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1.
Rev Soc Bras Med Trop ; 53: e20180463, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32049198

RESUMO

INTRODUCTION: The therapeutic efficacy of daily amphotericin B infusion is related to its maximum concentration in blood; however, trough levels may be useful in intermittent regimens of this antifungal drug. METHODS: : High performance liquid chromatography (HPLC) was used to determine the minimum concentration (Cmin) of amphotericin B in the serum of patients receiving deoxycholate (D-Amph) or liposomal amphotericin B (L-AmB) for the treatment of cryptococcal meningitis (n=28), histoplasmosis (n=8), paracoccidioidomycosis (n=1), and leishmaniasis (n=1). RESULTS: Daily use of D-Amph 30 to 50 mg or L-AmB 50 mg resulted in a similar Cmin, but a significant increase ocurred with L-AmB 100 mg/day. The geometric mean Cmin tended to decrease with a reduction in the dose and frequency of intermittent L-AmB infusions: 357 ng/mL (100 mg 4 to 5 times/week) > 263 ng/mL (50 mg 4 to 5 times/week) > 227 ng/mL (50 mg 1 to 3 times/week). The impact on Cmin was variable in patients whose dose or therapeutic scheme was changed, especially when administered the intermittent infusion of amphotericin B. The mean Cmin for each L-AmB schedule of intermittent therapy was equal or higher than the minimum inhibitory concentration of amphotericin B against Cryptococcus isolates from 10/12 patients. The Cmin of amphotericin B in patients with cryptococcal meningitis was comparable between those that survived or died. CONCLUSIONS: By evaluating the Cmin of amphotericin B, we demonstrated the therapeutic potential of its intermittent use including in the consolidation phase of neurocryptococcosis treatment, despite the great variability in serum levels among patients.


Assuntos
Anfotericina B/sangue , Antifúngicos/sangue , Ácido Desoxicólico/sangue , Anfotericina B/administração & dosagem , Anfotericina B/farmacocinética , Antifúngicos/administração & dosagem , Antifúngicos/farmacocinética , Cromatografia Líquida de Alta Pressão , Ácido Desoxicólico/administração & dosagem , Ácido Desoxicólico/farmacocinética , Histoplasmose/tratamento farmacológico , Humanos , Leishmaniose/tratamento farmacológico , Meningite Criptocócica/tratamento farmacológico , Paracoccidioidomicose/tratamento farmacológico
2.
J Drugs Dermatol ; 18(9): 870-877, 2019 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-31524342

RESUMO

BACKGROUND: ATX-101 (deoxycholic acid) causes adipocytolysis when injected into subcutaneous fat. OBJECTIVE: Evaluate the long-term safety and efficacy of ATX-101 for submental fat (SMF) reduction. METHODS: Adults (N=165) with moderate-to-extreme SMF received ≤6 treatments of open-label ATX-101 (2 mg/cm2) and were evaluated up to 12 months after last treatment. Efficacy end points included improvements in SMF based on clinician or subject assessment, patient-reported outcomes, downtime (via subject questionnaire), and skin laxity. Safety was evaluated throughout the study. RESULTS: Twelve weeks after last treatment, most subjects achieved a ≥1-grade improvement in SMF based on clinician (86.8%) or subject (83.8%) evaluation; at 12 months, 90.4% and 80.7% of these responders, respectively, maintained the response. Overall, 84.9% of subjects were satisfied with the appearance of their face/chin. At 12 months, 82.9% of subjects had unchanged, and 10.1% had improved, skin laxity relative to 12 weeks after last treatment. Adverse events were mild to moderate and mainly involved the treatment area. During the 7 days after the first treatment, 13.3% of subjects missed work and 33.9% missed social/leisure activities. Following subsequent treatments, 2.4%­6.0% of subjects missed work and 10.0%­15.7% missed social/leisure activities. CONCLUSION: The safety and efficacy of ATX-101 were sustained over 12 months. ClinicalTrials.gov identifier, NCT01426373 J Drugs Dermatol. 2019;18(9):870-877.


