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1.
BMJ Open ; 12(5): e054434, 2022 05 24.
Artigo em Inglês | MEDLINE | ID: mdl-35613774

RESUMO

INTRODUCTION: Tanzania is adapting a shortened injectable-free multidrug resistant tuberculosis (MDR-TB) regimen, comprising new drugs such as bedaquiline and delamanid and repurposed drugs such as clofazimine and linezolid. The regimen is implemented using a pragmatic prospective cohort study within the National TB and Leprosy Programme and is accompanied by a process evaluation. The process evaluation aims to unpack the implementation processes, their outcomes and the moderating factors in order to understand the clinical effectiveness of the regimen. This protocol describes the methods employed in understanding the implementation processes of the new MDR-TB regimen in 15 regions of Tanzania. METHODS: This study adopts a concurrent mixed-methods design. Using multiple data collection tools, we capture information on: implementation outcomes, stakeholder response to the intervention and the influence of contextual factors. Data will be collected from the 22 health facilities categorised as dispensaries, health centres, district hospitals and referral hospitals. Health workers (n=132) and patients (n=220) will fill a structured questionnaire. For each category of health facility, we will conduct five focus group discussions and in-depth interviews (n=45) for health workers. Participant observations (n=9) and review documents (n=22) will be conducted using structured checklists. Data will be collected at two points over a period of 1 year. We will analyse quantitative data using descriptive and inferential statistical methods. Thematic analysis will be used for qualitative data. ETHICS AND DISSEMINATION: This study received ethical approval from National Institute of Medical research (NIMR), Ref. NIMR/HQ/R.8a/Vol.IX/3269 and from the Mbeya Medical Research and Ethics Review Committee, Ref. SZEC-2439/R.A/V.I/38. Our findings are expected to inform the wider implementation of the new MDR-TB regimen as it is rolled out countrywide. Dissemination of findings will be through publications, conferences, workshops and implementation manuals for scaling up MDR-TB treatments.


Assuntos
Antituberculosos , Tuberculose Resistente a Múltiplos Medicamentos , Antituberculosos/uso terapêutico , Protocolos Clínicos , Humanos , Estudos Prospectivos , Tanzânia , Tuberculose Resistente a Múltiplos Medicamentos/tratamento farmacológico
2.
s.l; s.n; 20200504. 5 p.
Não convencional em Inglês, Espanhol, Português | Sec. Est. Saúde SP, HANSEN, LILACS, Hanseníase, SESSP-ILSLACERVO, Sec. Est. Saúde SP | ID: biblio-1087671

RESUMO

Documento desenvolvido pela Sociedade Brasileira de Hansenologia com orientações às pessoas atingidas pela hanseníase sobre a prevenção e tratamento do Covid-19. O trabalho foi feito por um grupo de hansenologistas da Sociedade Brasileira de Hansenologia (SBH) em versões em português, espanhol e inglês e mostra como os médicos acreditam que a doença de Hansen e a COVID-19 podem interagir


Document developed by the Brazilian Society of Hansenology with guidance to people affected by leprosy on the prevention and treatment of Covid-19. The work was done by a group of Hansenologists from the Brazilian Society of Hansenology (SBH) in Portuguese, Spanish and English versions and shows how doctors believe that Hansen's disease and COVID-19 can interact


Documento desarrollado por la Sociedad Brasileña de Hansenología con orientación a las personas afectadas por la lepra sobre la prevención y el tratamiento de Covid-19. El trabajo fue realizado por un grupo de hansenólogos de la Sociedad Brasileña de Hansenología (SBH) en versiones en portugués, español e inglés y muestra cómo los médicos creen que la enfermedad de Hansen y COVID-19 pueden interactuar


Assuntos
Comorbidade , Controle de Doenças Transmissíveis , Protocolos Clínicos/normas , Infecções por Coronavirus/prevenção & controle , Hanseníase , Saúde Pública
3.
s.l; s.n; 20200409. 3 p.
Não convencional em Inglês, Francês | Sec. Est. Saúde SP, HANSEN, LILACS, Hanseníase, SESSP-ILSLACERVO, Sec. Est. Saúde SP | ID: biblio-1087665

