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1.
Int J Mol Sci ; 24(7)2023 Mar 24.
Artigo em Inglês | MEDLINE | ID: mdl-37047078

RESUMO

Although the exact mechanism of the pathogenesis of coronavirus SARS-CoV-2 (COVID-19) is not fully understood, oxidative stress and the release of pro-inflammatory cytokines have been highlighted as playing a vital role in the pathogenesis of the disease. In this sense, alternative treatments are needed to reduce the level of inflammation caused by COVID-19. Therefore, this study aimed to investigate the potential effect of red photobiomodulation (PBM) as an attractive therapy to downregulate the cytokine storm caused by COVID-19 in a zebrafish model. RT-qPCR analyses and protein-protein interaction prediction among SARS-CoV-2 and Danio rerio proteins showed that recombinant Spike protein (rSpike) was responsible for generating systemic inflammatory processes with significantly increased levels of pro-inflammatory (il1b, il6, tnfa, and nfkbiab), oxidative stress (romo1) and energy metabolism (slc2a1a and coa1) mRNA markers, with a pattern similar to those observed in COVID-19 cases in humans. On the other hand, PBM treatment was able to decrease the mRNA levels of these pro-inflammatory and oxidative stress markers compared with rSpike in various tissues, promoting an anti-inflammatory response. Conversely, PBM promotes cellular and tissue repair of injured tissues and significantly increases the survival rate of rSpike-inoculated individuals. Additionally, metabolomics analysis showed that the most-impacted metabolic pathways between PBM and the rSpike treated groups were related to steroid metabolism, immune system, and lipid metabolism. Together, our findings suggest that the inflammatory process is an incisive feature of COVID-19 and red PBM can be used as a novel therapeutic agent for COVID-19 by regulating the inflammatory response. Nevertheless, the need for more clinical trials remains, and there is a significant gap to overcome before clinical trials can commence.


Assuntos
COVID-19 , Animais , Humanos , Peixe-Zebra/metabolismo , SARS-CoV-2/metabolismo , Síndrome da Liberação de Citocina , Citocinas/metabolismo , RNA Mensageiro , Proteínas de Membrana , Proteínas Mitocondriais
2.
J Prosthet Dent ; 130(5): 705-714, 2023 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-35012769

RESUMO

STATEMENT OF PROBLEM: In a prosthetically driven treatment plan, the tomographic sagittal root position in relation to the bone housing is an important factor in the decision-making process for immediate implant placement. However, other important parameters must be considered in the bone housing of each tooth, including the alveolar ridge dimensions, the buccal and the palatal bone thickness, and the root dimensions. PURPOSE: The purpose of this clinical study was to evaluate the relationship between the sagittal root position of maxillary anterior teeth and the bone housing. MATERIALS AND METHODS: A total of 420 maxillary anterior teeth were analyzed in 70 participants. The tomographic scans were classified as sagittal root position classes I, II, III, and IV. Measurements included buccal and palatal bone thickness, alveolar ridge height, alveolar ridge width, apical bone height, root length, and root width. The Pearson correlation, ANOVA, and Tukey post hoc tests were used to determine statistically significant differences (α=0.05). RESULTS: The sagittal root position distribution was 65.2%, 9.3%, 0.7%, and 24.8% for classes I, II, III, and IV, respectively. Bone housing measurements were significantly different in relation to the 4 sagittal root position classes (P<.05), except for alveolar ridge height. Post hoc analysis showed that, in class I, buccal bone thickness and alveolar bone height were significantly low, whereas root length and palatal bone thickness were high. The higher buccal bone thickness was found in class II, and lower alveolar ridge width and palatal bone thickness in class IV. These measurements in tooth groups were also significantly different over the sagittal root position classes (P<.05). The buccal bone thickness, palatal bone thickness, and alveolar ridge width presented different levels of correlation with alveolar ridge width over the sagittal root position classes. The buccal bone thickness and palatal bone thickness were weakly correlated in class I (r=0.163) and IV (r=0.222). CONCLUSIONS: Bone housing measurements were significantly different in relation to the sagittal root position of maxillary anterior teeth.