Assuntos
Técnicas Cosméticas , Ácido Desoxicólico/administração & dosagem , Lipólise/efeitos dos fármacos , Gordura Subcutânea/efeitos dos fármacos , Adulto , Queixo , Feminino , Seguimentos , Humanos , Injeções Subcutâneas , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente , Gordura Subcutânea/metabolismo , Resultado do Tratamento
3.
J Drugs Dermatol ; 18(7): 675-680, 2019 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-31334926

RESUMO

Introduction: Injectable deoxycholic acid (DCA; Kybella; Allergan, Irvine, CA) is currently approved only for treatment of persistent submental fat (SMF). Many cosmetic surgeons use DCA off-label to treat fat tissue in other areas of the body. There is no review summarizing the off-label uses of injectable DCA. Methods: A systematic literature search was conducted through PubMed, Cochrane, CINAHL, and Web of Science databases using search terms "ATX-101 OR Kybella OR deoxycholic OR deoxycholate NOT amphotericin NOT bile" in accordance to PRISMA guidelines to identify off-label uses for injectable DCA or ATX-101. Results: Ten pertinent articles were identified for review. Anatomic areas treated include the face, brassiere line, foot, and gluteotrochanteric region. Indications include facial contouring, paradoxical adipose hyperplasia, HIV/HAART-associated buccal fat pad lipodystrophy, and reduction of lipomatous tumors. DCA is efficacious at causing lipolysis and safe with minimal side effects. Most patients treated for cosmetic indications reported high patient satisfaction. Conclusion: Off-label use of injectable DCA demonstrate a similar safety profile, effectiveness, and overall patient satisfaction compared to FDA-approved use for persistent SMF. DCA appears to be a safe and efficacious alternative to surgical reduction of unwanted adipose tissue in non-submental areas. Larger-scale studies are warranted to explore further cosmetic and potential medical applications. J Drugs Dermatol. 2019;18(7):675-680.


Assuntos
Tecido Adiposo/efeitos dos fármacos , Técnicas Cosméticas/efeitos adversos , Ácido Desoxicólico/administração & dosagem , Uso Off-Label , Nádegas , Ácido Desoxicólico/efeitos adversos , Estética , Face , , Humanos , Injeções Subcutâneas/efeitos adversos , Lipólise/efeitos dos fármacos , Satisfação do Paciente , Resultado do Tratamento
4.
BMC Infect Dis ; 19(1): 558, 2019 Jun 26.
Artigo em Inglês | MEDLINE | ID: mdl-31242860

RESUMO

BACKGROUND: Amphotericin-induced phlebitis is a common infusion-related reaction in patients managed for cryptococcal meningitis. High-quality nursing care is critical component to successful cryptococcosis treatment. We highlight the magnitude and main approaches in the management of amphotericin-induced phlebitis and the challenges faced in resource-limited settings. METHODS: We prospectively determined the incidence of amphotericin-induced phlebitis during clinical trials in Kampala, Uganda from 2013 to 2018. We relate practical strategies and challenges faced in clinical management of phlebitis. RESULTS: Overall, 696 participants were diagnosed with HIV-related cryptococcal meningitis. Participants received 7-14 doses of intravenous (IV) amphotericin B deoxycholate 0.7-1.0 mg/kg/day for induction therapy through peripheral IV lines at a concentration of 0.1 mg/mL in 5% dextrose. Overall, 18% (125/696) developed amphotericin-induced phlebitis. We used four strategies to minimize/prevent the occurrence of phlebitis. First, after every dose of amphotericin, we gave one liter of intravenous normal saline. Second, we rotated IV catheters every three days. Third, we infused IV amphotericin over 4 h. Finally, early ambulation was encouraged to minimize phlebitis. To alleviate phlebitis symptoms, warm compresses were used. In severe cases, treatment included topical diclofenac gel and oral anti-inflammatory medicines. Antibiotics were used only when definite signs of infection developed. Patient/caregivers' education was vital in implementing these management strategies. Major challenges included implementing these interventions in participants with altered mental status and limited access to topical and oral anti-inflammatory medicines in resource-limited settings. CONCLUSIONS: Amphotericin-induced phlebitis is common with amphotericin, yet phlebitis is a preventable complication even in resource-limited settings. TRIAL REGISTRATION: The ASTRO-CM trial was registered prospectively. ClincalTrials.gov : NCT01802385 ; Registration date: March 1, 2013; Last verified: February 14, 2018.


