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Approximately 39 million people worldwide live with human immunodeficiency virus (HIV), and antiretroviral therapy (ART) has improved life expectancy for these individuals, with quality of life (QoL) being a crucial aspect. However, there is limited information on oral health-related quality of life (OHRQoL) for institutionalized patients with HIV. This study used a cross-sectional design and included 43 residents of a non-governmental institution who had a confirmed HIV diagnosis and a history of intravenous drug use. The Spanish version of the Oral Health Index Profile-14 (OHIPsp) was used to assess the OHRQoL, with the 50th percentile serving as the cutoff for good or poor quality of life. All 43 patients had one or more oral lesions, with 44.1% having AIDS-related oral lesions (AROLs). Over half of the participants (48.8%) reported a poor OHRQoL, and females experienced worse quality of life in all dimensions compared to males. Subjects with AROLs were three times more likely to have poor OHRQoL than those without AROLs (p = 0.03; OR = 3.1 IC 1.04-9.6). These results highlight the need for a comprehensive treatment plan for patients with HIV that includes oral health, particularly for women living in precarious conditions or who are institutionalized. Improving oral health can significantly enhance quality of life.
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BACKGROUND: Treatment guidance for children and older adult patients affected by cutaneous leishmaniasis (CL) is unclear due to limited representation of these groups in clinical trials. METHODS: We conducted a collaborative retrospective study to describe the effectiveness and safety of antileishmanial treatments in children ≤ 10 and adults ≥ 60 years of age, treated between 2014 and 2018 in ten CL referral centers in Latin America. RESULTS: 2,037 clinical records were assessed for eligibility. Of them, the main reason for non-inclusion was lack of data on treatment follow-up and therapeutic response (182/242, 75% of children and 179/468, 38% of adults). Data on 1,325 eligible CL patients (736 children and 589 older adults) were analyzed. In both age groups, disease presentation was mild, with a median number of lesions of one (IQR: 1-2) and median lesion diameter of less than 3 cm. Less than 50% of the patients had data for two or more follow-up visits post-treatment (being only 28% in pediatric patients). Systemic antimonials were the most common monotherapy regimen in both age groups (590/736, 80.2% of children and 308/589, 52.3% of older adults) with overall cure rates of 54.6% (95% CI: 50.5-58.6%) and 68.2% (95% CI: 62.6-73.4%), respectively. Other treatments used include miltefosine, amphotericin B, intralesional antimonials, and pentamidine. Adverse reactions related to the main treatment were experienced in 11.9% (86/722) of children versus 38.4% (206/537) of older adults. Most adverse reactions were of mild intensity. CONCLUSION: Our findings support the need for greater availability and use of alternatives to systemic antimonials, particularly local therapies, and development of strategies to improve patient follow-up across the region, with special attention to pediatric populations.
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Antiprotozoários , Leishmaniose Cutânea , Humanos , Criança , Idoso , Estudos Retrospectivos , Leishmaniose Cutânea/tratamento farmacológico , Pentamidina , Resultado do TratamentoRESUMO
Resumen Objetivo: Describir y analizar estudios sobre la conducta sexual en jóvenes iberoamericanos. Método: Revisión bibliográfica de 150 referencias, tomadas de las bases de datos Web of Science, Latindex, Scopus, ProQuest, Redaly, Scielo, Ebsco. Se hizo análisis de calidad mediante el uso de la Herra- mienta de Evaluación de Métodos Mixtos (MMAT) para 91 artículos finales. Resultados: Existe bibliografía sobre las conductas sexuales del dominio corporal, poca del dominio social; la edad de inicio de la actividad sexual promedio en hombres fue de 15,8 años y 15,7 en mujeres. En los últimos diez años la edad de inicio de las relaciones sexuales se reduce en Chile (15,3), Colombia (16,95), España (17,97) y México (16,97); se mantiene relativamente estable en Portugal (17,25) y Ecuador (16,43); aumenta en Brasil (15,3); en Cuba (14,85) y Perú (14,77) es inestable. Conclusiones: Se plantea la necesidad de un abordaje orientado al disfrute del ejercicio de la sexualidad (hedonismo responsable) alejado del paradigma erotofóbico imperante. Se tiene como limitación el número de artículos por región; queda abierta la vía de replicar el estudio con una mayor muestra, además de explorar y generar datos sobre las conductas eróticas desde el modelo de dominio social-corporal de Parra-Villarroel y Pérez-Villegas.