Assuntos
Habitação , Incisivo , Humanos , Tomografia Computadorizada de Feixe Cônico/métodos , Palato , Raiz Dentária/diagnóstico por imagem , Maxila/diagnóstico por imagem
3.
Angew Chem Int Ed Engl ; 62(28): e202305564, 2023 07 10.
Artigo em Inglês | MEDLINE | ID: mdl-37162307

RESUMO

Indocyanine green (ICG) is the only near-infrared (NIR) dye approved for clinical use. Despite its versatility in photonic applications and potential for photothermal therapy, its photobleaching hinders its application. Here we discovered a nanostructure of dimeric ICG (Nano-dICG) generated by using ICG to stabilize nanoemulsions, after which ICG enabled complete dimerization on the nanoemulsion shell, followed by J-aggregation of ICG-dimer, resulting in a narrow, red-shifted (780 nm→894 nm) and intense (≈2-fold) absorbance. Compared to ICG, Nano-dICG demonstrated superior photothermal conversion (2-fold higher), significantly reduced photodegradation (-9.6 % vs. -46.3 %), and undiminished photothermal effect (7 vs. 2 cycles) under repeated irradiations, in addition to excellent colloidal and structural stabilities. Following intravenous injection, Nano-dICG enabled real-time tracking of its delivery to mouse tumors within 24 h by photoacoustic imaging at NIR wavelength (890 nm) distinct from the endogenous signal to guide effective photothermal therapy. The unprecedented finding of nanostructure-driven ICG dimerization leads to an ultra-stable phototheranostic platform.


Assuntos
Nanopartículas , Nanoestruturas , Camundongos , Animais , Verde de Indocianina/química , Dimerização , Nanopartículas/química , Nanoestruturas/uso terapêutico , Nanoestruturas/química , Polímeros , Fototerapia/métodos , Linhagem Celular Tumoral
4.
J Proteome Res ; 21(7): 1640-1653, 2022 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-35674498

RESUMO

The coronavirus disease 2019 (Covid-19), which caused respiratory problems in many patients worldwide, led to more than 5 million deaths by the end of 2021. Experienced symptoms vary from mild to severe illness. Understanding the infection severity to reach a better prognosis could be useful to the clinics, and one study area to fulfill one piece of this biological puzzle is metabolomics. The metabolite profile and/or levels being monitored can help predict phenotype properties. Therefore, this study evaluated plasma metabolomes of 110 individual samples, 57 from control patients and 53 from recent positive cases of Covid-19 (IgM 98% reagent), representing mild to severe symptoms, before any clinical intervention. Polar metabolites from plasma samples were analyzed by quantitative 1H NMR. Glycerol, 3-aminoisobutyrate, formate, and glucuronate levels showed alterations in Covid-19 patients compared to those in the control group (Tukey's HSD p-value cutoff = 0.05), affecting the lactate, phenylalanine, tyrosine, and tryptophan biosynthesis and d-glutamine, d-glutamate, and glycerolipid metabolisms. These metabolic alterations show that SARS-CoV-2 infection led to disturbance in the energetic system, supporting the viral replication and corroborating with the severe clinical conditions of patients. Six polar metabolites (glycerol, acetate, 3-aminoisobutyrate, formate, glucuronate, and lactate) were revealed by PLS-DA and predicted by ROC curves and ANOVA to be potential prognostic metabolite panels for Covid-19 and considered clinically relevant for predicting infection severity due to their straight roles in the lipid and energy metabolism. Thus, metabolomics from samples of Covid-19 patients is a powerful tool for a better understanding of the disease mechanism of action and metabolic consequences of the infection in the human body and may corroborate allowing clinicians to intervene quickly according to the needs of Covid-19 patients.


Assuntos
COVID-19 , Aminoácidos , COVID-19/diagnóstico , Formiatos , Glucuronatos , Glicerol , Humanos , Lactatos , Metabolômica , SARS-CoV-2
5.
Am J Orthod Dentofacial Orthop ; 161(6): e580-e587, 2022 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-35430089

RESUMO

INTRODUCTION: This retrospective study evaluated the buccal bone thickness in mandibular canine, premolar, and molar areas, using as a reference the WALA ridge in patients with various facial patterns. METHODS: The sample comprised 51 cone-beam computerized tomography scans of subjects divided into 3 groups according to the facial pattern, determined by the Ricketts' VERT index, brachyfacial (group 1), mesofacial (group 2), and dolichofacial (group 3). A quantitative analysis of the buccal bone thickness was made in cone-beam computerized tomography scans in the region of the mandibular dental arch corresponding to the WALA ridge. The intergroup comparison of buccal bone thickness was performed with a 1-way analysis of variance and Tukey tests. RESULTS: Buccal bone thickness was similar among the groups, and it increased progressively from the mandibular first to the second molars. In the canine and premolar regions, the thickness was less and often not visible on tomography. There was no difference in the buccal bone thickness in the mandibular dental arch region corresponding to the WALA ridge reference among facial patterns, except for the mesial roots of the second molars, which were thicker in brachyfacial subjects than in dolichofacial subjects. CONCLUSIONS: The use of the WALA ridge as a clinical reference for individualized orthodontic arch diagramming should be made with caution and independent of the facial pattern.