RESUMO

The ILEP Technical Commission and the Global Leprosy Programme have issued the following advice on leprosy and COVID-19(AU)


La Commission Technique de l'ILEP et le Programme mondial de lutte contre la lèpre ont publié les conseils suivants sur la lèpre et COVID-19(AU)


Assuntos
Comorbidade , Controle de Doenças Transmissíveis , Protocolos Clínicos , Infecções por Coronavirus/prevenção & controle , Hanseníase , Saúde Pública/métodos
4.
BMC Infect Dis ; 20(1): 62, 2020 Jan 20.
Artigo em Inglês | MEDLINE | ID: mdl-31959113

RESUMO

BACKGROUND: To evaluate the effectiveness and safety of the World Health Organization antibiotic regimen for the treatment of paucibacillary (PB) and multibacillary (MB) leprosy compared to other available regimens. METHODS: We performed a search from 1982 to July 2018 without language restriction. We included randomized controlled trials, quasi-randomized trials, and comparative observational studies (cohorts and case-control studies) that enrolled patients of any age with PB or MB leprosy that were treated with any of the leprosy antibiotic regimens established by the WHO in 1982 and used any other antimicrobial regimen as a controller. Primary efficacy outcomes included: complete clinical cure, clinical improvement of the lesions, relapse rate, treatment failure. Data were pooled using a random effects model to estimate the treatment effects reported as relative risk (RR) with 95% confidence intervals (CI). RESULTS: We found 25 eligible studies, 11 evaluated patients with paucibacillary leprosy, while 13 evaluated patients with MB leprosy and 1 evaluated patients of both groups. Diverse regimen treatments and outcomes were studied. Complete cure at 6 months of multidrug therapy (MDT) in comparison to rifampin-ofloxacin-minocycline (ROM) found RR of 1.06 (95% CI 0.88-1.27) in five studies. Whereas six studies compare the same outcome at different follow up periods between 6 months and 5 years, according to the analysis ROM was not better than MDT (RR of 1.01 (95% CI 0.78-1.31)) in PB leprosy. CONCLUSION: Not better treatment than the implemented by the WHO was found. Diverse outcome and treatment regimens were studied, more statements to standardized the measurements of outcomes are needed.


Assuntos
Hansenostáticos/uso terapêutico , Hanseníase Multibacilar/tratamento farmacológico , Hanseníase Paucibacilar/tratamento farmacológico , Minociclina/uso terapêutico , Ofloxacino/uso terapêutico , Rifampina/uso terapêutico , Organização Mundial da Saúde , Adolescente , Adulto , Idoso , Criança , Protocolos Clínicos , Quimioterapia Combinada/efeitos adversos , Feminino , Humanos , Hansenostáticos/efeitos adversos , Masculino , Pessoa de Meia-Idade , Minociclina/efeitos adversos , Mycobacterium leprae/efeitos dos fármacos , Mycobacterium leprae/isolamento & purificação , Doenças Negligenciadas/tratamento farmacológico , Ofloxacino/efeitos adversos , Recidiva , Rifampina/efeitos adversos , Falha de Tratamento , Adulto Jovem
5.
Indian J Dermatol Venereol Leprol ; 84(5): 547-553, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30027912

RESUMO

BACKGROUND: Androgenetic alopecia is the commonest type of alopecia affecting over half of men and women. Low-level light therapy is a new technique for stimulating hair growth in both genders. AIMS: To overcome the shortcomings of previous epidemiological studies and a lack of controlled clinical trials on the subject, this study compared the effectiveness of adding low-level light therapy to minoxidil topical solution in the treatment of androgenetic alopecia in patients presenting to two skin clinics in Isfahan, Iran during 2014-2015. MATERIALS AND METHODS: This clinical trial included 50 patients aged 17-45 presenting to Khorshid and Alzahra educational centers and skin diseases research center for androgenetic alopecia during 2014-2015. The patients were randomly divided into a control and a case group. The case group received topical minoxidil 5% solution plus low-level light therapy twice per day. The control group was given the same topical solution and a laser comb system that was turned off to act as a placebo. Changes in patients' hair density and diameter and its overall regrowth as well as their satisfaction with the treatment were assessed at months 0 (baseline), 3, 6, 9 and 12. RESULTS: The percentage of recovery from androgenetic alopecia and the patients' satisfaction with their treatment were significantly higher in the case group compared to the control group. The patients' mean hair density and diameter were found to be higher in the case group after the intervention compared to the control group. LIMITATIONS: The study limitations included patient compliance, small sample size, patient insight due to novelty of the method and clinical judgement. CONCLUSION: As a new method of treatment, low-level light therapy can help improve the percentage of recovery from androgenetic alopecia and increase patients' satisfaction with their treatment.