Abstract Objective: Describe and analyze studies on sexual behavior in Ibero-American youngsters. Method: Bibliographic review of 150 references, taken from the databases Web of Science, Latindex, Scopus, ProQuest, Redaly, Scielo, Ebsco. Quality analysis was performed using the Mixed Methods Assessment Tool (MMAT) for 91 final articles. Results: There is bibliography on sexual behaviors of the corporal domain, little of the social domain; the average age of initiation of sexual activity in men was 15,8 years and 15,7 in women. Over the last ten years, the age of sexual debut has decreased in Chile (15,3), Colombia (16,95), Spain (17,97) and Mexico (16,97); it is relatively stable in Portugal (17,25) and Ecuador (16,43); it has increased in Brazil (15,3); in Cuba (14,85) and Peru (14,77) is unstable. Discussions: The need for an approach oriented to the enjoyment of the exercise of sexuality (respon- sible hedonism) away from the prevailing erotophobic paradigm is proposed. The limitation is the number of articles per region; the way is open to replicate the study with a larger sample, as well as to explore and generate data on erotic behaviors from the model of social bodily domains of Parra-Villarroel and Pérez-Villegas.
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Abstract Introduction: The SARS-CoV-2 pandemic has led to the cancellation of non-emergent surgeries in order to optimize the use of resources. Once the elective medical services are restored, a technical and ethical strategy becomes critical to select candidate patients for elective surgery. Objective: To describe the results from the implementation of MeNTS (Medically Necessary Time-sensitive Procedures), FI-CGA, and survey on COVID-19 symptoms Scales, as methods for the selection of patients who were candidates for elective surgery during the SARS-CoV-2 pandemic, in a third level institution in Cali, Colombia. Methods: The databases of the results on the administration of MeNTS, frailty index (FI-CGA) and COVID 19 symptoms scales in patients who were candidates for elective surgery in a third level clinic in Cali city, between March 1st and August 31st, 2020 were reviewed. Results: A total of 1,044 patients were included, of which 647 (62.0 %) were females, with a median age of52 years (interquartile range [IQR] 38-62). 98 % of the patients were asymptomatic, the overall median score for MeNTS was 48 (IQR 44-52) and the average for FI-CGA was 0.0 (standard deviation 0.1). Conclusions: MeNTS, FI-CGA and the Symptoms Survey are easily accessible scales amidst the pandemic and are helpful to select patients with intermediate and low risk of perioperative morbidity in elective surgery during the SARS-CoV-2 pandemic. Further studies are required to confirm these findings and to clarify the potential of these tools in the selection of patients that meet the high-risk criteria.
Resumen Introducción: La pandemia por SARS-CoV-2 ha ocasionado la suspensión de cirugías no urgentes con el fin de optimizar los recursos. Una vez los servicios médicos electivos son restablecidos, es fundamental disponer de una estrategia técnica y ética para la selección de los pacientes candidatos a cirugía electiva. Objetivo: Describir los resultados observados durante la implementación de las escalas MeNTS (Medically Necessary Time-sensitive Procedures), IF-VIG y Encuesta de síntomas para COVID-19, como métodos de selección de pacientes candidatos a cirugía electiva durante la pandemia por SARS-CoV-2 en una institución de nivel tres en la ciudad de Cali, Colombia. Metodología: Se revisaron las bases de datos de los resultados de la aplicación de escalas de MeNTS, índice de fragilidad (IF-VIG) y los síntomas para COVID 19, en pacientes candidatos a cirugía electiva en una clínica de tercer nivel en la ciudad de Cali, entre marzo 1 y agosto 31 del 2020. Resultados: En total 1.044 pacientes fueron incluidos, de los cuales 647 (62,0 %) fueron mujeres con una mediana de edad de 52 años (rango intercuartil [RIC] 38-62). El 98 % de los pacientes estuvieron asintomáticos, la mediana general de la puntuación total de MeNTS fue 48 (RIC 44-52) y el promedio para IF-VIG fue de 0,0 (desviación estándar 0,1). Conclusiones: MeNTS, IF-VIG y Encuesta de síntomas, son escalas fácilmente accesibles durante tiempos de pandemia y son de utilidad para seleccionar pacientes de riesgo intermedio y bajo de morbilidad perioperatoria en cirugía electiva durante la pandemia por SARS-CoV-2. Se requieren futuros estudios para confirmar estos hallazgos y para clarificar su potencial en la selección de pacientes con criterios que los definan como de riesgo alto.