Assuntos
Anfotericina B/efeitos adversos , Infecções por HIV/tratamento farmacológico , Meningite Criptocócica/tratamento farmacológico , Flebite/induzido quimicamente , Flebite/terapia , Infecções Oportunistas Relacionadas com a AIDS/tratamento farmacológico , Infecções Oportunistas Relacionadas com a AIDS/epidemiologia , Adulto , Anfotericina B/administração & dosagem , Antifúngicos/administração & dosagem , Antifúngicos/efeitos adversos , Ácido Desoxicólico/administração & dosagem , Ácido Desoxicólico/efeitos adversos , Combinação de Medicamentos , Feminino , Infecções por HIV/complicações , Infecções por HIV/epidemiologia , Recursos em Saúde/economia , Humanos , Incidência , Infusões Intravenosas , Masculino , Meningite Criptocócica/complicações , Meningite Criptocócica/epidemiologia , Flebite/epidemiologia , Áreas de Pobreza , Uganda/epidemiologia
5.
Int J Pharm ; 565: 391-408, 2019 Jun 30.
Artigo em Inglês | MEDLINE | ID: mdl-31085260

RESUMO

Safe and efficient delivery of microRNA (miRNA) molecules is essential for their successful transition from research to the clinic setting. In the present study, we have used a bile acid, deoxycholic acid (DA), to modify 1.8 kDa branched polyethylenimine (bPEI1.8) and subsequently investigated gene delivery features of the resultant conjugates (PEI-DAn). We found significant differences between the PEI-DAn conjugates and conventional bPEIs with respect to miRNA condensation ability, buffering capacity, cellular uptake, and intracellular gene release behavior in endothelial cells (ECs) isolated from human umbilical vein (HUVECs). Changes in the conjugation degree greatly influenced the transfection performance of the PEI-DAn conjugates with respect to miRNA condensation and decondensation properties as well as cellular uptake behavior. The PEI-DA3 conjugates could significantly enhance the expression level of miRNA-210 in HUVECs. The overexpressed miRNA-210, in turn, markedly downregulated the expression levels of Efna3 and Ptp1b as well as led to a substantial rise in HUVECs' migration rate in a wound healing assay. Collectively, our results have demonstrated that PEI-DA3 conjugates facilitate the formation of stable nanocomplexes that are loose enough to release miRNAs into the cytosol. The free bioavailable miRNAs, in turn, result in efficient gene silencing comparable to bPEI25 as well as Lipofectamine RNAiMAX.


Assuntos
Ácido Desoxicólico/administração & dosagem , MicroRNAs/administração & dosagem , Polietilenoimina/administração & dosagem , Células Cultivadas , Ácido Desoxicólico/química , Efrina-A3/genética , Inativação Gênica , Células Endoteliais da Veia Umbilical Humana/metabolismo , Humanos , MicroRNAs/química , Polietilenoimina/química , Proteína Tirosina Fosfatase não Receptora Tipo 1/genética , Transfecção , Cicatrização
6.
Dermatol Surg ; 45(12): 1531-1541, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-30998531