Assuntos
Tomografia Computadorizada de Feixe Cônico , Dente Molar , Tomografia Computadorizada de Feixe Cônico/métodos , Humanos , Mandíbula/diagnóstico por imagem , Estudos Retrospectivos , Raiz Dentária/diagnóstico por imagem
6.
Comput Commun ; 195: 99-110, 2022 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-35992726

RESUMO

The COVID-19 pandemic further highlighted the need to use low-cost remote monitoring procedures for medical patients. Since the results reported in the literature have shown that the use of Channel State Information (CSI) from Wi-Fi networks to remotely monitor patients can provide means to obtain a powerful medical information package in a non-invasive way and at low cost, a consistent review and analysis of the state of the art on this applied technique is developed in the present work. Initially, a mathematical overview of the CSI technology and its functional model is done. Subsequently, details about the technical approach necessary to use CSI in medical applications and a summary of the studies reported in the literature with such applications are presented. Based on the analyses and discussions carried out throughout this work, a better understanding of the current state of the art is achieved. Challenges and perspectives for future research are also highlighted.

7.
World J Urol ; 39(3): 953-962, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32388784

RESUMO

PURPOSE: To quantitatively assess the benefit-risk ratio on the efficacy and safety of all phosphodiesterase type 5 inhibitors (PDE5i) in men with erectile dysfunction. METHODS: A systematic review with network meta-analysis, surface under the cumulative ranking analysis and stochastic multicriteria acceptability analyses were performed. Searches were conducted in Pubmed, Scopus, Web of Science without limits for time-frame or language. Randomized controlled trials evaluating the efficacy or safety of any PDE5i compared to a placebo or to other PDE5i in males with erectile disfunction were included. RESULTS: Overall, 184 articles representing 179 randomized controlled trials (50,620 patients) were included. All PDE5i were significantly more efficient than placebo. Sildenafil 25 mg was statistically superior to all interventions in enhancing IIEF (with a 98% probability of being the most effective treatment), followed by sildenafil 50 mg (80% of probability). Taladafil 10 mg and 20 mg also presented good profiles (73% and 76%, respectively). Avanafil and lodenafil were less effective interventions. Mirodenafil 150 mg was the treatment that caused more adverse events, especially flushing and headaches. Sildenafil 100 mg was more related to visual disorders, while vardenafil and udenafil were more prone to cause nasal congestion. CONCLUSION: Sildenafil at low doses and tadalafil should be the first therapeutic options. Avanafil, lodenafil and mirodenafil use are hardly justified given the lack of expressive efficacy or high rates of adverse events.


Assuntos
Técnicas de Apoio para a Decisão , Disfunção Erétil/tratamento farmacológico , Inibidores da Fosfodiesterase 5/administração & dosagem , Administração Oral , Humanos , Masculino , Metanálise em Rede , Inibidores da Fosfodiesterase 5/efeitos adversos , Resultado do Tratamento
8.
Sensors (Basel) ; 21(16)2021 Aug 16.
Artigo em Inglês | MEDLINE | ID: mdl-34450950

RESUMO

Simulation is a useful and common technique to evaluate the performance of networks when the implementation of a real scenario is not available. Specifically for Wireless Body Area Networks (WBAN), it is crucial to perform evaluations in environments as close as possible to the real conditions of use. To achieve that, simulations must include different protocol layers involved in WBAN and models close to reality to create realistic simulation environments for e-health applications. To satisfy these needs, this work presents the BNS framework, a flexible tool for WBAN simulations. The proposal is an extension of the Castalia framework, which includes: (1) a new wireless channel model considering real radio-propagation over the human body; (2) an updated implementation of the WBAN MAC protocol in Castalia, with functionalities and requirements in accordance with the IEEE 802.15.6 standard; (3) a new comprehensive and configurable mobility model for simulating intra-WBAN communication; (4) a temperature module based on the Pennes bioheat transfer equation, to model the temperature of a WBAN node based on the activity of the node; and (5) a Healthcare Application Layer that implements data representation and a communication protocol between Personal Health Devices (PHD) following the ISO/IEEE 11073 standard. Three use cases are presented, where WBAN scenarios are simulated and evaluated using the proposed BNS framework. Results show that BNS is a valid and flexible tool to evaluate WBAN solutions through simulation.


