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Cardiol Rev ; 28(6): 332-334, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32773440


Severe acute respiratory coronavirus-2 (SARS-CoV-2) is responsible for one of the greatest public health challenges of our lifetime, the coronavirus disease 2019 (COVID-19) pandemic. Because of the complicated postinfection sequelae and grave consequences, the search for effective therapies has become a worldwide priority. The antiviral agent remdesivir has become a viable option and is now available in the United States for hospitalized patients through an emergency use authorization. This article describes remdesivir's historical background, pharmacology, key trials, adverse events, and issues regarding accessibility.

Monofosfato de Adenosina/análogos & derivados , Alanina/análogos & derivados , Betacoronavirus/efeitos dos fármacos , Infecções por Coronavirus/tratamento farmacológico , Pneumonia Viral/tratamento farmacológico , Monofosfato de Adenosina/farmacologia , Alanina/farmacologia , Antivirais/farmacologia , Infecções por Coronavirus/virologia , Humanos , Pandemias , Pneumonia Viral/virologia , Resultado do Tratamento
Cardiol Rev ; 28(4): 213-216, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32496364


When the coronavirus disease 2019 (COVID-19) wreaked an unprecedented havoc of an escalating number of deaths and hospitalization in the United States, clinicians were faced with a myriad of unanswered questions, one of the them being the implication of the renin-angiotensin-aldosterone system in patients with COVID-19. Animal data and human studies have shown that angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) increase the expression of ACE2. ACE2 is an enzyme found in the heart, kidney, gastrointestinal tract, and lung and is a coreceptor for severe acute respiratory syndrome-related coronavirus-2 (SARS-CoV2), the virus responsible for COVID-19. Therefore, one can speculate that discontinuing ACE inhibitor or ARB therapy may lead to decreased ACE2 expression, thereby attenuating the infectivity of SARS-CoV-2, and mitigating the disease progression of COVID-19. However, several studies have also shown that ACE2 exhibits reno- and cardioprotection and preserves lung function in acute respiratory distress syndrome, which would favor ACE inhibitor or ARB therapy. This article is to examine and summarize the 2 opposing viewpoints and provide guideline recommendations to support the use or discontinuation of ACE inhibitors and ARBs in patients with COVID-19.

Antagonistas de Receptores de Angiotensina/farmacologia , Inibidores da Enzima Conversora de Angiotensina/farmacologia , Betacoronavirus/efeitos dos fármacos , Infecções por Coronavirus/tratamento farmacológico , Pneumonia Viral/tratamento farmacológico , Guias de Prática Clínica como Assunto , Sistema Renina-Angiotensina/efeitos dos fármacos , Infecções por Coronavirus/virologia , Humanos , Pandemias , Pneumonia Viral/virologia
Cardiol Rev ; 22(1): 43-50, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-24304809


Obesity is a risk factor for a wide range of conditions, including cardiovascular disease. Although lifestyle modifications remain the cornerstone for the management of obesity, pharmacologic agents may be a helpful addition to patients who have comorbidities and do not respond adequately to diet and exercise. Lorcaserin and phentermine/topiramate ER are 2 long-awaited agents, approved in 2012 for obesity management, 13 years since orlistat received US Food and Drug Administration approval in 1999. Lorcaserin is a serotonin agonist, whereas phentermine/topiramate is a combination of a sympathomimetic agent and an antiepileptic drug; both these agents have been shown to reduce weight significantly and improve cardiovascular and metabolic parameters, such as blood pressure, lipids, and HbA1C. This article reviews the pharmacology and clinical efficacy and safety of each of these agents. The differences among the three available agents for long-term management of obesity will also be examined.

Fármacos Antiobesidade/uso terapêutico , Benzazepinas/uso terapêutico , Frutose/análogos & derivados , Obesidade/tratamento farmacológico , Fentermina/uso terapêutico , Anticonvulsivantes/uso terapêutico , Depressores do Apetite/uso terapêutico , Índice de Massa Corporal , Comorbidade , Aprovação de Drogas , Combinação de Medicamentos , Frutose/uso terapêutico , Humanos , Serotonina/metabolismo , Simpatomiméticos/uso terapêutico , Topiramato , Resultado do Tratamento , Estados Unidos , United States Food and Drug Administration
J Neurol Neurosurg Psychiatry ; 84(11): 1186-91, 2013 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-23595944


OBJECTIVES: To investigate the associations of serum lipid profile with disease progression in high-risk clinically isolated syndromes (CIS) after the first demyelinating event. METHODS: High density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C) and total cholesterol (TC) were obtained in pretreatment serum from 135 high risk patients with CIS (≥ 2 brain MRI lesions and ≥ 2 oligoclonal bands) enrolled in the Observational Study of Early Interferon ß-1a Treatment in High Risk Subjects after CIS study (SET study), which prospectively evaluated the effect of intramuscular interferon ß-1a treatment following the first demyelinating event. Thyroid stimulating hormone, free thyroxine, 25-hydroxy vitamin D3, active smoking status and body mass index were also obtained. Clinical and MRI assessments were obtained within 4 months of the initial demyelinating event and at 6, 12 and 24 months. RESULTS: The time to first relapse and number of relapses were not associated with any of the lipid profile variables. Higher LDL-C (p=0.006) and TC (p=0.001) levels were associated with increased cumulative number of new T2 lesions over 2 years. Higher free thyroxine levels were associated with lower cumulative number of contrast-enhancing lesions (p=0.008). Higher TC was associated as a trend with lower baseline whole brain volume (p=0.020). Higher high density lipoprotein was associated with higher deseasonalised 1,25-dihydroxy vitamin D3 (p=0.003) levels and a trend was found for deseasonalised 25-hydroxy vitamin D3 (p=0.014). CONCLUSIONS: In early multiple sclerosis, lipid profile variables particularly LDL-C and TC levels are associated with inflammatory MRI activity measures.

Adjuvantes Imunológicos/uso terapêutico , HDL-Colesterol/sangue , LDL-Colesterol/sangue , Colesterol/sangue , Doenças Desmielinizantes/tratamento farmacológico , Interferon beta/uso terapêutico , Esclerose Múltipla/tratamento farmacológico , Adulto , Índice de Massa Corporal , Encéfalo/efeitos dos fármacos , Encéfalo/patologia , Calcifediol/sangue , Estudos de Coortes , República Tcheca , Doenças Desmielinizantes/sangue , Intervenção Médica Precoce , Feminino , Humanos , Injeções Intramusculares , Interferon beta-1a , Estudos Longitudinais , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Esclerose Múltipla/sangue , Esclerose Múltipla/diagnóstico , Estudos Prospectivos , Fumar/efeitos adversos , Fumar/sangue , Tireotropina/sangue , Tiroxina/sangue , Adulto Jovem