RESUMO

BACKGROUND: ATX-101 (deoxycholic acid injection) is approved for reduction of moderate or severe submental fat (SMF). OBJECTIVE: To evaluate the efficacy and safety of ATX-101 in subjects with mild or extreme SMF. PATIENTS AND METHODS: Adults with mild or extreme SMF (based on clinician assessment) were randomized to receive ≤6 treatments with ATX-101 or placebo. Efficacy end points, evaluated at 12 weeks after last treatment, included percentage of subjects who achieved ≥1-grade improvement in SMF from baseline based on both clinician and patient assessment (composite CR-1/PR-1 response) as well as multiple subject-reported outcomes. Safety end points included change in skin laxity and incidence of adverse events. RESULTS: Overall, 61.3% of ATX-101-treated subjects versus 6.7% of placebo-treated subjects with mild SMF and 89.3% versus 13.3% of subjects, respectively, with extreme SMF achieved a composite CR-1/PR-1 response (p < .001 for both). ATX-101-treated subjects also reported higher levels of satisfaction and greater reductions in the psychological impact of SMF versus placebo-treated subjects regardless of baseline SMF severity. Skin laxity was unchanged or improved in most of the subjects. Adverse events were mainly mild/moderate, transient, and associated with the injection site. CONCLUSION: ATX-101 was efficacious and well tolerated for reduction of mild or extreme SMF.


Assuntos
Ácido Desoxicólico/administração & dosagem , Satisfação do Paciente , Ritidoplastia/métodos , Gordura Subcutânea/diagnóstico por imagem , Adolescente , Adulto , Idoso , Queixo , Ácido Desoxicólico/efeitos adversos , Método Duplo-Cego , Estética , Feminino , Humanos , Injeções Subcutâneas/efeitos adversos , Lipólise/efeitos dos fármacos , Masculino , Pessoa de Meia-Idade , Placebos/administração & dosagem , Placebos/efeitos adversos , Resultado do Tratamento , Adulto Jovem
8.
Molecules ; 24(6)2019 Mar 26.
Artigo em Inglês | MEDLINE | ID: mdl-30917485

RESUMO

Camptothecin (CPT) shows potent anticancer activity through inhibition of topoisomerase I. However, its water insolubility and severe toxicity limit its clinical application. Coupling with bile acid moieties is a promising method for liver-targeted drug delivery, which takes advantage of the bile acid receptors on hepatocytes. In this study, we evaluated the potential liver targeting and stability of a deoxycholic acid-CPT conjugate (G2). The competitive inhibition of antitumor activity experiment based on bile acid transporters was performed using the MTT method. The effects of deoxycholic acid on uptake of G2 and CPT were assessed in 2D and 3D HepG2 cell models. The stability of G2 and CPT was evaluated in vitro (in simulated gastric fluid, simulated intestinal fluid, and fresh rat plasma). Finally, biodistribution of G2 and CPT was investigated in Kunming mice following oral administration. The results showed that deoxycholic acid pretreatment could significantly reduce the antitumor activity and cellular uptake of G2 in HepG2 cells, but had no distinct effects on CPT. Meanwhile, G2 exhibited better stability compared with CPT. More importantly, biodistribution study in mice demonstrated that the liver targeting index of G2 increased 1.67-fold than that of CPT. Overall, the study suggests that conjugation with deoxycholic acid is a feasible method to achieve liver targeting delivery of CPT.


Assuntos
Antineoplásicos Fitogênicos/farmacocinética , Camptotecina/administração & dosagem , Ácido Desoxicólico/química , Fígado/química , Administração Oral , Animais , Camptotecina/química , Camptotecina/farmacocinética , Proliferação de Células/efeitos dos fármacos , Ácido Desoxicólico/administração & dosagem , Estabilidade de Medicamentos , Células Hep G2 , Humanos , Camundongos , Modelos Biológicos , Ratos , Solubilidade , Distribuição Tecidual
9.
J Drugs Dermatol ; 18(3): 266-272, 2019 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-30909331