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Pâncreas DivisumRESUMO
Although infection with Leishmania braziliensis is perhaps the key reason to treat New World cutaneous leishmaniasis (CL) and mucosal leishmaniasis (ML), the total literature contains relatively few reported cases. With the aim of supplementing the meager clinical information available, we searched the records of Jorochito (Dermatology) Hospital, Bolivia, for the years 1999-2020 and identified treatment records for 1,696 naive CL patients and 355 naive ML patients. Because follow-up was poor for this real-world treatment experience in the developing world, only 255 CL patients (15%) and 114 ML patients (32%) attended follow-up at Hospital. We therefore engaged in an Active Search for "lost" patients, located a further 542 CL patients (32%) and 142 ML patients (44%), thus eventually accomplished follow up on 697 CL patients (41%) and 256 ML patients (72%). Granular adverse event data derived from hospital records is listed for the 902 CL and 86 ML patients administered Glucantime intramuscularly, the 401 CL and 202 ML patients administered Glucantime intravenously, and the 163 CL and 89 ML patients administered miltefosine orally. Efficacy was obtained from hospital records for patients seen at hospital and from patient recall communicated by telephone for the patients found in the Active Search. The overall CL cure rate was 508 of 697 CL patients (73%) with follow-up: intramuscular Glucantime-196/293 (67%); intravenous Glucantime-90/126 (71%); intralesional Glucantime-34/54 (63%); oral miltefosine-52/69 (75%). The overall ML cure rate was 161 of 256 ML patients (63%) with follow-up: intramuscular Glucantime-26/48 (54%); intravenous Glucantime-66/104 (63%); intravenous amphotericin B deoxycholate-19/35 (54%); oral miltefosine-50/71 (70%). We offer this extensive adverse event and efficacy experience as useful guides for clinicians presented with a L. braziliensis infection. The cure rates also illustrate the quandary of New World CL and ML chemotherapy: sufficiently high to be useful but nevertheless needing augmentation with new agents.
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Antiprotozoários , Leishmania braziliensis , Leishmaniose Cutânea , Leishmaniose Mucocutânea , Bolívia/epidemiologia , Humanos , Leishmaniose Cutânea/tratamento farmacológico , Leishmaniose Cutânea/epidemiologia , Leishmaniose Mucocutânea/tratamento farmacológico , Leishmaniose Mucocutânea/epidemiologia , Antimoniato de Meglumina/uso terapêutico , Resultado do TratamentoRESUMO
We present case reports of two patients treated with miltefosine for mucocutaneous leishmaniasis whose gastrointestinal symptoms were initially diagnosed as a drug reaction and only later recognized as due to COVID-19. Gastrointestinal symptoms of COVID-19 are unusual, whereas gastrointestinal adverse drug reactions are very common. These reports exemplify that this infrequent presentation of COVID-19 is likely to be ascribed to a more common etiology such as a gastrointestinal drug reaction.
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COVID-19/diagnóstico , Fosforilcolina/análogos & derivados , SARS-CoV-2 , Erros de Diagnóstico , Humanos , Masculino , Pessoa de Meia-Idade , Fosforilcolina/efeitos adversos , Adulto JovemRESUMO
Human infection with Fasciola hepatica leads to obstruction of the common bile duct by adult worms and disease characterized by biliary colic, epigastric pain, and nausea. Recommended treatment is a single dose of triclabendazole (TCBZ) (10 mg/kg). Because in the 1990s the Bolivian Altiplano bordering Lake Titicaca was thought to have the highest prevalence of human fascioliasis worldwide, the Bolivian Ministry of Health instituted TCBZ mass drug administration (MDA). From 2008 to 2016 (excepting 2015), one dose of 250 mg was administered, usually in September/October, to each resident of highly endemic regions willing to participate. This is apparently the first reported use of MDA for Fasciola. The proportion of persons in key regions receiving TCBZ MDA was 87% in 2016. In 2017, we resurveyed key regions, and found that the MDA program had been dramatically successful. Whereas Fasciola prevalence was reported as 26.9% in Huacullani/Tiahuanaco and 12.6% in Batallas in 1999, there was 0.7% prevalence in Huacullani/Tiahuanaco and 1% in Batallas in 2017. However, lessons from schistosomiasis control efforts suggest that for sustained control of Fasciola infection, Fasciola MDA needs to be maintained and coupled with measures to control infection in the intermediary snail and in the animal hosts of F. hepatica.