Assuntos
Alopecia/tratamento farmacológico , Alopecia/radioterapia , Terapia com Luz de Baixa Intensidade/métodos , Minoxidil/administração & dosagem , Vasodilatadores/administração & dosagem , Adolescente , Adulto , Alopecia/diagnóstico , Protocolos Clínicos , Terapia Combinada/métodos , Método Duplo-Cego , Composição de Medicamentos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente , Resultado do Tratamento , Adulto Jovem
6.
J Foot Ankle Surg ; 56(4): 898-904, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28633800

RESUMO

Assessing ankle stability in nondisplaced Lauge-Hansen supination external rotation type II injuries requires stress imaging. Gravity stress mortise imaging is routinely used as an alternative to manual stress imaging to assess deltoid integrity with the goal of differentiating type II from type IV injuries in cases without a posterior or medial fracture. A type II injury with a nondisplaced fibula fracture is typically treated with cast immobilization, and a type IV injury is considered unstable and often requires operative repair. The present case series (two patients) highlights a standardized 2-view gravity stress imaging protocol and introduces the gravity stress cross-table lateral view. The gravity stress cross-table lateral view provides a more thorough evaluation of the posterior malleolus owing to the slight external rotation and posteriorly directed stress. External rotation also creates less bony overlap between the tibia and fibula, allowing for better visualization of the fibula fracture. Gravity stress imaging confirmed medial-sided injury in both cases, confirming the presence of supination external rotation type IV or bimalleolar equivalent fractures. Open reduction and internal fixation was performed, and both patients achieved radiographic union. No further treatment was required at 21 and 33 months postoperatively.


Assuntos
Fraturas do Tornozelo/diagnóstico por imagem , Adulto , Idoso , Fraturas do Tornozelo/cirurgia , Protocolos Clínicos , Feminino , Gravitação , Humanos , Amplitude de Movimento Articular , Rotação
7.
Lepr Rev ; 87(4): 553-61, 2016 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30226361

RESUMO

Objectives: An expert group of peripheral nerve surgeons, reconstructive surgeons, and immunologists who have extensive experience with Hansen's Disease convened to discuss the status of nerve decompression as a treatment for leprous neuropathy. The expert group recommended an international, multi-center randomised controlled trial (RCT). Subsequently, a study protocol called Decompression for Leprous Neuropathy (DELN) was designed and further refined by multiple investigators worldwide. The DELN Protocol: The DELN RCT seeks to determine the long-term effect of nerve decompression on sensibility, motor function, neuropathic pain, disability, and quality of life. The RCT would enroll patients with clinically diagnosed leprous neuropathy and positive Tinel signs in the upper and lower extremities. Patients would then be randomized to receive nerve decompression or not. Outcomes of interest include sensory function, motor function, pain, disability, and quality of life. The development of ulcers or amputations after surgery and the influence of corticosteroid therapy are also important outcomes that DELN seeks to determine. Conclusions: The study Decompression for Leprous Neuropathy (DELN) is an international, multi-center RCT with the potential to produce high quality data to address whether nerve decompression for leprous neuropathy can conclusively improve patient outcomes. We invite discussion from all those involved in the peripheral nerve and leprosy communities.