RESUMO

Copy: The injectable adipocytolytic drug deoxycholic acid (DCA) is the first pharmacological intervention approved for the reduction of submental fat (SMF) and offers an alternative to invasive measures to improve the submental profile and the cervico-mental angle. DCA injection (ATX-101, Kybella [United States], Belkyra [Canada]; Kythera Biopharmaceuticals, Inc., Westlake Village, CA, acquired by Allergan, Inc.), are proprietary formulations of synthetically derived DCA that is FDA approved for improvement in the appearance of moderate to severe convexity or fullness associated with SMF. Aim: As none of the aforementioned are available in India, we undertook this study to study the efficacy of generic DCA for SMF reduction in Indian patients. Methods: 50 patients with confirmed Indian ethnicity and unwanted SMF were injected 3 mg/cm2 of generic DCA into their SMF, with a 12-week follow-up period. In each session, 5 ml of 30 mg /ml DCA was injected. The sessions were spaced approximately 2 months apart. All these patients with reductions in SMF were reported using Clinician Reported SMF Rating Scale (CR-SMFRS) and Patient Reported SMF Rating Scale (PR-SMFRS) using the Validated Rating Scale for improvement in the appearance of their chin, the neck, and the cervico-mental profile. Also, for objective assessment of improvement in SMF, caliper measurements were used. Results: One session was required in 2 patients, 12 patients needed 2 sessions, 32 patients needed 3 sessions, and 4 patients needed 4 sessions. Altogether, 90% patients showed at least a decrease of 1 point in (CR-SMFRS). Reduction in SMF as confirmed by caliper measurements was statistically significant. Conclusion: The findings show generic deoxycholic acid to be equally effective in the treatment for SMF in Indian patients. J Drugs Dermatol. 2019;18(3):266-272.


Assuntos
Técnicas Cosméticas , Ácido Desoxicólico/administração & dosagem , Lipólise/efeitos dos fármacos , Gordura Subcutânea/efeitos dos fármacos , Adulto , Queixo/anatomia & histologia , Grupo com Ancestrais do Continente Europeu , Feminino , Humanos , Índia , Injeções Subcutâneas , Masculino , Pessoa de Meia-Idade , Pescoço/anatomia & histologia , Estudos Prospectivos , Resultado do Tratamento , Adulto Jovem
10.
Dermatol Surg ; 45(10): 1285-1293, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-30789506

RESUMO

BACKGROUND: Deoxycholic acid (DCA; ATX-101) injection was approved for the treatment of mild-to-moderate convexity associated with submental fat in 2015. OBJECTIVE: To evaluate the experience with DCA injections in a clinical practice setting. MATERIALS AND METHODS: This ongoing, prospective, single-center, single-arm, observational study evaluated 100 consecutive patients treated with subcutaneous DCA (2 mg/cm) injections (maximum 6 sessions at ≥1-month intervals). Treatment response was assessed using the clinician-reported submental fat rating scale (CR-SMFRS) and confirmed by independent physician review of photographs at 1 and 5 to 7 weeks after treatment. RESULTS: Since the previous published report, 17 patients have undergone additional treatment sessions, with a total of 100 patients having undergone 195 treatment sessions: 41, 36, 14, 6, 2, and 1 patient underwent 1, 2, 3, 4, 5, and 6 sessions, respectively. Overall, 91.7% of patients in the single treatment session group and 100% in the multiple treatment session group had an improvement of ≥1 point on the CR-SMFRS. The mean (SD) duration of local edema, numbness, and tenderness after treatment was 7.1 (5.1), 27.9 (11.3), and 3.5 (3.5) days, respectively. CONCLUSION: Deoxycholic acid injections were generally well tolerated, and ≥2 treatment sessions were required to achieve the desired aesthetic goal in a private practice setting.


Assuntos
Colagogos e Coleréticos/administração & dosagem , Técnicas Cosméticas/efeitos adversos , Ácido Desoxicólico/administração & dosagem , Reação no Local da Injeção/epidemiologia , Gordura Subcutânea/efeitos dos fármacos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Queixo , Colagogos e Coleréticos/efeitos adversos , Ácido Desoxicólico/efeitos adversos , Edema/induzido quimicamente , Edema/epidemiologia , Estética , Feminino , Seguimentos , Humanos , Hipestesia/induzido quimicamente , Hipestesia/epidemiologia , Injeções Subcutâneas/efeitos adversos , Masculino , Pessoa de Meia-Idade , Pescoço , Estudos Prospectivos , Resultado do Tratamento , Adulto Jovem
13.
J Drugs Dermatol ; 18(1): 40-48, 2019 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-30681793