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Antiplatelmínticos/administração & dosagem , Fasciola hepatica , Fasciolíase/epidemiologia , Fasciolíase/prevenção & controle , Administração Massiva de Medicamentos , Triclabendazol/administração & dosagem , Adolescente , Adulto , Animais , Antiplatelmínticos/uso terapêutico , Bolívia/epidemiologia , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Triclabendazol/uso terapêutico , Adulto JovemRESUMO
BACKGROUND: Cutaneous leishmaniasis (CL) presents as 1 or more skin lesions, which makes local therapy inherently attractive compared to systemic therapy that exposes the whole body to a drug. For 30 years, 15% paromomycin topical formulations have been in clinical experimentation. Recently, 15% paromomycin in Aquaphilic, a complex base to facilitate adsorption into the lesion, was found superior to aquaphilic vehicle for Old World Leishmania major disease. METHODS: We performed a randomized trial of 15% paromomycin in Aquaphilic (40 patients) vs Aquaphilic vehicle (20 patients) vs a positive control (intralesional pentamidine; 20 patients) against L. braziliensis CL in Bolivia. RESULTS: Cure rates after 6 months of follow-up were 31 of 40 (77.5%, 95% confidence interval [CI] 62.5-88%) for paromomycin-Aquaphilic, 2 of 20 (10%, 95% CI 3-30%) for Aquaphilic vehicle (P < .0001 vs paromomycin-Aquaphilic), and 14 of 20 (70%, 95% CI 48-85.5%) for intralesional pentamidine. Both paromomycin-Aquaphilic and the Aquaphilic vehicle were very well tolerated, with only grade 1 adverse reactions in 5-10% of patients. CONCLUSIONS: Against L. braziliensis CL, a prevalent, aggressive form of New World CL, 15% paromomycin-aquaphilic was vastly superior to a negative vehicle control and was comparable in efficacy to a positive control. This study enlarges the potential use of 15% paromomycin-Aquaphilic from one form of Old World CL to CL more generally. CLINICAL TRIALS REGISTRATION: NCT03096457.
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Antiprotozoários/uso terapêutico , Leishmania braziliensis , Leishmaniose Cutânea/tratamento farmacológico , Paromomicina/uso terapêutico , Administração Tópica , Adulto , Antiprotozoários/administração & dosagem , Humanos , Paromomicina/administração & dosagem , Pentamidina/administração & dosagem , Pentamidina/uso terapêutico , Adulto JovemRESUMO
Bolivian cutaneous leishmaniasis due to Leishmania braziliensis was treated with the combination of miltefosine (150 mg/day for 28 days) plus intralesional pentamidine (120 µg/mm2 lesion area on days 1, 3, and 5). Ninety-two per cent of 50 patients cured. Comparison to historic controls at our site suggests that the efficacy of the two drugs was additive. Adverse effects and cost were also additive. This combination may be attractive when a prime consideration is efficacy (e.g., in rescue therapy), avoidance of parenteral therapy, or the desire to treat locally and also provide systemic protection against parasite dissemination.