Assuntos
Hanseníase/complicações , Doenças do Sistema Nervoso Periférico/cirurgia , Ensaios Clínicos Controlados Aleatórios como Assunto , Protocolos Clínicos , Descompressão Cirúrgica , Humanos , Nervo Ulnar
8.
Trials ; 16: 175, 2015 Apr 18.
Artigo em Inglês | MEDLINE | ID: mdl-25927626

RESUMO

BACKGROUND: The optimal post-operative care regimen after surgically fixed Lauge Hansen supination exorotation injuries remains to be established. This study compares whether unprotected weight bearing as tolerated is superior to protected weight bearing and unprotected non-weight bearing in terms of functional outcome and safety. METHODS/DESIGN: The WOW! Study is a prospective multicenter clinical trial. Patients between 18 and 65 years of age with a Lauge Hansen supination exorotation type 2, 3 or 4 ankle fractures requiring surgical treatment are eligible for inclusion. An expert panel validates the classification and inclusion eligibility. After surgery, patients are randomized to either the 1) unprotected non-weight-bearing, 2) protected weight-bearing, or 3) unprotected weight-bearing group. The primary outcome measure is ankle-specific disability measured by the Olerud-Molander ankle score. Secondary outcomes are 1) quality of life (e.g., return to work and resumption of sport), 2) complications, 3) range of motion, 4) calf wasting, and 5) maximum pressure load after 3 months and 1 year. DISCUSSION: This trial is designed to compare the effectiveness and safety of unprotected weight bearing with two commonly used post-operative treatment regimens after internal fixation of specified, intrinsically stable but displaced ankle fractures. An expert panel has been established to evaluate every potential subject, which ensures that every patient is strictly screened according to the inclusion and exclusion criteria and that there is a clear indication for surgical fixation. TRIAL REGISTRATION: The WOW! Study is registered in the Dutch Trial Register ( NTR3727 ). Date of registration: 28-11-2012.


Assuntos
Fraturas do Tornozelo/cirurgia , Articulação do Tornozelo/cirurgia , Moldes Cirúrgicos , Muletas , Fixação Interna de Fraturas , Modalidades de Fisioterapia , Cuidados Pós-Operatórios , Adolescente , Adulto , Idoso , Fraturas do Tornozelo/diagnóstico , Fraturas do Tornozelo/fisiopatologia , Articulação do Tornozelo/fisiopatologia , Fenômenos Biomecânicos , Protocolos Clínicos , Terapia Combinada , Avaliação da Deficiência , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Países Baixos , Cuidados Pós-Operatórios/instrumentação , Cuidados Pós-Operatórios/métodos , Estudos Prospectivos , Qualidade de Vida , Amplitude de Movimento Articular , Recuperação de Função Fisiológica , Projetos de Pesquisa , Retorno ao Trabalho , Fatores de Tempo , Resultado do Tratamento , Suporte de Carga , Adulto Jovem
11.
13.
BMC Neurol ; 12: 159, 2012 Dec 18.
Artigo em Inglês | MEDLINE | ID: mdl-23249098

RESUMO

BACKGROUND: Nerve damage in leprosy often causes disabilities and deformities. Prednisolone is used to treat nerve function impairment (NFI). However, optimal dose and duration of prednisolone treatment has not been established yet. Besides treating existing NFI it would be desirable to prevent NFI. Studies show that before NFI is clinically detectable, nerves often show subclinical damage. Within the 'Treatment of Early Neuropathy in LEProsy' (TENLEP) study two double blind randomized controlled trials (RCT) will be carried out: a trial to establish whether prednisolone treatment of 32 weeks duration is more effective than 20 weeks in restoring nerve function in leprosy patients with clinical NFI (Clinical trial) and a trial to determine whether prednisolone treatment of early sub-clinical NFI can prevent clinical NFI (Subclinical trial). METHODS: Two RCTs with a follow up of 18 months will be conducted in six centers in Asia. In the Clinical trial leprosy patients with recent (< 6 months) clinical NFI, as determined by Monofilament Test and Voluntary Muscle Test, are included. The primary outcomes are the proportion of patients with restored or improved nerve function. In the Subclinical trial leprosy patients with subclinical neuropathy, as determined by Nerve Conduction Studies (NCS) and/or Warm Detection Threshold (WDT), and without any clinical signs of NFI are randomly allocated to a placebo group or treatment group receiving 20 weeks prednisolone. The primary outcome is the proportion of patients developing clinical NFI. Reliability and normative studies are carried out before the start of the trial. DISCUSSION: This study is the first RCT testing a prednisolone regimen with a duration longer than 24 weeks. Also it is the first RCT assessing the effect of prednisolone in the prevention of clinical NFI in patients with established subclinical neuropathy. The TENLEP study will add to the current understanding of neuropathy due to leprosy and provide insight in the effectiveness of prednisolone on the prevention and recovery of NFI in leprosy patients. In this paper we present the research protocols for both Clinical and Subclinical trials and discuss the possible findings and implications. TRIAL REGISTRATION: Netherlands Trial Register: NTR2300 Clinical Trial Registry India: CTRI/2011/09/002022.