RESUMO

Perceptions of attractiveness can be negatively affected by submental fullness. Patients seeking to improve their submental contour have a variety of treatment options including surgical procedures, energy-based devices, and injectable treatment. The Condition of Submental Fullness and Treatment Outcomes Registry (CONTOUR) was designed to provide insights into the treatment of submental fat (SMF) in clinical practice. CONTOUR was a prospective observational study that enrolled 1029 adults at 91 sites in the United States and Canada. Patients were followed until treatment completion, discontinuation, or 1 year elapsed from enrollment without treatment. Final data from CONTOUR are reported here. Of the 676 patients who underwent treatment, 570 were treated with ATX-101 (deoxycholic acid injection), 77 with energy-based devices, 23 with surgical liposuction, 5 with laser liposuction, and 9 with other treatments. The majority of treated patients were facial aesthetic treatment naive. A markedly greater percentage of patients with mild or moderate SMF at baseline received treatment with ATX-101 or energy-based devices, whereas the majority of patients undergoing liposuction had severe or extreme SMF. Physicians most frequently cited a preference for a noninvasive/minimally invasive procedure as the reason for choosing either ATX-101 or energy-based devices. The majority of patients were at least partially satisfied with results, regardless of the chosen treatment. Data from CONTOUR indicate that cost is the most important factor in a patient's decision to undergo treatment, that choice of treatment method is most influenced by SMF severity and preference for nonsurgical versus surgical intervention, and that the availability of noninvasive/minimally invasive options has made SMF treatment an attractive first procedure for patients who have not undergone previous facial aesthetic treatments. ClinicalTrials.gov identifier: NCT02438813. J Drugs Dermatol. 2019;18(1):40-48.


Assuntos
Ácido Desoxicólico/administração & dosagem , Dermatoses Faciais/tratamento farmacológico , Adulto , Canadá , Técnicas Cosméticas , Dermatoses Faciais/cirurgia , Feminino , Humanos , Injeções Subcutâneas , Lipectomia , Masculino , Estudos Prospectivos , Sistema de Registros , Gordura Subcutânea/efeitos dos fármacos , Resultado do Tratamento , Estados Unidos
14.
J Cosmet Dermatol ; 18(4): 976-984, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30444074

RESUMO

INTRODUCTION: We propose a medical filler treatment algorithm of the profile which includes forehead, nose, and chin and to evaluate profilometric results and complications. MATERIALS AND METHODS: 83 case reviews of associated liquid forehead, nose, and chin plasty performed consecutively from 2014 to 2016. We monitored the horizontal and vertical sagittal stability into two age group: <40 y.o. and >40 y.o. using profilometric Arnett analysis measurements on the F, Gb, Na, Nd, Nt, Sn, ULA, LLA, B, Pg, and Gn soft-tissue points. RESULTS: The results at both 3 and 6 months were consistent with the normal ranges indicated by Arnett, with a 0.8 mm maximum of defect/excess. Forehead treatment was performed in 51 (61.4%) patient. Patients >40 y.o. always needed a global correction of the forehead profile. We performed nasal treatment in 83 (100%) patient, acute nasolabial angles was the more frequent nasal defect. The lips were injected in 59 patients (71.1) more frequently >40 y.o. In 83 (100%) patients we perform a chin augmentation. The average advancement of the chin was 3 mm. CONCLUSIONS: The correction of the projection of the forehead, of the profile and shape of the nose, of the lips and chin as well as an overall improvement in face aesthetics and harmony gives a good solution in patients avoiding the need for a surgical intervention, scars and cost of general anesthesia, thus providing the optimum in patient satisfaction.


