Assuntos
Intervenção Coronária Percutânea , Infarto do Miocárdio com Supradesnível do Segmento ST , África Subsaariana/epidemiologia , Cateterismo , Côte d'Ivoire , Humanos , Reperfusão Miocárdica , Intervenção Coronária Percutânea/efeitos adversos , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico , Infarto do Miocárdio com Supradesnível do Segmento ST/epidemiologia , Infarto do Miocárdio com Supradesnível do Segmento ST/terapiaRESUMO
Despite remaining one of the most widely abused drugs worldwide, Cannabis sativa exhibits remarkable medicinal properties. The phytocannabinoids, cannabidiol and Δ-9-tetrahydrocannabinol, reduce nausea and vomiting, particularly during chemotherapy. This is attributed to their ability to reduce the release of serotonin from enterochromaffin cells in the small intestine, which would otherwise orchestrate the vomiting reflex. Although there are many preclinical and clinical studies on the effects of Δ-9-tetrahydrocannabinol during nausea and vomiting, little is known about the role that cannabidiol plays in this scenario. Since cannabidiol does not induce psychotropic effects, in contrast to other cannabinoids, its use as an anti-emetic is of great interest. This review aims to summarize the available literature on cannabinoid use, with a specific focus on the nonpsychotropic drug cannabidiol, as well as the roles that cannabinoids play in preventing several other adverse side effects of chemotherapy including organ toxicity, pain and loss of appetite.
Assuntos
Antineoplásicos/efeitos adversos , Dor do Câncer/prevenção & controle , Canabidiol/uso terapêutico , Transtornos da Alimentação e da Ingestão de Alimentos/prevenção & controle , Náusea/tratamento farmacológico , Vômito/tratamento farmacológico , Analgésicos não Narcóticos/farmacologia , Analgésicos não Narcóticos/uso terapêutico , Antieméticos/farmacologia , Antieméticos/uso terapêutico , Apetite/efeitos dos fármacos , Estimulantes do Apetite/farmacologia , Estimulantes do Apetite/uso terapêutico , Dor do Câncer/induzido quimicamente , Canabidiol/farmacologia , Cannabis/química , Transtornos da Alimentação e da Ingestão de Alimentos/induzido quimicamente , Humanos , Náusea/induzido quimicamente , Neoplasias/tratamento farmacológico , Vômito/induzido quimicamenteRESUMO
AIMS: To evaluate a novel modality utilising ultrasound for renal denervation designed to reduce the duration of the intervention as well as to increase the consistency of the clinical outcome. METHODS AND RESULTS: Eleven consecutive patients suffering from resistant hypertension as defined by the ESH-ESC guidelines were treated by transcatheter renal denervation using the CE-marked PARADISE™ technology (ReCor Medical, Ronkonkoma, NY, USA). An average of 5.1 ultrasound emissions were delivered in each subject for a total denervation duration of less than four minutes and the treatment was well tolerated by all patients. Both office and home blood pressure measurements showed an immediate, significant and sustained decrease in blood pressure. Three-month results were comparable to published data on radiofrequency renal denervation with an average reduction in office and home blood pressure of -36/-17 mmHg and -22/-12 mmHg, respectively. CONCLUSIONS: Ultrasound renal denervation appears to be a safe and effective treatment for resistant hypertension and further studies will be performed to confirm these preliminary results.
Assuntos
Denervação Autônoma/métodos , Pressão Sanguínea , Procedimentos Endovasculares , Hipertensão/terapia , Rim/inervação , Terapia por Ultrassom , Adulto , Idoso , Idoso de 80 Anos ou mais , Anti-Hipertensivos/uso terapêutico , Denervação Autônoma/efeitos adversos , Pressão Sanguínea/efeitos dos fármacos , Resistência a Medicamentos , Procedimentos Endovasculares/efeitos adversos , Estudos de Viabilidade , Feminino , Humanos , Hipertensão/fisiopatologia , Rim/irrigação sanguínea , Masculino , Pessoa de Meia-Idade , África do Sul , Fatores de Tempo , Resultado do Tratamento , Terapia por Ultrassom/efeitos adversosRESUMO
OBJECTIVES: The goal of this study was to evaluate a new drug-eluting stent (DES) comprising a bioabsorbable polymer eluting a moderate dose of paclitaxel in a clinically relevant animal model. BACKGROUND: Although DES limit restenosis, adverse vascular pathologies and toxicities continue to be of major concern. Optimization of DES components, especially completely absorbable polymers, may reduce these toxicities. METHODS: Bare-metal (BM), absorbable polymer coating only (POLY), and polymer-based paclitaxel-eluting (PACL) stents were implanted in porcine coronary arteries using intravascular ultrasound (IVUS) to optimize stent apposition. The dose density of paclitaxel was 0.30-0.35 mcg/mm2, with in vitro elution studies demonstrating a gradual elution over 6-8 weeks. The animals were terminated at 1 week, 1 month and 3 months. Histopathologic and histomorphometric analyses were perform. RESULTS: The arteries with PACL showed extensive smooth muscle cell necrosis at 1 week and poor apposition of stent struts at 1 month (malapposition measured as gap width between strut and internal elastic lamina), with greater gap width compared to the BM and POLY groups (0.22 mm +/- 0.02 vs. 0.03 mm +/- 0.02 and 0.02 mm +/- 0.01, respectively; p < 0.001). At 3 months, the PACL group showed rebound neointimal thickness and histological percent stenosis compared to the BM group (0.48 mm +/- 0.14 vs. 0.07 mm +/- 0.02, respectively; p < 0.001 and 59% +/- 11 vs. 17% +/- 2, respectively; p < 0.001). CONCLUSIONS: Despite in vitro data showing slow, sustained release of paclitaxel from a bioabsorbable polymer, the porcine coronary artery model demonstrated a sequence of medial necrosis, stent malapposition and late neointimal thickening. Since the therapeutic window for paclitaxel may be narrower than currently inferred, thorough preclinical testing coupled with the polymer development process for stents eluting paclitaxel is needed.