Assuntos
Redes de Comunicação de Computadores , Tecnologia sem Fio , Humanos , Comunicação , Simulação por Computador
9.
Exp Parasitol ; 216: 107936, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32535116

RESUMO

This study evaluated the germination capacity of Pochonia chlamydosporia (VC4) fungus after its passage through the gastrointestinal tract of domestic chickens and its interaction with Ascaridia galli and Heterakis gallinarum eggs. Twenty-two domestic chickens were divided in two groups: control group (G1) received shredded corn substrate without VC4; and treatment group (G2) received a single dose of 29 g corn substrate containing 3.3 × 106 conidia/chlamydospores (VC4). Subsequently, chicken fecal samples were collected at intervals of 0, 6, 8, 10, 12, 18 and 24 h. Petri dishes from fecal samples of the treated group (G2) were subdivided (G2a and G2b), and then replicated in 2% agar-water medium for the microbiological test. After VC4 growth, approximately 200 eggs of A. galli (G2a) and H. gallinarum (G2b) were added to each subgroup to evaluation of ovicidal activity. There was fungal viability after passage through chicken gastrointestinal tract and egg predation of 59.9% and 43.2% for A. galli and H. gallinarum, respectively. The present work demonstrates the ability of the fungus P. chlamydosporia to survive after passing through the gastrointestinal tract of domestic chickens, an extreme environment (low pH, enzymes, microbiota and mechanical action), and still germinate after being excreted with feces.


Assuntos
Ascaridíase/veterinária , Galinhas , Trato Gastrointestinal/microbiologia , Hypocreales/fisiologia , Doenças das Aves Domésticas/prevenção & controle , Infecções por Spirurida/veterinária , Animais , Ascaridia/microbiologia , Ascaridíase/prevenção & controle , Fezes/microbiologia , Feminino , Trato Gastrointestinal/parasitologia , Nematoides/fisiologia , Doenças das Aves Domésticas/parasitologia , Infecções por Spirurida/prevenção & controle , Spirurina/microbiologia
10.
J Enzyme Inhib Med Chem ; 35(1): 1345-1358, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32588679

RESUMO

Trypanothione synthetase (TryS) produces N1,N8-bis(glutathionyl)spermidine (or trypanothione) at the expense of ATP. Trypanothione is a metabolite unique and essential for survival and drug-resistance of trypanosomatid parasites. In this study, we report the mechanistic and biological characterisation of optimised N5-substituted paullone analogues with anti-TryS activity. Several of the new derivatives retained submicromolar IC50 against leishmanial TryS. The binding mode to TryS of the most potent paullones has been revealed by means of kinetic, biophysical and molecular modelling approaches. A subset of analogues showed an improved potency (EC50 0.5-10 µM) and selectivity (20-35) against the clinically relevant stage of Leishmania braziliensis (mucocutaneous leishmaniasis) and L. infantum (visceral leishmaniasis). For a selected derivative, the mode of action involved intracellular depletion of trypanothione. Our findings shed light on the molecular interaction of TryS with rationally designed inhibitors and disclose a new set of compounds with on-target activity against different Leishmania species.


Assuntos
Benzazepinas/química , Glutationa/análogos & derivados , Leishmania/metabolismo , Espermidina/análogos & derivados , Animais , Glutationa/biossíntese , Espermidina/biossíntese
11.
Water Sci Technol ; 79(4): 699-708, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30975936

RESUMO

The possibility of using the first stage of the French System (FS) of vertical wetlands composed of only two units in parallel requires hydraulic investigations to allow a better understanding of its operation under tropical climatic environments. This study evaluated the pattern of the outflow hydrograph along an extended cycle of operation (seven days of feeding) and the influence of the sludge deposit, rainfall occurrence and duration of pulse application on the outflow hydrograph in a modified full-scale FS in Brazil. The results indicated that, as the feeding cycle days increased, there was an increase in the time of filtration and the internal storage of the liquid volume, probably due to a reduction in the filter permeability. Greater hydraulic gradient favoured the infiltration velocity, decreased the amount of liquid stored within the system, and delayed the loss of permeability. The sludge layer contributed to a momentary liquid retention, and also allowed greater evapotranspiration, reducing the liquid volume to be treated. The sludge deposit seemed to hinder the liquid percolation, especially at the end of the cycle, modifying the hydraulic conductivity of the filter as a whole. Intense rainfall events demonstrated that precipitation could modify the flow dynamics within the system.


