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1.
Am J Vet Res ; 85(4)2024 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-38346393

RESUMO

OBJECTIVE: To determine the effects of a single dose of the NSAIDs phenylbutazone, firocoxib, flunixin meglumine, and ketoprofen on concentrations of growth factors and cytokines in autologous protein solution (APS) and platelet-rich plasma (PRP). ANIMALS: 6 adult university-owned horses. METHODS: For the first phase, 6 horses were randomized to receive ketoprofen (1,000 mg) or flunixin meglumine (500 mg) IV. Blood was obtained and processed for APS (Pro-Stride) and PRP (Restigen) before and 6 hours after administration of NSAIDs. Horses underwent a 2-week washout period, after which the protocol was repeated using a crossover design. For the second phase, following at least a 2-week washout period, the study protocol was repeated with phenylbutazone (1 g) or firocoxib (57 mg) administered orally. Plasma was collected 6 hours after administration for evaluation of drug concentrations, and APS and PRP were analyzed for concentrations of drug, platelets, leukocytes, and several growth factors and cytokines (PDGF, fibroblast growth factor, TGF-ß1, IL-1ß, IL-10, IL-6, IL-8, and tumor necrosis factor-α) before and 6 hours after administration of NSAIDs using immunoassays. RESULTS: There were no significant differences in concentrations of cytokines or growth factors before or after administration of any NSAID. There were significant differences in concentrations of leukocytes and platelets based on both product and time. NSAID concentrations in plasma were not significantly different from concentrations in APS and PRP. CLINICAL RELEVANCE: These results help guide clinicians on the appropriate use of these NSAIDs in conjunction with the processing of APS and PRP, which is unlikely to significantly alter the final product after single-dose administration.


Assuntos
Anti-Inflamatórios não Esteroides , Citocinas , Cavalos , Plasma Rico em Plaquetas , Animais , 4-Butirolactona/administração & dosagem , 4-Butirolactona/efeitos adversos , 4-Butirolactona/análogos & derivados , Anti-Inflamatórios não Esteroides/administração & dosagem , Anti-Inflamatórios não Esteroides/efeitos adversos , Citocinas/sangue , Citocinas/metabolismo , Cavalos/sangue , Cavalos/metabolismo , Cetoprofeno/administração & dosagem , Cetoprofeno/efeitos adversos , Fenilbutazona/administração & dosagem , Fenilbutazona/efeitos adversos , Plasma Rico em Plaquetas/metabolismo , Sulfonas/administração & dosagem , Sulfonas/efeitos adversos , Distribuição Aleatória
2.
Vet Med Sci ; 7(5): 1504-1508, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34021731

RESUMO

A 9-year-old intact female toy poodle was presented with oedema around the neck, including pus and cutaneous necrosis, 2 days after starting firocoxib treatment and placement of a cervical collar for intervertebral disc disease. Cytology of the pus revealed predominantly mature neutrophils with fewer macrophages and lymphocytes, indicating sterile inflammation. Although a skin biopsy could have provided more diagnostic information, it was not performed at presentation. Firocoxib treatment was discontinued, and immunosuppressive therapy including cyclosporine was initiated, which significantly alleviated the skin lesions. The dog recovered fully in 7 weeks. The final diagnosis was a possible cutaneous adverse drug reaction to firocoxib based on history, clinical signs and response to therapy.


Assuntos
Doenças do Cão , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos , 4-Butirolactona/efeitos adversos , 4-Butirolactona/análogos & derivados , Animais , Anti-Inflamatórios não Esteroides , Doenças do Cão/induzido quimicamente , Doenças do Cão/tratamento farmacológico , Cães , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/tratamento farmacológico , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/veterinária , Feminino , Sulfonas/efeitos adversos
3.
J Am Anim Hosp Assoc ; 55(6): 323-327, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31525093

RESUMO

Fanconi syndrome is a renal proximal tubulopathy characterized by excessive urinary loss of glucose, amino acids, several electrolytes, and bicarbonate. Here, we report the case of transient Fanconi syndrome in a dog following administration of firocoxib, cefadroxil, tramadol, and famotidine. A 10 mo old Maltese was presented with lethargy, anorexia, vomiting, and weight loss. Transient Fanconi syndrome without azotemia was associated with firocoxib, cefadroxil, tramadol, and famotidine treatment. The dog received supportive care including IV fluids, gastroprotectants, and oral nutritional supplements. Two months after initial diagnosis and treatment, the dog showed complete resolution of glucosuria and aminoaciduria. The unique features of Fanconi syndrome in this case emphasize the potential renal tubular toxicity of this widely used multiple-drug combination.