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Antiprotozoários/uso terapêutico , Leishmania braziliensis/efeitos dos fármacos , Leishmania/efeitos dos fármacos , Leishmaniose Cutânea/tratamento farmacológico , Pentamidina/uso terapêutico , Fosforilcolina/análogos & derivados , Adulto , Antiprotozoários/administração & dosagem , Antiprotozoários/economia , Bolívia , Quimioterapia Combinada/efeitos adversos , Quimioterapia Combinada/economia , Feminino , Humanos , Masculino , Pentamidina/administração & dosagem , Pentamidina/efeitos adversos , Pentamidina/economia , Fosforilcolina/administração & dosagem , Fosforilcolina/efeitos adversos , Fosforilcolina/economia , Fosforilcolina/uso terapêutico , Resultado do TratamentoRESUMO
INTRODUCTION: Progress with the treatment of cutaneous leishmaniasis (CL) has been hampered by inconsistent methodologies used to assess treatment effects. A sizable number of trials conducted over the years has generated only weak evidence backing current treatment recommendations, as shown by systematic reviews on old-world and new-world CL (OWCL and NWCL). MATERIALS AND METHODS: Using a previously published guidance paper on CL treatment trial methodology as the reference, consensus was sought on key parameters including core eligibility and outcome measures, among OWCL (7 countries, 10 trial sites) and NWCL (7 countries, 11 trial sites) during two separate meetings. RESULTS: Findings and level of consensus within and between OWCL and NWCL sites are presented and discussed. In addition, CL trial site characteristics and capacities are summarized. CONCLUSIONS: The consensus reached allows standardization of future clinical research across OWCL and NWCL sites. We encourage CL researchers to adopt and adapt as required the proposed parameters and outcomes in their future trials and provide feedback on their experience. The expertise afforded between the two sets of clinical sites provides the basis for a powerful consortium with potential for extensive, standardized assessment of interventions for CL and faster approval of candidate treatments.
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Antiprotozoários/uso terapêutico , Ensaios Clínicos como Assunto/normas , Leishmaniose Cutânea/tratamento farmacológico , Humanos , Resultado do TratamentoRESUMO
A novel therapy, intralesional (IL) pentamidine, was compared to intralesional therapy with antimony (ILSb), a World Health Organization-recommended therapy, for single Bolivian Leishmania braziliensis lesions. In Study 1, 90 patients were randomized equally between three injections of ILSb over 5 days, five injections of ILSb over 11 days, and three injections of IL pentamidine (120 µg/mm(2)lesion area [ILPenta-120-3]) over 5 days. Cure rates at 6 months were 57% for ILSb-3 injections, 73% for ILSb-5 injections, and 72% for ILPenta-120-3 injections. Adverse effects were local irritation and injection-site pain-ILSb (60 patients): mild (25), moderate (4); IL pentamidine (30 patients): mild (4), moderate (3). In Study 2, 60 patients were randomized equally between five injections of ILSb and three injections of a double dose of IL pentamidine (240 µg/mm(2)[ILPenta-240-3]). In Study 2, cure rates were 67% for ILSb-5 injections and 73% for ILPenta-240-3. For three IL injections of pentamidine, efficacy was optimized at a dose of 120 µg/mm(2)lesion area. The cure rate of that regimen was similar to that for ILSb-5 injections and nonstatistically larger than that of ILSb-3 injections. IL pentamidine is an attractive alternative to ILSb on the basis of efficacy for Bolivian L. braziliensis, the threat of Sb-resistant parasites, tolerance, and patient convenience of three visits over 5 days.
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Leishmania braziliensis/efeitos dos fármacos , Leishmaniose Cutânea/tratamento farmacológico , Pentamidina/administração & dosagem , Tripanossomicidas/administração & dosagem , Adulto , Antimônio/administração & dosagem , Antimônio/uso terapêutico , Esquema de Medicação , Feminino , Humanos , Injeções Intralesionais/métodos , Masculino , Pentamidina/uso terapêutico , Resultado do Tratamento , Tripanossomicidas/uso terapêuticoRESUMO
Leishmaniasis, a disease caused by parasites of the Leishmania genus, constitutes a significant health and social problem in many countries and is increasing worldwide. The conventional treatment, meglumine antimoniate (MA), presents numerous disadvantages, including invasiveness, toxicity, and frequent therapeutic failure, justifying the attempts at finding alternatives to the first-line therapy. We have studied the comparative long-term efficacy of MA against miltefosine (MF) in Leishmania infection in experimental mice. The criteria for efficacy evaluation were footpad lesion size, anti-Leishmania antibodies level, histopathology of the site of inoculation (right footpad, RFP), splenic index (SI), and the presence of parasites in RFP, spleen, and liver, determined by polymerase chain reaction (PCR). Swiss mice, infected with Leishmania (Leishmania) amazonensis were treated, at different time points (5 and 40 days after infection) with either MA or MF. The efficacy of MF was better than that of MA for inhibiting lesions and for reducing tissue damage and presence/load of amastigotes in spleen and liver. Moreover, early administration of MF produced a clear reduction in splenomegaly and was equal in reducing antibody titles in comparison with MA. Our results demonstrated that MF is an effective and safe therapeutic alternative for leishmaniasis by L. (L.) amazonensis and is more efficacious than MA.