Assuntos
Eliminação de Resíduos Líquidos/métodos , Áreas Alagadas , Brasil , Filtração , Esgotos
12.
Value Health ; 21(7): 874-880, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-30005760

RESUMO

BACKGROUND: Acromegaly results from the hypersecretion of growth hormone. Because of the low incidence rates of this disease worldwide, few clinical trials evaluating drug treatments have been conducted. OBJECTIVES: To conduct the first network meta-analysis simultaneously comparing all available drugs used in acromegaly treatment so as to provide more robust evidence in this field. METHODS: A systematic review was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses and Cochrane Collaboration recommendations (PROSPERO database under the registration number CRD42017059880). The electronic searches were conducted in PubMed (MEDLINE), Scopus, and Web of Science databases. Randomized controlled trials comparing any drug for the treatment of acromegaly head-to-head or versus placebo were included. Outcomes concerning the efficacy and safety of treatments were evaluated. The statistical analyses were performed using Aggregate Data Drug Information System version 1.16.8 (drugis.org, Groningen, The Netherlands). RESULTS: The initial search retrieved 2059 articles. Of these, 10 randomized controlled trials were included in a qualitative analysis and 7 in a quantitative analysis. The network meta-analysis for the efficacy outcome (number of patients achieving insulinlike growth factor 1 control) showed that pegvisomant and lanreotide autogel were statistically superior to placebo (odds ratio [95% credible interval] 0.06 [0.00-0.55] and 0.09 [0.01-0.88]). No further differences were found. The probability rank indicated that pegvisomant and pasireotide have the highest probabilities (33% and 34%, respectively) of being the best therapeutic options. No major side effects were noted. CONCLUSIONS: Pegvisomant is still a good option for acromegaly treatment, but pasireotide seems to be a promising alternative. Nevertheless, other important key factors such as drug costs and effectiveness (real-world results) should be taken into account when selecting acromegaly treatment.


Assuntos
Acromegalia/tratamento farmacológico , Antagonistas de Hormônios/uso terapêutico , Hormônio do Crescimento Humano/análogos & derivados , Hormônio do Crescimento Humano/metabolismo , Peptídeos Cíclicos/uso terapêutico , Receptores da Somatotropina/antagonistas & inibidores , Somatostatina/análogos & derivados , Acromegalia/metabolismo , Acromegalia/fisiopatologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Antagonistas de Hormônios/efeitos adversos , Hormônio do Crescimento Humano/efeitos adversos , Hormônio do Crescimento Humano/uso terapêutico , Humanos , Masculino , Pessoa de Meia-Idade , Peptídeos Cíclicos/efeitos adversos , Receptores da Somatotropina/metabolismo , Somatostatina/efeitos adversos , Somatostatina/uso terapêutico , Resultado do Tratamento , Adulto Jovem
13.
Eur J Clin Pharmacol ; 74(11): 1513-1521, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30022333

RESUMO

PURPOSE: Although randomized controlled trials (RCTs) are the gold standard for the assessment of clinical outcomes, long-term extension trials (LTEs) and observational cohorts may help generate evidence. Our goal was to compare the discontinuation rates of abatacept, rituximab, and tocilizumab in rheumatoid arthritis (RA) reported in different study designs. METHODS: A systematic review was conducted with searches in PubMed, Scopus, and the Cochrane Library, plus a manual search, for RCTs, LTEs, and observational cohorts reporting discontinuation rates by any of three causes (all-cause, inefficacy, adverse events). Meta-analyses with sensitivity analyses and meta-regressions were conducted. RESULTS: Of the 111 studies included, 74 were RCTs (n = 55) or LTEs (n = 17) reporting data on abatacept (n = 33), rituximab (n = 10), and tocilizumab (n = 31) and 37 were observational cohort studies (abatacept = 11, rituximab = 8, tocilizumab = 18). The follow-up duration did not differ among the study designs. Discontinuation rates were similar among the drugs but varied among the study designs. Discontinuation rates were significantly higher in cohort studies than those in interventional studies for the three drugs. Sensitivity analyses could not identify patient characteristics associated with these differences. Meta-regression analyses demonstrated no correlation between study follow-up duration and discontinuation rates. CONCLUSIONS: The discontinuation rates reported for non-anti-TNF drugs varied relative to the study design in which they were investigated. Regulatory agencies, price-setting entities, and evidence-gathering researchers should consider the effect of the real-life environment in their decisions and conclusions.