Assuntos
4-Butirolactona/análogos & derivados , Cefadroxila/efeitos adversos , Doenças do Cão/induzido quimicamente , Famotidina/efeitos adversos , Síndrome de Fanconi/veterinária , Sulfonas/efeitos adversos , Tramadol/efeitos adversos , 4-Butirolactona/administração & dosagem , 4-Butirolactona/efeitos adversos , Analgésicos Opioides/administração & dosagem , Analgésicos Opioides/efeitos adversos , Animais , Antibacterianos/administração & dosagem , Antibacterianos/efeitos adversos , Antiulcerosos/administração & dosagem , Antiulcerosos/efeitos adversos , Cefadroxila/administração & dosagem , Cães , Famotidina/administração & dosagem , Síndrome de Fanconi/induzido quimicamente , Glucose , Glicosúria , Masculino , Sulfonas/administração & dosagem , Tramadol/administração & dosagem
4.
Toxicol In Vitro ; 47: 129-136, 2018 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-29174024

RESUMO

The use of natural products in therapeutics has been growing over the years. Lignans are compounds with large pharmaceutical use, which has aroused interest in the search for new drugs to treat diseases. The present study evaluated the cytotoxicity of (-)-trachelogenin, a dibenzylbutyrolactone type lignan isolated from Combretum fruticosum, against several tumor and non-tumor cell lines using the MTT assay and its possible mechanism of action. (-)-Trachelogenin showed IC50 values ranging of 0.8-32.4µM in SF-295 and HL-60 cell lines, respectively and IC50 values >64µM in non-tumor cell lines. (-)-trachelogenin persistently induced autophagic cell death, with cytoplasmic vacuolization and formation of autophagosomes mediated by increasing LC3 activation and altering the expression levels of Beclin-1.


Assuntos
4-Butirolactona/análogos & derivados , Antineoplásicos Fitogênicos/farmacologia , Autofagia/efeitos dos fármacos , Neoplasias do Colo/tratamento farmacológico , Combretum/química , Descoberta de Drogas , Caules de Planta/química , 4-Butirolactona/efeitos adversos , 4-Butirolactona/química , 4-Butirolactona/isolamento & purificação , 4-Butirolactona/farmacologia , Antineoplásicos Fitogênicos/efeitos adversos , Antineoplásicos Fitogênicos/química , Antineoplásicos Fitogênicos/isolamento & purificação , Autofagossomos/efeitos dos fármacos , Autofagossomos/patologia , Proteína Beclina-1/agonistas , Proteína Beclina-1/metabolismo , Brasil , Linhagem Celular , Linhagem Celular Tumoral , Sobrevivência Celular/efeitos dos fármacos , Neoplasias do Colo/patologia , Combretum/crescimento & desenvolvimento , Etnofarmacologia , Células HCT116 , Humanos , Concentração Inibidora 50 , Medicina Tradicional , Proteínas Associadas aos Microtúbulos/agonistas , Proteínas Associadas aos Microtúbulos/metabolismo , Estrutura Molecular , Proteínas de Neoplasias/agonistas , Proteínas de Neoplasias/metabolismo , Caules de Planta/crescimento & desenvolvimento , Vacúolos/efeitos dos fármacos , Vacúolos/patologia
5.
Brain Res Bull ; 126(Pt 1): 47-60, 2016 09.
Artigo em Inglês | MEDLINE | ID: mdl-26855327