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Antiprotozoários/uso terapêutico , Leishmania mexicana/efeitos dos fármacos , Leishmaniose Cutânea/tratamento farmacológico , Fosforilcolina/análogos & derivados , Animais , Antiprotozoários/administração & dosagem , Antiprotozoários/farmacologia , Leishmaniose Cutânea/parasitologia , Leishmaniose Cutânea/patologia , Masculino , Meglumina/administração & dosagem , Meglumina/farmacologia , Meglumina/uso terapêutico , Antimoniato de Meglumina , Camundongos , Compostos Organometálicos/administração & dosagem , Compostos Organometálicos/farmacologia , Compostos Organometálicos/uso terapêutico , Fosforilcolina/administração & dosagem , Fosforilcolina/farmacologia , Fosforilcolina/uso terapêutico , Baço/patologiaRESUMO
Endophytic fungi colonize plants without causing symptoms of disease and can enhance the resistance of their host to pathogens. We cultivated 53 fungal strains from wild lima bean (Phaseolus lunatus) and investigated their effects on pathogens using in vitro assays and experiments in planta. Most strains were annotated as Rhizopus, Fusarium, Penicillium, Cochliobolus, and Artomyces spp. by the sequence of their 18S rRNA gene. In vitro confrontation assays between endophytes and three pathogens (the bacteria Pseudomonas syringae pv. syringae and Enterobacter sp. strain FCB1, and the fungus Colletotrichum lindemuthianum) revealed strong and mainly symmetric reciprocal effects: endophyte and pathogen either mutually inhibited (mainly Enterobacter FCB1 and Colletotrichum) or facilitated (P. syringae) the growth of each other. In planta, the endophytes had a strong inhibitory effect on P. syringae when they colonized the plant before the bacterium, whereas infection was facilitated when P. syringae colonized the plant before the endophyte. Infection with Enterobacter FCB1 was facilitated when the bacterium colonized the plant before or on the same day with the endophyte, but not when the endophyte was present before the bacterium. The order of arrival determines whether fungal endophytes enhance plant resistance to bacterial pathogens or facilitate disease.
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Endófitos/fisiologia , Fungos/fisiologia , Phaseolus/microbiologia , Doenças das Plantas/microbiologia , Antibiose , Resistência à Doença , Pseudomonas syringae/patogenicidade , RNA Fúngico/genética , RNA Ribossômico 18S/genéticaRESUMO
The use of medicinal plants in treating illnesses has been reported since ancestral times. In the case of hepatic diseases, several species such as Silybum marianum, Phyllanthus niruri, and Panus giganteus (Berk.) have been shown to ameliorate hepatic lesions. Silymarin is a natural compound derived from the species Silybum marianum, which is commonly known as Milk thistle. This plant contains at least seven flavoligands and the flavonoid taxifolin. The hepatoprotective and antioxidant activity of silymarin is caused by its ability to inhibit the free radicals that are produced from the metabolism of toxic substances such as ethanol, acetaminophen, and carbon tetrachloride. The generation of free radicals is known to damage cellular membranes and cause lipoperoxidation. Silymarin enhances hepatic glutathione and may contribute to the antioxidant defense of the liver. It has also been shown that silymarin increases protein synthesis in hepatocytes by stimulating RNA polymerase I activity. A previous study on humans reported that silymarin treatment caused a slight increase in the survival of patients with cirrhotic alcoholism compared with untreated controls.