Assuntos
Técnicas Cosméticas , Preenchedores Dérmicos/administração & dosagem , Estética , Face/anatomia & histologia , Adolescente , Adulto , Estudos de Coortes , Ácido Desoxicólico/administração & dosagem , Feminino , Humanos , Ácido Hialurônico/administração & dosagem , Injeções Subcutâneas , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente , Resultado do Tratamento , Adulto Jovem
17.
BMC Res Notes ; 11(1): 918, 2018 Dec 22.
Artigo em Inglês | MEDLINE | ID: mdl-30577877

RESUMO

OBJECTIVE: Based on studies in India (as there was no studies from outside India) amphotericin B deoxycholate has been considered as a backup drug for treatment of visceral leishmaniasis. However, treatment response and adverse effect to anti-leishmanial drugs may vary across different populations and in Bangladesh the effect to amphotericin B deoxycholate for treatment of visceral leishmaniasis is still unknown. Therefore, there is a need to explore cure rate and adverse effects to amphotericin B deoxycholate to justify its use on visceral leishmaniasis patients in Bangladesh. RESULT: Here we report 34 visceral leishmaniasis patients who received treatment with amphotericin B deoxycholate in the Surya Kanta Kala-azar Research Centre from December 2011 to June 2015. The dose of the treatment was 1 mg/kg body weight for 15 days followed up until 12 months after treatment. Response to amphotericin B deoxycholate treatment was excellent as all 34 patients achieved a final cure. Hypokalaemia (47%), shivering (47%), vomiting (35%) and acidity (15%) were most common adverse events. However, we did not observe any serious adverse events. Amphotericin B deoxycholate for relapse visceral leishmaniasis was found to be highly effective and safe. Our study justified to include amphotericin B deoxycholate as a second line drug for visceral leishmaniasis in Bangladesh.


Assuntos
Anfotericina B/farmacologia , Anti-Infecciosos/farmacologia , Ácido Desoxicólico/farmacologia , Leishmaniose Visceral/tratamento farmacológico , Adolescente , Adulto , Anfotericina B/administração & dosagem , Anfotericina B/efeitos adversos , Anti-Infecciosos/administração & dosagem , Anti-Infecciosos/efeitos adversos , Bangladesh , Criança , Estudos Transversais , Ácido Desoxicólico/administração & dosagem , Ácido Desoxicólico/efeitos adversos , Combinação de Medicamentos , Feminino , Humanos , Masculino , Recidiva , Resultado do Tratamento
18.
J Biol Regul Homeost Agents ; 32(5): 1279-1283, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30334426

RESUMO

Nonsurgical cosmetic facial procedures have gained popularity in recent decades. These procedures are commonly referred to as facial rejuvenation, and only a few are performed in the neck region. Herein, the authors describe their experience with off-label use of deoxycholic acid (DC) injections on 18 patients for remodeling of the neck and lower jaw. The injection protocol was personalized for each patient, and lidocaine was always premixed with the DC. After the initial injection visit, at least 3 months passed before further injections were considered. All documented side effects, including swelling and dysesthesia, resolved spontaneously. All patients received follow-up for at least 3 months, and only 2 patients required a second session of injections. By personalizing the injection protocol for each patient, good outcomes were achieved, including aesthetic enhancement of the shape and contour of the jaw and neck. Although the study is limited by the relatively small sample size, the results are promising and warrant additional investigations.


Assuntos
Técnicas Cosméticas , Ácido Desoxicólico/administração & dosagem , Ácido Desoxicólico/farmacologia , Arcada Osseodentária/efeitos dos fármacos , Pescoço , Rejuvenescimento , Ácido Desoxicólico/efeitos adversos , Seguimentos , Humanos , Injeções , Lidocaína/administração & dosagem , Lidocaína/farmacologia , Uso Off-Label
19.
Carbohydr Polym ; 198: 537-545, 2018 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-30093032