RESUMO

Gamma-hydroxybutyrate (GHB) is a putative neurotransmitter, a drug of abuse, and a medical treatment for narcolepsy and other neuropsychiatric disorders. Its precursors gamma-butyrolactone (GBL) and 1,4-butanediol (1,4-BD) are endogenously converted to GHB and thereby exert their psychobehavioural effects. In humans, GHB has a wide spectrum of properties ranging from stimulation and euphoria in lower doses, to sedation, deep sleep, and coma after ingestion of high doses. However, behavioural studies in healthy volunteers remain scarce and are usually limited to psychomotor performance testing. Most available data arise from either qualitative studies with illicit users or clinical trials examining therapeutic properties of GHB (then usually termed sodium oxybate). Here, we present an overview of the behavioural effects of GHB, GBL, and 1,4-BD in these three populations. GHB and its precursors strongly influence behaviours related to core human autonomic functions such as control of food intake, sexual behaviour, and sleep-wake regulation. These effects are instrumentalised by illicit users and clinically utilised in neuropsychiatric disorders such as narcolepsy, fibromyalgia, and binge-eating syndrome. Considering the industry withdrawal from psychopharmacology development, repurposing of drugs according to their behavioural and clinical profiles has gained increasing relevance. As such, GHB seems to be an attractive candidate as an experimental therapeutic in depression.


Assuntos
Depressores do Sistema Nervoso Central/efeitos adversos , Ritmo Circadiano/efeitos dos fármacos , Ingestão de Alimentos/efeitos dos fármacos , Comportamento Sexual/efeitos dos fármacos , Síndrome de Abstinência a Substâncias , 4-Butirolactona/efeitos adversos , Animais , Butileno Glicóis/efeitos adversos , Depressores do Sistema Nervoso Central/farmacologia , Humanos , Comportamento Social , Oxibato de Sódio/efeitos adversos , Síndrome de Abstinência a Substâncias/epidemiologia , Síndrome de Abstinência a Substâncias/psicologia , Síndrome de Abstinência a Substâncias/terapia
6.
J Am Assoc Lab Anim Sci ; 54(4): 405-10, 2015 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-26224441

RESUMO

Pain management in laboratory animals is generally accomplished by using opioids and NSAIDs. However, opioid use is hindered by controlled substance requirements and a relatively short duration of action. In this study, we compared the analgesic efficacy of firocoxib (a cyclooxygenase-2-selective NSAID) with that of buprenorphine in the mouse model of plantar incisional pain by objective measurement of mechanical allodynia and thermal hyperalgesia using von Frey and Hargreaves equipment, respectively. Our experimental design included 5 treatment groups: firocoxib at 10 mg/kg IP every 24 h (F10 group); firocoxib at 20 mg/kg IP every 24 h (F20); buprenorphine at 0.2 mg/kg SC every 8 h; intraperitoneal normal saline every 24 h; and sham group (anesthesia, no incision) treated with firocoxib at 20 mg/kg IP every 24 h (sham+F20). All mice underwent nociceptive assays at 24 h before and 4, 24, 48, and 72 h after surgery. Buprenorphine alleviated allodynia at all time points after incision. The F10 treatment alleviated allodynia at 4, 24, and 48 h, whereas F20 alleviated allodynia at 24, 48, and 72 h. None of the treatments alleviated thermal hyperalgesia at 4h. Except for F10 and buprenorphine at 24 h, all treatments alleviated thermal hyperalgesia at 24, 48, and 72 h. No significant differences were noted between the 2 doses of firocoxib and buprenorphine regarding mechanical allodynia and thermal hyperalgesia at all time points. In conclusion, the analgesic efficacy of firocoxib is comparable to that of buprenorphine in this mouse pain model.


Assuntos
4-Butirolactona/análogos & derivados , Inibidores de Ciclo-Oxigenase 2/administração & dosagem , Hiperalgesia/veterinária , Dor Pós-Operatória/veterinária , Doenças dos Roedores/tratamento farmacológico , Sulfonas/administração & dosagem , 4-Butirolactona/administração & dosagem , 4-Butirolactona/efeitos adversos , Analgésicos Opioides/administração & dosagem , Analgésicos Opioides/efeitos adversos , Animais , Buprenorfina/administração & dosagem , Buprenorfina/efeitos adversos , Inibidores de Ciclo-Oxigenase 2/efeitos adversos , Feminino , Hiperalgesia/tratamento farmacológico , Camundongos , Camundongos Endogâmicos C57BL , Dor Pós-Operatória/tratamento farmacológico , Distribuição Aleatória , Organismos Livres de Patógenos Específicos , Sulfonas/efeitos adversos
7.
Br J Nutr ; 113(5): 749-57, 2015 Mar 14.
Artigo em Inglês | MEDLINE | ID: mdl-25716060