Assuntos
Antirreumáticos/administração & dosagem , Artrite Reumatoide/tratamento farmacológico , Projetos de Pesquisa , Abatacepte/administração & dosagem , Anticorpos Monoclonais Humanizados/administração & dosagem , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto , Rituximab/administração & dosagem
14.
Pituitary ; 21(6): 642-652, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30159696

RESUMO

PURPOSE: Acromegaly is a rare disease that results in the enlargement of body extremities and in organomegaly. Treatments include surgery, drugs, and radiotherapy, which are all onerous. Therefore, well-conducted cost-analyses are crucial in the decision-making process. METHODS: A systematic review of cost-effectiveness studies on acromegaly therapies was performed following PRISMA and Cochrane recommendations. The search for records was conducted in PubMed, Scopus, and Web of Science (May 2018). The quality of the included studies was assessed using the Joana Briggs Institute Tool. RESULTS: From initial 547 records, 16 studies were included in the review. The studies could present more than one economic evaluation, and encompassed cost-effectiveness (n = 13), cost-utility (n = 5), and cost-consequence (n = 1) analyses. All studies were model-based and evaluated only direct medical costs. Eleven records did not mention discounting and only 10 performed sensitivity analyses. The characteristic of the studies, the cost-effectiveness results and the studies' conclusions are described and commented upon. The main limitation of the studies was discussed and aspects to improve in future studies were pointed out. CONCLUSIONS: Cost-effectiveness studies on acromegaly have been performed in several scenarios, evaluating different phases of treatment. However, the studies present limitations and, overall, were considered of moderate quality. Further economic models should be developed following health economics guidelines recommendations, and must improve transparency.


Assuntos
Acromegalia/tratamento farmacológico , Acromegalia/economia , Análise Custo-Benefício , Hormônio do Crescimento Humano/análogos & derivados , Hormônio do Crescimento Humano/uso terapêutico , Humanos , Octreotida/uso terapêutico , Peptídeos Cíclicos/uso terapêutico , Somatostatina/análogos & derivados , Somatostatina/uso terapêutico
15.
Mycoses ; 61(10): 754-763, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-29893450

RESUMO

Amphotericin formulations, indicated for invasive fungal infections (IFIs), vary in effectiveness, safety and costs. In Brazil, only the conventional formulation is provided by the Public Health System. The aim of this study was to perform a cost-effectiveness analysis comparing conventional amphotericin B (CAB), liposomal amphotericin B (LAB) and amphotericin B lipid complex (ABLC). Therefore, a decision tree was developed. The model began with high-risking patients on suspicion or confirmation of IFI. The analysis was conducted under the perspective of the Brazilian Public Health System. Model health states were defined according to medication use and clinical evolution. Clinical efficacy (cure) and transition probabilities were derived from the literature. Resource use was estimated from Brazilian data. Time horizon followed the maximum treatment time determined in the patient information leaflets (3 or 6 weeks). One-way and probabilistic-sensitivity analyses were conducted. The conventional formulation was the most cost-effective. No dominance was observed; however, high incremental cost-effectiveness ratios were obtained for LAB (USD 313 130) and ABLC (USD 1 711 280). Sensitivity analyses demonstrated the robustness of the results. CAB is the most cost-effective treatment, followed by LAB and ABLC. Although CAB presents critical safety aspects, the high acquisition costs of the other formulations prevent their large-scale use in Brazil.