Assuntos
Glucocorticoides/uso terapêutico , Hanseníase/tratamento farmacológico , Doenças do Sistema Nervoso Periférico/tratamento farmacológico , Prednisolona/uso terapêutico , Adolescente , Adulto , Protocolos Clínicos , Método Duplo-Cego , Esquema de Medicação , Feminino , Glucocorticoides/administração & dosagem , Humanos , Hanseníase/complicações , Masculino , Pessoa de Meia-Idade , Doenças do Sistema Nervoso Periférico/etiologia , Prednisolona/administração & dosagem , Resultado do Tratamento
14.
Mem. Inst. Oswaldo Cruz ; 107(supl.1): 22-27, Dec. 2012. graf, tab
Artigo em Inglês | LILACS | ID: lil-659736

RESUMO

Leprosy will continue to be a public health problem for several decades. The World Health Organization (WHO) recommends that, for treatment purposes, leprosy cases be classified as either paucibacillary or multibacillary (MB). A uniform leprosy treatment regimen would simplify treatment and halve the treatment duration for MB patients. The clinical trial for uniform multidrug therapy (U-MDT) for leprosy patients (LPs) in Brazil is a randomised, open-label clinical trial to evaluate if the effectiveness of U-MDT for leprosy equals the regular regimen, to determine the acceptability of the U-MDT regimen and to identify the prognostic factors. This paper details the clinical trial methodology and patient enrolment data. The study enrolled 858 patients at two centres and 78.4% of participants were classified as MB according to the WHO criteria. The main difficulty in evaluating a new leprosy treatment regimen is that no reliable data are available for the current treatment regimen. Relapse, reaction and impaired nerve function rates have never been systematically determined, although reaction and impaired nerve function are the two major causes of nerve damage that lead to impairments and disabilities in LPs. Our study was designed to overcome the need for reliable data about the current treatment and to compare its efficacy with that of a uniform regimen.


Assuntos
Adolescente , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Protocolos Clínicos , Hansenostáticos/administração & dosagem , Hanseníase Multibacilar/tratamento farmacológico , Hanseníase Paucibacilar/tratamento farmacológico , Brasil , Quimioterapia Combinada/métodos , Resultado do Tratamento
15.
Mem Inst Oswaldo Cruz ; 107 Suppl 1: 22-7, 2012 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-23283449

RESUMO

Leprosy will continue to be a public health problem for several decades. The World Health Organization (WHO) recommends that, for treatment purposes, leprosy cases be classified as either paucibacillary or multibacillary (MB). A uniform leprosy treatment regimen would simplify treatment and halve the treatment duration for MB patients. The clinical trial for uniform multidrug therapy (U-MDT) for leprosy patients (LPs) in Brazil is a randomised, open-label clinical trial to evaluate if the effectiveness of U-MDT for leprosy equals the regular regimen, to determine the acceptability of the U-MDT regimen and to identify the prognostic factors. This paper details the clinical trial methodology and patient enrolment data. The study enrolled 858 patients at two centres and 78.4% of participants were classified as MB according to the WHO criteria. The main difficulty in evaluating a new leprosy treatment regimen is that no reliable data are available for the current treatment regimen. Relapse, reaction and impaired nerve function rates have never been systematically determined, although reaction and impaired nerve function are the two major causes of nerve damage that lead to impairments and disabilities in LPs. Our study was designed to overcome the need for reliable data about the current treatment and to compare its efficacy with that of a uniform regimen.