RESUMO

Consumption of flaxseed lignans is associated with various health benefits; however, little is known about the bioavailability of purified lignans in flaxseed. Data on their bioavailability and hence pharmacokinetics (PK) are necessary to better understand their role in putative health benefits. In the present study, we conducted a comparative PK analysis of the principal lignan of flaxseed, secoisolariciresinol diglucoside (SDG), and its primary metabolites, secoisolariciresinol (SECO), enterodiol (ED) and enterolactone (EL) in rats. Purified lignans were intravenously or orally administered to each male Wistar rat. SDG and its primary metabolites SECO, ED and EL were administered orally at doses of 40, 40, 10 and 10 mg/kg, respectively, and intravenously at doses of 20, 20, 5 and 1 mg/kg, respectively. Blood samples were collected at 0 (pre-dose), 5, 10, 15, 20, 30 and 45 min, and at 1, 2, 4, 6, 8, 12 and 24 h post-dosing, and serum samples were analysed. PK parameters and oral bioavailability of purified lignans were determined by non-compartmental methods. In general, administration of the flaxseed lignans SDG, SECO and ED demonstrated a high systemic clearance, a large volume of distribution and short half-lives, whereas administration of EL at the doses of 1 mg/kg (intravenously) and 10 mg/kg (orally administered) killed the rats within a few hours of dosing, precluding a PK analysis of this lignan. PK parameters of flaxseed lignans exhibited the following order: systemic clearance, SDG < SECO < ED; volume of distribution, SDG < SECO < ED; half-life, SDG < ED < SECO. The percentage of oral bioavailability was 0, 25 and < 1 % for SDG, SECO and ED, respectively.


Assuntos
Estrogênios/metabolismo , Linho/química , Lignanas/metabolismo , Fitoestrógenos/metabolismo , Sementes/química , 4-Butirolactona/administração & dosagem , 4-Butirolactona/efeitos adversos , 4-Butirolactona/análogos & derivados , 4-Butirolactona/metabolismo , 4-Butirolactona/farmacocinética , Administração Oral , Animais , Disponibilidade Biológica , Butileno Glicóis/administração & dosagem , Butileno Glicóis/efeitos adversos , Butileno Glicóis/metabolismo , Butileno Glicóis/farmacocinética , Suplementos Nutricionais/efeitos adversos , Relação Dose-Resposta a Droga , Estrogênios/administração & dosagem , Estrogênios/efeitos adversos , Estrogênios/farmacocinética , Glucosídeos/administração & dosagem , Glucosídeos/efeitos adversos , Glucosídeos/metabolismo , Glucosídeos/farmacocinética , Meia-Vida , Injeções Intravenosas , Absorção Intestinal , Cinética , Lignanas/administração & dosagem , Lignanas/efeitos adversos , Lignanas/farmacocinética , Masculino , Taxa de Depuração Metabólica , Fitoestrógenos/administração & dosagem , Fitoestrógenos/efeitos adversos , Fitoestrógenos/farmacocinética , Distribuição Aleatória , Ratos Wistar
8.
J Vet Intern Med ; 27(1): 126-33, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-23205923