Assuntos
Anfotericina B/economia , Anfotericina B/uso terapêutico , Antifúngicos/economia , Antifúngicos/uso terapêutico , Análise Custo-Benefício , Infecções Fúngicas Invasivas/tratamento farmacológico , Brasil , Humanos
16.
J Pediatr ; 185: 129-135.e6, 2017 06.
Artigo em Inglês | MEDLINE | ID: mdl-28285752

RESUMO

OBJECTIVES: To evaluate the safety and efficacy of different doses of fluconazole used for invasive prophylaxis of fungal infection in neonates. STUDY DESIGN: A systematic search was conducted with PubMed, Scopus, and Web of Science. A manual search was performed as well. Only randomized controlled trials of neonates in a neonatal intensive care unit (NICU) who received fluconazole prophylaxis for invasive fungal infection, regardless of the dose or therapeutic regimen, were included in this review. Data on baseline characteristics, outcomes incidence of proven invasive Candida infection, overall mortality, and invasive Candida infection-related mortality were extracted. RESULTS: Eleven studies were included in the review, with fluconazole doses of 3, 4, or 6?mg/kg. When the incidence of invasive Candida and invasive Candida-related mortality were considered as outcomes, the 3 and 6?mg/kg fluconazole doses were found to be statistically superior to placebo (OR, 5.48 [95% credible interval, 1.81-18.94] and 2.63 [1.18-7.02], respectively, and 15.32 [1.54-54.31] and 9.14 [1.26-142.7], respectively), but data for the 3 doses were not statistically significantly different. CONCLUSIONS: Use of the lowest fluconazole dose (3?mg/kg) should be recommended for Candida prophylaxis in neonates, given that increasing the fluconazole dose is not associated with higher efficacy and has greater potential for toxicity and increased cost.


Assuntos
Antifúngicos/administração & dosagem , Candidíase Invasiva/prevenção & controle , Fluconazol/administração & dosagem , Relação Dose-Resposta a Droga , Humanos , Unidades de Terapia Intensiva Neonatal , Metanálise em Rede
17.
J Gastroenterol Hepatol ; 32(4): 749-755, 2017 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-27785825

RESUMO

BACKGROUND AND AIM: Ledipasvir with sofosbuvir (LED/SOF) for the treatment of patients infected with genotype 1 hepatitis C virus can be used with or without ribavirin (RBV). RBV is well known to promote significant adverse events (AE). The aim of this study was to compare the efficacy and safety of treatment with LED/SOF, with or without RBV, in patients infected with hepatitis C virus genotype 1. METHODS: We performed a systematic review followed by a pairwise meta-analysis including randomized controlled trials that reported efficacy (rapid virological response, sustained virological response at 4 and 12 weeks post-treatment (SVR4 and 12), and viral relapse) and safety outcomes (any AE, serious AE, discontinuation owing to AE, anemia, and rash). It was performed a subgroup analysis evaluating the SVR12 including only cirrhotic patients. Results were reported as risk ratios (RR) and with 95% confidence intervals (95% CI). RESULTS: Seven randomized controlled trials were analyzed. LED/SOF with RBV showed a worse safety profile when compared with LED/SOF without RBV for the following outcomes: any AE (RR 0.56 [95% CI 0.46-0.69]), anemia (RR 0.08 [95% CI 0.04-0.17]), and rash (RR 0.35 [95% CI 0.19-0.65]). No significant differences were observed regarding serious AE, rapid virological response, SVR4, SVR12, or viral relapse. The subgroup analysis did not show significant differences between either treatment groups. CONCLUSION: Administration of LED/SOF + RBV to treatment-naïve patients with or without cirrhosis, and non-cirrhotic treatment-experienced patients, did not promote significant additional benefits. Furthermore, it is still unclear whether cirrhotic treatment-experienced patients could benefit from combined therapy.


Assuntos
Antivirais/administração & dosagem , Benzimidazóis/administração & dosagem , Fluorenos/administração & dosagem , Genótipo , Hepacivirus/genética , Hepatite C Crônica/tratamento farmacológico , Hepatite C Crônica/virologia , Ribavirina/administração & dosagem , Sofosbuvir/administração & dosagem , Antivirais/efeitos adversos , Benzimidazóis/efeitos adversos , Bases de Dados Bibliográficas , Quimioterapia Combinada , Fluorenos/efeitos adversos , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto , Ribavirina/efeitos adversos , Sofosbuvir/efeitos adversos , Resultado do Tratamento
18.
Anal Chem ; 88(17): 8421-7, 2016 09 06.
Artigo em Inglês | MEDLINE | ID: mdl-27494768