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BACKGROUND: Cutaneous leishmaniasis is an ultimately self-curing disease for which systemic therapy with pentavalent antimony (Sb) is effective but with side effects. We evaluated 2 local treatments, intralesional (IL) Sb and cryotherapy, for single lesions due to Bolivian Leishmania (v.) braziliensis in a placebo-controlled study. METHODS: Patients were randomized between IL Sb (650 µg/mm(2) of lesion area on days 1, 3, and 5), cryotherapy (days 1 and 14), and placebo cream (daily for 20 days) in a 3:2:3 allocation. Lesion area was measured prior to therapy, and at 1, 3, and 6 months after therapy. The criteria for lesion cure were as follows: not doubling in size at 1 month, at least 50% diminution in size at 3 months, and complete reepithelialization at 6 months. Local adverse effects were recorded. RESULTS: Cure rates were 21 of 30 (70%; 95% confidence interval [CI], 52%-83%) for IL Sb, 4 of 20 (20%; 95% CI, 8%-42%) for cryotherapy, and 5 of 30 (17%; 95% CI, 7%-34%) for placebo cream (P < .001 for IL Sb vs each other group). IL Sb adverse events were limited to injection site pain, with a mean value of 1.0 (mild). CONCLUSIONS: The comparative cure rate, small amount of drug administered, and tolerance data for IL Sb suggest that if local therapy for single L. braziliensis lesions is chosen, this treatment is attractive. Given the difficulties of performing placebo-controlled trials in the New World, the combined placebo and cryotherapy cure rate (18%; 95% CI, 10%-31%) is likely to become the standard against which future interventions for L. braziliensis are compared. CLINICAL TRIALS REGISTRATION: NCT01300975.
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Antimônio/administração & dosagem , Antiprotozoários/administração & dosagem , Leishmaniose Cutânea/tratamento farmacológico , Administração Tópica , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Antimônio/efeitos adversos , Antiprotozoários/efeitos adversos , Bolívia , Criança , Crioterapia , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/epidemiologia , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/patologia , Feminino , Humanos , Leishmania braziliensis/efeitos dos fármacos , Leishmania braziliensis/isolamento & purificação , Leishmaniose Cutânea/parasitologia , Leishmaniose Cutânea/patologia , Masculino , Pessoa de Meia-Idade , Placebos/administração & dosagem , Resultado do Tratamento , Adulto JovemRESUMO
There are few reports that demonstrate the antigenotoxic potential of cranberries. Although the types of berry fruits consumed worldwide are many, this paper focuses on cranberries that are commonly consumed in Mexico (Vaccinium macrocarpon species). The purpose of the present study is to determine whether cranberry ethanolic extract (CEE) can prevent the DNA damage produced by benzo[a]pyrene (B[a]P) using an in vivo mouse peripheral blood micronucleus assay. The experimental groups were organized as follows: a negative control group (without treatment), a positive group treated with B[a]P (200 mg/kg), a group administered with 800 mg/kg of CEE, and three groups treated with B[a]P and CEE (200, 400, and 800 mg/kg) respectively. The CEE and benzo[a]pyrene were administered orally for a week, on a daily basis. During this period the body weight, the feed intake, and the determination of antigenotoxic potential were quantified. At the end of this period, we continued with the same determinations for one week more (recovery period) but anymore administration of the substances. The animals treated with B[a]P showed a weight increase after the first week of administration. The same phenomenon was observed in the lots combined with B[a]P and CEE (low and medium doses). The dose of 800 mg/kg of CEE showed similar values to the control group at the end of the treatment period. In the second part of the assay, when the substances were not administered, these experimental groups regained their normal weight. The dose of CEE (800 mg/kg) was not genotoxic nor cytotoxic. On the contrary, the B[a]P increases the frequency of micronucleated normochromatic erythrocytes (MNNE) and reduces the rate of polychromatic erythrocytes (PE) at the end of the treatment period. With respect to the combined lots, a significant decrease in the MN rate was observed from the sixth to the eighth day of treatment with the two high doses applied; the highest protection (60%) was obtained with 800 mg/kg of CEE. The same dose showed an anticytotoxic effect which corresponded to an improvement of 62.5% in relation to the animals administered with the B[a]P. In the second period, all groups reached values that have been seen in the control group animals. Our results suggest that the inhibition of clastogenicity of the cranberry ethanolic extract against B[a]P is related to the antioxidant capacity of the combination of phytochemicals present in its chemical composition.