RESUMO

BACKGROUND: Cisplatin combined with a nonselective cyclooxygenase (cox) inhibitor has potent antitumor activity against transitional cell carcinoma (TCC) in dogs, but this treatment is limited by renal toxicosis. Cox-2 is expressed in TCC, but only in limited sites within the kidney. A cox-2 inhibitor could enhance the antitumor activity of cisplatin with potentially fewer adverse effects on the kidney. HYPOTHESIS: Cisplatin/cox-2 inhibitor treatment will have greater antitumor activity but no more renal toxicosis than cisplatin alone in dogs with TCC. ANIMALS: Forty-four dogs with naturally occurring urinary bladder TCC. METHODS: Dogs were randomized to receive cisplatin (60 mg/m(2) IV q21d), firocoxib (5 mg/kg PO q24h), or the combination. Tumor measurements were determined before and at 6-week intervals during treatment. Renal function was monitored by serum creatinine concentration, iohexol clearance, and urine specific gravity. Toxicoses were graded according to Veterinary Co-Operative Oncology Group (VCOG) criteria. RESULTS: The remission rate with cisplatin/firocoxib (57%) was significantly (P = .021) higher than that with cisplatin alone (13%). Renal and gastrointestinal toxicoses were common in dogs receiving cisplatin, but there were no significant differences between dogs receiving cisplatin or cisplatin/firocoxib. Firocoxib alone induced partial remission or stable disease in 20 and 33% of dogs, respectively. CONCLUSIONS: Firocoxib significantly enhanced the antitumor activity of cisplatin resulting in partial remission in more than half of the cases. The toxicoses inherent to cisplatin, however, were noted in dogs receiving this combination. Firocoxib had antitumor effects as a single agent and can be considered a palliative treatment for dogs with TCC.


Assuntos
4-Butirolactona/análogos & derivados , Antineoplásicos/uso terapêutico , Carcinoma de Células de Transição/veterinária , Cisplatino/uso terapêutico , Doenças do Cão/tratamento farmacológico , Sulfonas/uso terapêutico , Neoplasias da Bexiga Urinária/veterinária , 4-Butirolactona/administração & dosagem , 4-Butirolactona/efeitos adversos , 4-Butirolactona/uso terapêutico , Animais , Antineoplásicos/administração & dosagem , Antineoplásicos/efeitos adversos , Carcinoma de Células de Transição/tratamento farmacológico , Cisplatino/administração & dosagem , Cisplatino/efeitos adversos , Doenças do Cão/induzido quimicamente , Cães , Quimioterapia Combinada , Feminino , Gastroenteropatias/induzido quimicamente , Gastroenteropatias/veterinária , Masculino , Qualidade de Vida , Sulfonas/administração & dosagem , Sulfonas/efeitos adversos , Neoplasias da Bexiga Urinária/tratamento farmacológico
10.
J Vet Pharmacol Ther ; 30(3): 218-23, 2007 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-17472653

RESUMO

This study evaluated the adverse effects of oral firocoxib in dogs. Six dogs (20.2+/-6.3 kg) were studied. Values for complete blood count (CBC), serum urea, creatinine, alanine transaminase, alanine phosphatase, gamma-glutamyl transferase, occult blood in feces, platelet aggregation, and buccal mucosal bleeding time were measured before and 7, 14, 21, and 29 days after SID treatment with firocoxib 5.3+/-0.34 mg/kg (FG) or lactose 1 mg/kg (LG) for 28 days, in a randomized crossover study. Gastrointestinal (GI) tract endoscopy was performed before treatment began and at 29 days. Lesions were scored from grade 0 to 6. Data were analyzed using anova and paired t-tests (P<0.05). None of the dogs presented adverse clinical effects. There were no significant changes in CBC, biochemical profiles within groups, or differences between groups. Pretreatment mean+/-SD bleeding time (LG, 70.7+/-32.1 sec; FG, 75.8+/-38.1 sec) and platelet aggregation (LG, 86.4+/-10.2%; FG, 85.6+/-9.2%) were not significantly different from readings at 29 days (LG, 95.2+/-25 sec; FG, 91.7+/-24 sec and LG, 73.2+/-15.1%; FG, 84+/-10.3%) nor the groups were different. None of the dogs had positive fecal occult blood tests, and endoscopic lesion scores were grade 0 both before treatment and at 29 days. Administration of firocoxib did not cause any adverse effects on GI, or hematological or serum biochemical variables and appears to have been well tolerated by dogs.