RESUMO

Ginsenoside compound K (CK) has been shown to exhibit anticancer properties. In this study, chitosan nanoparticles loaded with ginsenoside compound K (CK-NPs) were prepared as a delivery system using a self-assembly technique with amphipathic deoxycholic acid-O carboxymethyl chitosan as the carrier, which improved the water solubility of CK. By evaluating drug loading, entrapment efficiency, and in vitro release behavior, the feasibility of CK-NPs as a drug carrier nanoparticle for the treatment of human hepatic carcinoma cells (HepG2) was investigated. Result revealed that CK and CK-NPs showed a dose-dependent inhibitory effect on HepG2 cells with IC50 values of 23.33 and 16.58 µg/mL, respectively. Furthermore, fluorescence imaging demonstrated that CK-NPs promoted cellular uptake in vitro. Therefore, all results indicated that CK-NPs might be a novel drug delivery system to improve the solubility and enhance the cytotoxic and apoptotic potentials of CK for effective liver cancer chemotherapy.


Assuntos
Antineoplásicos/administração & dosagem , Quitosana/análogos & derivados , Ácido Desoxicólico/administração & dosagem , Portadores de Fármacos/administração & dosagem , Ginsenosídeos/administração & dosagem , Nanopartículas/administração & dosagem , Antineoplásicos/química , Apoptose/efeitos dos fármacos , Carcinoma Hepatocelular/tratamento farmacológico , Sobrevivência Celular/efeitos dos fármacos , Quitosana/administração & dosagem , Quitosana/química , Ácido Desoxicólico/química , Portadores de Fármacos/química , Liberação Controlada de Fármacos , Ginsenosídeos/química , Células Hep G2 , Humanos , Neoplasias Hepáticas/tratamento farmacológico , Nanopartículas/química
20.
Curr Med Res Opin ; 34(12): 2187-2195, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30022696

RESUMO

OBJECTIVES: Voriconazole, amphotericin B (AmB) formulations, and isavuconazole are all included in guideline recommendations for treatment of patients with invasive aspergillosis (IA) but the relative efficacy of isavuconazole versus AmB formulations has not been directly compared. We aimed to estimate the relative efficacy of isavuconazole compared with AmB deoxycholate (AmB-D), liposomal AmB (L-AmB), and voriconazole for the treatment of patients with proven/probable IA. METHODS: Nine literature databases were screened for randomized controlled trials comparing treatments with any of voriconazole, AmB-D, L-AmB and isavuconazole for treatment of proven/probable IA. Articles meeting the criteria were included in a meta-analysis to determine the efficacy of AmB-D, L-AmB and voriconazole relative to isavuconazole based on all-cause mortality (ACM) and overall response using a fixed-effects model. RESULTS: Four articles were identified that compared L-AmB with AmB-D (Study 1), standard-dose L-AmB (3-5 mg/kg/day) with high-dose L-AmB (10 mg/kg/day; Study 2), voriconazole with AmB-D (Study 3), and isavuconazole with voriconazole (Study 4). In the network meta-analysis, isavuconazole was statistically superior to AmB-D on both ACM (odds ratio [95% credible intervals] shown as natural log, 1.00 [0.26, 1.74]) and overall response (-1.39 [-2.21, -0.63]). Differences between isavuconazole, and standard-dose L-AmB, high-dose L-AmB and voriconazole were not statistically significant for either ACM (0.18 [-1.17, 1.53], 0.50 [-1.11, 2.13] and 0.32 [-0.19, 0.84], respectively) or overall response (-0.99 [-2.21, 0.29], -0.89 [-2.41, 0.65] and 0.06 [-0.43, 0.57], respectively). CONCLUSIONS: This data suggests that the efficacy of isavuconazole for treatment of IA is superior to AmB-D and comparable with both L-AmB and voriconazole.


Assuntos
Antifúngicos/uso terapêutico , Aspergilose/tratamento farmacológico , Nitrilos/administração & dosagem , Piridinas/administração & dosagem , Triazóis/administração & dosagem , Anfotericina B/administração & dosagem , Ácido Desoxicólico/administração & dosagem , Combinação de Medicamentos , Humanos , Metanálise em Rede , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento , Voriconazol/administração & dosagem
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