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Clin Infect Dis ; 2021 Jan 19.
Artigo em Inglês | MEDLINE | ID: mdl-33462580


BACKGROUND: Dengue is the most significant mosquito-borne viral disease; there are no specific therapeutics. The antiparasitic drug ivermectin efficiently inhibits the replication of all 4 dengue virus serotypes in vitro. METHODS: We conducted 2 consecutive randomized, double-blind, placebo-controlled trials in adult dengue patients to evaluate safety and virological and clinical efficacies of ivermectin. After a phase 2 trial with 2 or 3 days of 1 daily dose of 400 µg/kg ivermectin, we continued with a phase 3, placebo-controlled trial with 3 days of 400 µg/kg ivermectin. RESULTS: The phase 2 trial showed a trend in reduction of plasma nonstructural protein 1 (NS1) clearance time in the 3-day ivermectin group compared with placebo. Combining phase 2 and 3 trials, 203 patients were included in the intention to treat analysis (100 and 103 patients receiving ivermectin and placebo, respectively). Dengue hemorrhagic fever occurred in 24 (24.0%) of ivermectin-treated patients and 32 (31.1%) patients receiving placebo (P = .260). The median (95% confidence interval [CI]) clearance time of NS1 antigenemia was shorter in the ivermectin group (71.5 [95% CI 59.9-84.0] hours vs 95.8 [95% CI 83.9-120.0] hours, P = .014). At discharge, 72.0% and 47.6% of patients in the ivermectin and placebo groups, respectively had undetectable plasma NS1 (P = .001). There were no differences in the viremia clearance time and incidence of adverse events between the 2 groups. CONCLUSIONS: A 3-day 1 daily dose of 400 µg/kg oral ivermectin was safe and accelerated NS1 antigenemia clearance in dengue patients. However, clinical efficacy of ivermectin was not observed at this dosage regimen.

Blood Purif ; 38(3-4): 253-62, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-25573488


BACKGROUND/AIMS: We aimed to define the dosing and risk factors for death in patients undergoing twice-weekly hemodialysis. METHODS: A prospective multi-center cohort study was conducted with one-year observation. Patients treated with twice- or thrice-weekly hemodialysis were identified. Death and first admission were the outcomes. spKt/V was a factor of interest. RESULTS: We enrolled 504 twice-weekly and 169 thrice-weekly hemodialysis patients. The mean weekly values of spKt/V in the two groups were 3.4 and 5.1. The one-year survival rate and times to hospitalization were similar in both groups. The hazard ratios for death in higher spKt/V quartile was not associated with lower mortality, p = 0.70. The four significant predictors for death were serum albumin, HR = 2.6, current smoking, HR = 19.3, age, HR = 1.1, and the Index of Coexistent Disease [ICED], HR = 1.9. CONCLUSION: The effect of spKt/V on short-term mortality was not obvious in twice-weekly dialysis patients. Attention should be paid to patients who smoke, have hypoalbuminemia, are elderly, or have a high ICED.

Falência Renal Crônica/terapia , Diálise Renal/métodos , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Doenças Cardiovasculares/epidemiologia , Comorbidade , Complicações do Diabetes/epidemiologia , Feminino , Hepatite Viral Humana/epidemiologia , Hospitalização/estatística & dados numéricos , Humanos , Hipoalbuminemia/epidemiologia , Hipoalbuminemia/etiologia , Estimativa de Kaplan-Meier , Falência Renal Crônica/mortalidade , Masculino , Pessoa de Meia-Idade , Prognóstico , Modelos de Riscos Proporcionais , Estudos Prospectivos , Diálise Renal/efeitos adversos , Fatores de Risco , Albumina Sérica/análise , Fumar/efeitos adversos , Fumar/epidemiologia , Tailândia/epidemiologia , Adulto Jovem
Ren Fail ; 24(3): 297-305, 2002 May.
Artigo em Inglês | MEDLINE | ID: mdl-12166696


During a recent outbreak of leptospirosis in northeastern Thailand, 148 patients with serologically diagnosed leptospirosis were seen in Loei hospital. The common serotypes were L. pyrogenes, and L. sejroe. Hypotension with a mean arterial pressure less than 70 mmHg upon admission or within 24 h after admission was observed in 94 patients or 64%. 30 patients had normal renal function; 30 patients had prerenal azotemia with mild pulmonary complication in 2; and 34 patients had acute renal failure. 29 patients with acute renal failure had pulmonary complications including pulmonary hemorrhage in 8, pulmonary edema in 3, acute respiratory distress syndrome (ARDS) in 14 and interstitial pneumonitis in 4. 54 patients had normal blood pressure. In this group 5 patients had acute renal failure; 16 had prerenal azotemia and 33 had normal renal function. Interstitial pneumonitis was noted in one patient with prerenal azotemia. Less renal complication and minimal pulmonary complication were seen in leptospirosis patients with normal blood pressure. The patients with normal renal function had no pulmonary complication. Good association existed between hypotension, renal failure and pulmonary complications.

Lesão Renal Aguda/etiologia , Hipotensão/etiologia , Leptospirose/complicações , Pneumopatias/etiologia , Lesão Renal Aguda/mortalidade , Lesão Renal Aguda/fisiopatologia , Adolescente , Adulto , Idoso , Biomarcadores/sangue , Pressão Sanguínea/fisiologia , Nitrogênio da Ureia Sanguínea , Criança , Creatinina/sangue , Feminino , Humanos , Hiperbilirrubinemia/etiologia , Hiperbilirrubinemia/mortalidade , Hiperbilirrubinemia/fisiopatologia , Hipotensão/mortalidade , Hipotensão/fisiopatologia , Rim/irrigação sanguínea , Rim/metabolismo , Rim/fisiopatologia , Leptospirose/mortalidade , Leptospirose/fisiopatologia , Pneumopatias/mortalidade , Pneumopatias/fisiopatologia , Masculino , Pessoa de Meia-Idade , Índice de Gravidade de Doença , Análise de Sobrevida , Tailândia/epidemiologia , Resultado do Tratamento , Fator de Necrose Tumoral alfa/metabolismo , Uremia/etiologia , Uremia/mortalidade , Uremia/fisiopatologia
Artigo em Inglês | MEDLINE | ID: mdl-12118444


During an outbreak of leptospirosis in northeastern Thailand, 148 patients with serologically diagnosed leptospirosis were seen in Loei Hospital. The clinical features were consistent with those described for the classic manifestation of the disease. However, hypotension was a common finding: noted in 94 patients (64%) upon admission or early in the course of the disease. Of these hypotensive patients, 64 (68%) had impaired renal function: 30 patients (32%) had prerenal azotemia and 34 (36%) were in renal failure. Pulmonary complications, including pulmonary edema, hemorrhage, ARDS, and interstitial pneumonitis, occurred in 22% of patients and were often associated with renal failure. A clear association existed between hypotension and renal failure and pulmonary complications. The overall mortality rate was 3.4%. The causes of death were pulmonary complications, renal failure, and sepsis. The death rate among patients with complications was 11.6%. Blood exchange, in addition to conventional treatment, was beneficial in severe leptospirosis with complications and hyperbilirubinemia.

Hipotensão/etiologia , Leptospirose/epidemiologia , Adulto , Idoso , Bilirrubina/sangue , Surtos de Doenças , Humanos , Rim/fisiopatologia , Leptospirose/complicações , Leptospirose/tratamento farmacológico , Leptospirose/fisiopatologia , Pessoa de Meia-Idade , Tailândia/epidemiologia , Resultado do Tratamento