Assuntos
Protocolos Clínicos , Hansenostáticos/administração & dosagem , Hanseníase Multibacilar/tratamento farmacológico , Hanseníase Paucibacilar/tratamento farmacológico , Adolescente , Adulto , Idoso , Brasil , Quimioterapia Combinada/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento , Adulto Jovem
16.
Artigo em Inglês | MEDLINE | ID: mdl-21079315

RESUMO

Hemangiomas are indolent birthmarks of vascular origin, which are known to appear soon after birth, proliferate for 8-18 months, and then slowly regress over the next 5-8 years, leaving behind normal or slightly blemished skin. In rare instances, hemangiomas may encroach upon and endanger vital structures with a mortality of up to 60%. Multiple therapeutic modalities are available for hemangiomas with variable results and associated with side effects. We report two cases of hemangioma, successfully treated with propranolol. Case 1 was a 5-month-old female child who presented with a giant segmental hemangioma since birth. She was unable to open her left eye over the past 7 days. Within 48 hours of administering full dose of oral propranolol (2 mg/kg/day), the lesion decreased considerably, and the patient was able to open her eye. Case 2 was a 1-year-old female child who presented with hemangioma over the danger area of face. Oral propranolol was given for a period of 6 months with monthly follow up. Both the cases showed dramatic response, with more than 80% regression, without any relapse after stopping the treatment.


Assuntos
Hemangioma/diagnóstico , Hemangioma/tratamento farmacológico , Propranolol/uso terapêutico , Protocolos Clínicos , Feminino , Humanos , Lactente
18.
Mem Inst Oswaldo Cruz ; 104(4): 549-54, 2009 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-19722074

RESUMO

Treatments for Chagas disease have been administered since the first attempts by Mayer & Rocha Lima (1912, 1914) and up to the drugs currently in use (nifurtimox and benznidazole), along with potential drugs such as allopurinol and first, second and third-generation antifungal agents (imidazoles and triazoles), in separate form. Several diseases such as tuberculosis, leprosy and AIDS only came under control after they were treated with associations of drugs with different mechanisms of action. This not only boosts the action of the different compounds, but also may avoid the development of parasite resistance .To this end, over the short term, we propose experimental studies on laboratory animals and clinical trials with the following associations: (i) nifurtimox (8 mg/kg/day) + benznidazole (5 mg/kg/day) x 60 consecutive days; (ii) nifurtimox (8 mg/kg/day) or benznidazole (5 mg/kg/day) + allopurinol (8-10 mg/kg/day) x 60 days and (iii) nifurtimox (8 mg/kg/day) or benznidazole (5 mg/kg/day) + ketoconazole, fluconazole or itraconazole (5-6 mg/kg/day) x 60 consecutive days. The doses of the drugs and the treatment schedules for the clinical trials must be adapted according to the side effects. From these, other double or triple associations could be made, using drugs with different mechanisms of action. This proposal does not exclude investigations on new drugs over the median and long terms, targeting other aspects of the metabolism of Trypanosoma cruzi. Until such time as the ideal drug for specific treatment of Chagas disease might be discovered, we need to develop new strategies for achieving greater efficacy with the old drugs in associations and to develop rational experimentation with new drugs.


Assuntos
Doença de Chagas/tratamento farmacológico , Tripanossomicidas/administração & dosagem , Animais , Protocolos Clínicos , Quimioterapia Combinada , Humanos , Tripanossomicidas/uso terapêutico
19.
Mem. Inst. Oswaldo Cruz ; 104(4): 549-554, July 2009.
Artigo em Inglês | LILACS | ID: lil-523717