Assuntos
4-Butirolactona/análogos & derivados , Inibidores de Ciclo-Oxigenase 2/farmacocinética , Doenças do Cão/induzido quimicamente , Cães/metabolismo , Hipersensibilidade a Drogas/veterinária , Sulfonas/farmacocinética , 4-Butirolactona/administração & dosagem , 4-Butirolactona/efeitos adversos , 4-Butirolactona/sangue , 4-Butirolactona/farmacocinética , Administração Oral , Animais , Análise Química do Sangue/veterinária , Estudos Cross-Over , Inibidores de Ciclo-Oxigenase 2/administração & dosagem , Inibidores de Ciclo-Oxigenase 2/efeitos adversos , Inibidores de Ciclo-Oxigenase 2/sangue , Hipersensibilidade a Drogas/etiologia , Endoscopia Gastrointestinal/veterinária , Feminino , Masculino , Sangue Oculto , Sulfonas/administração & dosagem , Sulfonas/efeitos adversos , Sulfonas/sangue
11.
Eur J Cancer Prev ; 15(3): 225-32, 2006 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-16679865

RESUMO

BACKGROUND: The scientific debate on the role of dietary phytoestrogens for prevention of breast cancer is still ongoing. We previously reported an inverse association between dietary phytoestrogen intake and premenopausal breast cancer risk and now examine the relationship with plasma phytoestrogen concentrations. METHODS: We measured enterolactone (mammalian lignan) and genistein (isoflavone) concentrations in plasma samples of 220 premenopausal cases and 237 age-matched controls from a population-based case-control study in Germany. RESULTS: Median plasma enterolactone concentrations in cases and controls were 6.3 and 9.7 nmol/l, respectively, and median genistein concentrations were 4.5 and 3.7 nmol/l, respectively. Premenopausal breast cancer risk decreased with increasing plasma enterolactone concentrations. Adjusted odds ratios (95% confidence intervals) were 0.42 (0.20-0.90) and 0.38 (0.17-0.85) (P for trend 0.007) for women in the third and fourth quartile of plasma enterolactone compared to those in the lowest quartile. There was no significant association between plasma genistein concentration and premenopausal breast cancer risk. CONCLUSION: Using biomarkers of phytoestrogen intake, we confirmed the strong inverse association between enterolactone and premenopausal breast cancer risk as found with dietary intake estimates. This result gives support to the potential role of mammalian lignans for breast cancer prevention among premenopausal women in Western populations.


Assuntos
4-Butirolactona/análogos & derivados , Neoplasias da Mama/epidemiologia , Genisteína/sangue , Lignanas/sangue , Pré-Menopausa/sangue , 4-Butirolactona/efeitos adversos , 4-Butirolactona/sangue , Adulto , Neoplasias da Mama/sangue , Estudos de Casos e Controles , Dieta/efeitos adversos , Feminino , Genisteína/efeitos adversos , Humanos , Lignanas/efeitos adversos , Pessoa de Meia-Idade , Fitoestrógenos/efeitos adversos , Fitoestrógenos/sangue , Preparações de Plantas/efeitos adversos , Fatores de Risco
12.
Clin Chim Acta ; 365(1-2): 58-67, 2006 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-16168401

RESUMO

Lignans are natural plant compounds with estrogenic properties and are probably the most important source of phytoestrogens in western diets. They have been suggested to have anticarcinogenic potential. For an evaluation of the effect of these compounds, namely enterolactone, on breast cancer risk, we have reviewed the literature available on major epidemiological studies. We analyzed methodological issues, the design and results of 3 studies providing data on enterolactone dietary intake, 3 studies on urinary excretion and 4 studies concerning blood measurements of enterolactone. All studies on dietary intake were retrospective and based on questionnaires. Two studies showed a significant inverse relationship between dietary lignans consumption and breast cancer incidence, specifically in premenopausal women. No effect was evident in the third study. Among the urinary enterolactone excretion studies, two studies (one retrospective, the other prospective) showed a definite protective effect. However, one retrospective study failed to show any significant interaction. Again, conflicting results were obtained from enterolactone blood measurement studies: two studies demonstrated a protective effect due to enterolactone in premenopausal women, while the other two studies failed to demonstrate any association. In summary, epidemiological evidence to date is conflicting. Prospective large scale studies will require assessing the consumption of antibiotics and dietary habits during adolescence in order to obtain definitive conclusions.


Assuntos
4-Butirolactona/análogos & derivados , Neoplasias da Mama/induzido quimicamente , Lignanas/efeitos adversos , 4-Butirolactona/efeitos adversos , Dieta , Humanos , Fatores de Risco
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