A4, por ejemplo claritromicina, puede provocar aumento de las concentraciones de RPV. Se recomienda la administración de RPV con alimentos para obtener mejor absorción y valores plasmáticos adecuados


Rilpivirine (RPV) is a nonnucleoside reverse transcriptase inhibitor (NNRTI) that has been approved for use in treatment-naïve patients and which has potent antiviral activity. Its adverse effects profile differs from that of first-generation NNRTs. The pharmacological interactions produced by RPV are due to its effects on the CYP450 system; RPV is a substrate and mild inducer of CYP3A4. Moreover, in vitro, RPV inhibits glycoprotein-P. RPV has clinically significant pharmacological interactions, especially with protease inhibitors (except boosted darunavir and lopinavir) and the NNRTIs efavirenz and nevirapine. Coadministration of RPV with drugs that increase gastric pH, such as omeprazole, or those inducing CYP3A4, such as rifampicin, can significantly reduce RPV concentrations and is contraindicated. The concomitant use of RPV with a CYP3A4 inhibitor (such as clarithromycin) can increase RPV concentrations. Administration of PRV with food is recommended to obtain better absorption and adequate plasma values


Assuntos
Humanos , Fármacos Anti-HIV/farmacocinética , Citocromo P-450 CYP3A/metabolismo , Indutores do Citocromo P-450 CYP3A/farmacocinética , Nitrilas/farmacocinética , Pirimidinas/farmacocinética , Inibidores da Transcriptase Reversa/farmacocinética , Fármacos Anti-HIV/uso terapêutico , Anti-Infecciosos , Anticonvulsivantes/farmacocinética , Inibidores do Citocromo P-450 CYP3A/farmacocinética , Anticoncepcionais Orais/farmacocinética , Fármacos Gastrointestinais/farmacocinética , Nitrilas/uso terapêutico , Bombas de Próton/farmacocinética , Pirimidinas/uso terapêutico , Inibidores da Transcriptase Reversa/administração & dosagem
20.
Gastroenterol. hepatol. (Ed. impr.) ; 33(8): 586-590, Oct. 2010. ilus, tab, graf
Artigo em Espanhol | IBECS | ID: ibc-85663

RESUMO

Levosulpirida es un isómero de la sulpirida que ejerce su acción procinética mediante un mecanismo dual: 1) antagonista de los receptores dopaminérgicos D2, y 2) agonista de los receptores serotoninérgicos 5HT4, lo que le confiere una acción facilitadora colinérgica. A una dosis de 25mg tres veces al día levosulpirida acelera el vaciamiento gástrico y de la vesícula biliar. Ensayos clínicos han mostrado que levosulpirida es más eficaz que placebo en la reducción de los síntomas dispépticos, y estudios comparativos han mostrado que levosulpirida posee un efecto similar o superior al de otros fármacos antagonistas dopaminérgicos. El perfil de seguridad de levosulpirida es bueno, y la frecuencia de acontecimientos adversos similar a la de otros fármacos antagonistas D2. Por ello, este fármaco constituye una opción terapéutica útil en el manejo de los pacientes con dispepsia funcional, así como en pacientes con retraso del vaciamiento gástrico como la gastroparesia (AU)


Levosulpiride is a sulpiride isomer that exerts its prokinetic action through a dual mechanism: 1) as a D2 dopamine receptor antagonist and 2) as a serotonin 5HT4 receptor agonist, conferring this drug with a cholinergic effect. At a dosage of 25mg three times daily, levosulpiride accelerates gastric and gallbladder emptying. Clinical trials have shown that this agent is more effective than placebo in reducing the symptoms of dyspepsia, while comparative studies have demonstrated that its effect is similar or superior to that of other dopamine antagonists. The safety profile of levosulpiride is good and the frequency of adverse events is similar to that of other D2 dopamine antagonists. Therefore, this drug is a useful therapeutic option in the management of patients with functional dyspepsia, as well as in those with delayed gastric emptying (AU)


Assuntos
Humanos , Animais , Antagonistas de Dopamina/uso terapêutico , Dispepsia/tratamento farmacológico , Fármacos Gastrointestinais/uso terapêutico , Gastroparesia/tratamento farmacológico , Receptores de Dopamina D2/antagonistas & inibidores , Receptores 5-HT4 de Serotonina/uso terapêutico , Ensaios Clínicos como Assunto , Esvaziamento Gástrico , Cobaias , Sulpirida/efeitos adversos , Sulpirida
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