RESUMO

Treatments for Chagas disease have been administered since the first attempts by Mayer & Rocha Lima (1912, 1914) and up to the drugs currently in use (nifurtimox and benznidazole), along with potential drugs such as allopurinol and first, second and third-generation antifungal agents (imidazoles and triazoles), in separate form. Several diseases such as tuberculosis, leprosy and AIDS only came under control after they were treated with associations of drugs with different mechanisms of action. This not only boosts the action of the different compounds, but also may avoid the development of parasite resistance .To this end, over the short term, we propose experimental studies on laboratory animals and clinical trials with the following associations: (i) nifurtimox (8 mg/kg/day) + benznidazole (5 mg/kg/day) x 60 consecutive days; (ii) nifurtimox (8 mg/kg/day) or benznidazole (5 mg/kg/day) + allopurinol (8-10 mg/kg/day) x 60 days and (iii) nifurtimox (8 mg/kg/day) or benznidazole (5 mg/kg/day) + ketoconazole, fluconazole or itraconazole (5-6 mg/kg/day) x 60 consecutive days. The doses of the drugs and the treatment schedules for the clinical trials must be adapted according to the side effects. From these, other double or triple associations could be made, using drugs with different mechanisms of action. This proposal does not exclude investigations on new drugs over the median and long terms, targeting other aspects of the metabolism of Trypanosoma cruzi. Until such time as the ideal drug for specific treatment of Chagas disease might be discovered, we need to develop new strategies for achieving greater efficacy with the old drugs in associations and to develop rational experimentation with new drugs.


Assuntos
Animais , Humanos , Doença de Chagas/tratamento farmacológico , Tripanossomicidas/administração & dosagem , Protocolos Clínicos , Quimioterapia Combinada , Tripanossomicidas/uso terapêutico
20.
Int J Tuberc Lung Dis ; 13(2): 153-64, 2009 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-19146741

RESUMO

This paper summarises tuberculosis (TB) research over almost 30 years in Karonga District, northern Malawi, an area typical of much of rural Africa. The dominant factor has been the human immunodeficiency virus (HIV), which arrived in the district about 1980, leading to an increase in TB incidence to a peak of approximately 65 smear-positive pulmonary cases per 100000 population in 2000. Tuberculin surveys indicate annual risks of Mycobacterium tuberculosis infection of approximately 1%; thus, most of the population is uninfected and at risk of primary infection and disease. Molecular epidemiological studies demonstrate that about two thirds of TB arises from recent infection, but recognisable recent contact is responsible for only about 10% of disease. By 2001, 57% of TB was directly attributable to HIV, implying that it would have declined were it not for HIV. HIV infection increases the risk of TB most among young adults, and greatly increases the risk of recurrence from new infection after treatment. Mortality rates in the HIV-infected are high, but there is no association of HIV with drug resistance. Other risk factors with relatively smaller effects include age and sex, contact, several genetic polymorphisms and area. Neither one nor two doses of the bacille Calmette-Guérin (BCG) vaccine provides protection against adult pulmonary TB, despite protecting against leprosy. Skin test surveys, cohort studies and comparative immunological studies with the UK suggest that exposure to environmental mycobacteria provides some protection against TB and that BCG's failure is attributable partly to this widespread heterologous exposure masking effects of the vaccine. Drug resistance has remained constant (<10%) over more than 20 years. Immunotherapy with M. vaccae provided no benefits, but treatment of HIV-positive patients with cotrimoxazole reduced mortality. The Karonga programme illustrates the value of long-term population-based studies to investigate the natural history of TB and to influence TB control policy. Current studies focus on immunological markers of infection, disease and protection, and on elucidating the impact of antiretroviral treatment on TB incidence at population level.


Assuntos
Mycobacterium tuberculosis , Serviços Preventivos de Saúde/estatística & dados numéricos , Tuberculose Pulmonar/epidemiologia , Tuberculose Pulmonar/microbiologia , Antituberculosos/uso terapêutico , Vacina BCG , Protocolos Clínicos , Comorbidade , Quimioterapia Combinada , Predisposição Genética para Doença , Infecções por HIV/epidemiologia , Infecções por HIV/prevenção & controle , Humanos , Malaui/epidemiologia , Serviços Preventivos de Saúde/métodos , Ensaios Clínicos Controlados Aleatórios como Assunto , Fatores de Risco , Saúde da População Rural/estatística & dados numéricos , Serviços de Saúde Rural , Fatores Sexuais , Tuberculose Resistente a Múltiplos Medicamentos , Tuberculose Pulmonar/genética , Tuberculose Pulmonar/prevenção & controle , Vacinação
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