RESUMO

Current methods employed for the analysis of the chemical composition of solid matrices (such as plant, animal, or human tissues; soil; etc.) often require many sample treatment steps, including an extraction step with exclusively dedicated solvents. This work describes an optimized analytical setup in which the extraction of a solid sample is directly coupled to its analysis by high-performance liquid chromatography. This approach avoids (i) the use of pumps and valves other than those comprising the HPLC instrument, (ii) the use of solvents other than those of the mobile phase, and (iii) the need to stop the mobile phase flow at any time during the full analytical procedure. The compatibility of this approach with the direct analysis of fresh tissues (leaves, stems, and seeds of four plant species with dissimilar chemical compositions) was successfully demonstrated, leading to the elimination of sample preparation steps such as drying, grinding, concentration, dilution, and filtration, among others. This work describes a new, simple, and efficient green approach to minimize or eliminate sample treatment procedures. It could be easily applied for quality control of plant materials and their derived products through chromatographic fingerprints and for untargeted metabolomic investigations of solid matrices, among other applications.

19.
J Biochem Mol Toxicol ; 30(10): 506-512, 2016 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-27111380

RESUMO

We investigated the effects of acute diazepam (DZP) administration on thiobarbituric acid-reactive substance (TBARS) levels, protein carbonyl content, and on the activities of the antioxidant enzymes catalase, glutathione peroxidase, and superoxide dismutase in the brain of rats. Additionally, we investigated the antioxidant role of chronic pretreatment with simvastatin on the effects provoked by DZP. Simvastatin was administered (1 or 10 mg/kg by oral gavage) for 30 days. On the 30th day of treatment, groups were randomized and DZP was administered (0.5 or 1.0 mg/kg by intraperitoneal injection). Control groups received saline. Results showed that DZP enhanced TBARS levels and protein carbonyl content and altered enzymatic activity in the brain of rats. Simvastatin prevented most of the alterations caused by DZP on the oxidative stress parameters. Data indicate that DZP administration causes an oxidative imbalance in the brain areas studied; however, in the presence of simvastatin, some of these alterations in oxidative stress were prevented.


Assuntos
Anticolesterolemiantes/farmacologia , Diazepam/efeitos adversos , Hipnóticos e Sedativos/efeitos adversos , Estresse Oxidativo/efeitos dos fármacos , Sinvastatina/farmacologia , Administração Oral , Animais , Encéfalo/efeitos dos fármacos , Encéfalo/metabolismo , Catalase/metabolismo , Diazepam/antagonistas & inibidores , Esquema de Medicação , Glutationa Peroxidase/metabolismo , Hipnóticos e Sedativos/antagonistas & inibidores , Injeções Intraperitoneais , Peroxidação de Lipídeos/efeitos dos fármacos , Oxirredução , Carbonilação Proteica/efeitos dos fármacos , Ratos , Ratos Wistar , Superóxido Dismutase/metabolismo , Substâncias Reativas com Ácido Tiobarbitúrico/metabolismo
20.
An Acad Bras Cienc ; 88(1): 335-48, 2016 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-26871491

RESUMO

The present study aims to directly investigate the behavioral and antioxidant effects of simvastatin in a model of bipolar mania induced by lisdexamfetamine dimesylate. Wistar rats were treated for 30 days with simvastatin. On the 24th day after the start of treatment, each rat was administered lisdexamfetamine dimesylate for 7 days. The results suggest that simvastatin combined with lisdexamfetamine dimesylate induced a significant increased locomotion and lisdexamfetamine dimesylate administration causes an oxidative imbalance determined by an increment in lipid peroxidation, protein oxidation and alterations in the activities of antioxidant enzymes in brain areas; moreover, in the presence of simvastatin, most of these effects were prevented. These findings contribute to a better understanding of the critical roles of lisdexamfetamine dimesylate in the treatment of neuropsychiatric disorders, associated with increased oxidative stress and changes in antioxidant enzymatic defense. In view of the central role played by lisdexamfetamine dimesylate, the established antioxidant effect of simvastatin therapy is of major interest.


Assuntos
Antimaníacos/farmacologia , Antioxidantes/farmacologia , Comportamento Animal/efeitos dos fármacos , Transtorno Bipolar/tratamento farmacológico , Sinvastatina/farmacologia , Animais , Antimaníacos/uso terapêutico , Antioxidantes/uso terapêutico , Transtorno Bipolar/induzido quimicamente , Estimulantes do Sistema Nervoso Central , Peroxidação de Lipídeos/efeitos dos fármacos , Dimesilato de Lisdexanfetamina , Masculino , Estresse Oxidativo/efeitos dos fármacos , Ratos , Ratos Wistar , Sinvastatina/uso terapêutico
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