Effect of a calcium hydroxide-based intracanal medicament containing N-2-methyl pyrrolidone as a vehicle against Enterococcus faecalis biofilm

Abstract This study investigated the effect of a calcium hydroxide (CH) paste (CleaniCal®) containing N-2-methyl pyrrolidone (NMP) as a vehicle on Enterococcus faecalis (E. faecalis) biofilms compared with other products containing saline (Calasept Plus™) or propylene glycol (PG) (Calcipex II®). Methodology Standardized bovine root canal specimens were used. The antibacterial effects were measured by colony-forming unit counting. The thickness of bacterial microcolonies and exopolysaccharides was assessed using confocal laser scanning microscopy. Morphological features of the biofilms were observed using field-emission scanning electron microscopy (FE-SEM). Bovine tooth blocks covered with nail polish were immersed into the vehicles and dispelling was observed. The data were analyzed using one-way analysis of variance and Tukey tests (p<0.05). Results CleaniCal® showed the highest antibacterial activity, followed by Calcipex II® (p<0.05). Moreover, NMP showed a higher antibacterial effect compared with PG (p<0.05). The thickness of bacteria and EPS in the CleaniCal® group was significantly lower than that of other materials tested (p<0.05). FE-SEM images showed the specimens treated with Calasept Plus™ were covered with biofilms, whereas the specimens treated with other medicaments were not. Notably, the specimen treated with CleaniCal® was cleaner than the one treated with Calcipex II®. Furthermore, the nail polish on the bovine tooth block immersed in NMP was completely dispelled. Conclusions CleaniCal® performed better than Calasept Plus™ and Calcipex II® in the removal efficacy of E. faecalis biofilms. The results suggest the effect might be due to the potent dissolving effect of NMP on organic substances.

High frequency of dolutegravir resistance in patients failing a raltegravir-containing salvage regimen

OBJECTIVES: Dolutegravir is a second-generation integrase strand transfer inhibitor (InSTI) that has been recently approved by the FDA to treat antiretroviral therapy-naive as well as treatment-experienced HIV-infected individuals, including those already exposed to the first-generation InSTI. Despite having a different mutational profile, some cross-resistance mutations may influence its susceptibility. The aim of this study was to evaluate the impact of a raltegravir-containing salvage regimen on dolutegravir activity. PATIENTS AND METHODS: Blood samples of 92 HIV-infected individuals with virological failure (two or more viral loads >50 copies/mL after 6 months of treatment) using raltegravir with optimized background therapy were sequenced and evaluated according to the Stanford University HIV Drug Resistance Database algorithm. RESULTS: Among the 92 patients analysed, 32 (35%) showed resistance to dolutegravir, in most cases associated with the combination of Q148H/R/K with G140S/A mutations. At genotyping, patients with resistance to dolutegravir had viral load values closer to the highest previously documented viral load. CONCLUSIONS: Changes in viraemia during virological failure may indicate the evolution of raltegravir resistance and may predict the emergence of secondary mutations that are associated with a decrease in dolutegravir susceptibility. Early discontinuation of raltegravir from failing regimens might favour subsequent salvage with dolutegravir, but further studies are necessary to evaluate this issue.

A reduced grade of liver fibros-steatosis after raltegravir, maraviroc and fosamprenavir in an HIV/HCV co-infected patient with chronic hepatitis, cardiomyopathy, intolerance to nelfinavir and a marked increase of serum creatine phosphokinase levels probably related to integrase inhibitor use / Grado reducido de fibroesteatosis tras la administración de raltegravir, maraviroc y fosamprenavir en un paciente co-infectado de VIH/VHC con hepatitis crónica, cardiomiopatía, intolerancia al nelfinavir y un aumento pronunciado de los niveles de creatina fosfoquinasa sérica probablemente debido al uso del inhibidor de la integrasa

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

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

Fallo terapeutico y eventos adversos asociados al uso de levetiracetam generico: un reporte de 4 casos / Therapeutic failure and adverse events associated to generic levetiracetam use: a 4 cases report

El levetiracetam es un antiepileptico derivado de las pirrolidonas, altera los niveles de calcio intraneuronalreduciendo su liberacion de los depositos intracelulares, inhibe parcialmente los canales de calcio tipo N, y revierte parcialmente la reduccion en las corrientes de GABA y glicina inducidas porel Zinc y las beta-carbolinas, posee un perfil farmacocinetico y de seguridad favorable que lo han convertido en un medicamento de utilidad en el manejo adyuvante de crisis parciales no controladas. Se presentan 4 casos de pacientes manejados con levetiracetam innovador, que presentaron eventos adversos intolerables y fallo terapeutico al cambiar a levetiracetam generico, se concluye que se necesitan estudios locales adicionales para corroborar que cambio hacia el levetiracetam generico pueden afectar la adherencia al tratamiento por parte de los pacientes y generar situaciones potencialmente fatales como estado epileptico.

Levetiracetam an antiepileptic drug derived from pyrrolidones, alters intraneuronal calcium levels by reducing its release from intracellular stores, partially inhibits N-type calcium channels and partially reversed the reductionin GABA and glycine currents induced by Zinc and beta-carbolines. Levetiracetam has favorable pharmacokinetic and safety profiles that have made it a useful drug in the adjuvant management of uncontrolled partial seizures. This paper report 4 cases of patients managed with levetiracetam innovative, who presented intolerable adverse events and therapeutic failure by switching to generic levetiracetam, it is concluded that further local studies are required to corroborate the consequences of shift to generic levetiracetam that may affect treatment adherence and generate life-threatening situations such as status epilepticus.

Blood compatibility of tubular polymeric materials studied by biological surface interactions

Tubular polymeric materials modified by radiation techniques can be used as vascular prosthesis and components of prosthetic devices. The biological interction between these materials and blood was studied by in vitro and ex vivo methods. Silicone rubber tubes were copolymerized with acrylamide and N-vinylpyrrolidone by radiation-grafting techniques. The irradiation was performed with y-rays from a 60Co source at a constant dose rate (0.2 kGy/h) for various time intervals (4-15 h). To evaluate the antithrombogenicity of the grafted tubes, the surface adsorption of 125I-albumin and 125I-fibrinogen was studied. All graft copolymers show a preference for albumin, and the degree of preference appears to correlate with antithrombogenic tendency. In the ex vivo experiment with animals, tubes were implanted in the carotid artery of dogs and the blood flow in the graft copolymers was detected with an ultrasonic flow meter. The blood flow rate in the ungrafted implants decreased more rapidly (stopped completely after 15 to 210 min) compared to the flow rate in the grafted ones (decreased slowly from 38 to 35 ml/min and 70 to 60 ml/min). There was a direct relationship between both methods in the study of blood compatibility of the materials. The results suggest that the graft copolymers can be used as biomaterials for long-term use in cardiovascular systems

Estudo duplo-cego entre aniracetam e placebo em labirintopatias / Double-blind study between aniracetan and placebo in labyrinthopathies

Quarenta pacientes, abaixo dos 70 anos de idade, portadores de labirintopatias, foram tratados sob esquema duplo-cego com aniracetan (1 g/dia) ou placebo durante seis semanas. A avaliaçäo final da eficácia mostrou diferença estatisticamente significativa a favor do aniracetam (remissäo dos sintomas ou melhora acentuada em 55% dos pacientes tratados com aniracetam, contra 20% daqueles que receberam placebo). O sintoma que mostrou melhor resposta ao aniracetam foi o "zumbido" durante as crises. A tolerabilidade foi excelente tanto para o aniracetam quanto para o placebo, näo havendo diferença estatística significativa entre os dois grupos