Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 2.421
Filtrar
2.
Medicine (Baltimore) ; 99(44): e23002, 2020 Oct 30.
Artigo em Inglês | MEDLINE | ID: mdl-33126381

RESUMO

BACKGROUND: Chronic renal failure (CRF) is a common kidney disease characterized by a slow and progressive decline in kidney function. Clinical practice suggests that traditional Chinese medicinal enemas have a therapeutic effect on CRF. To assess the therapeutic efficacy and safety of traditional Chinese medicinal enemas in treating CRF, we created a protocol for a systematic review to inform future clinical applications. METHODS: We completed a literature search of all clinical randomized controlled trials evaluating traditional Chinese medicinal enemas on CRF in the following five English and four Chinese databases completed before August 2020: Medline, EMBASE, Web of Science, Cochrane Central Register of Controlled Trials (CENTRAL), Cochrane Library database, Chinese National Knowledge Infrastructure (CNKI), WANFANE Database, Chinese Scientific and Technological Periodical Database (VIP) and Chinese Biomedical Database (CBM). The primary outcomes evaluated blood urea nitrogen levels, uric acid levels, endogenous creatinine clearance rate, and serum creatinine, and the secondary outcomes included clinical efficacy and adverse effects of treatment. Two independent researchers performed data extraction and quality assessment. RevMan5.3 software was used to assess data quality and bias. This protocol was conducted according to the Preferred Reporting Item for Systematic Review and Meta-analysis Protocol (PRISMA-P) statement. RESULTS: This study will provide a rational synthesis of current evidence for traditional Chinese medicinal enemas for the treatment of CRF. CONCLUSION: This study presents evidence on whether traditional Chinese medicinal enemas are an effective and safe intervention for CRF patients. REGISTRATION NUMBER: INPLASY202080052.


Assuntos
Medicamentos de Ervas Chinesas/uso terapêutico , Falência Renal Crônica/terapia , Administração Retal , Medicamentos de Ervas Chinesas/administração & dosagem , Humanos , Projetos de Pesquisa
3.
Medicine (Baltimore) ; 99(42): e22672, 2020 Oct 16.
Artigo em Inglês | MEDLINE | ID: mdl-33080710

RESUMO

BACKGROUND: 100 mg rectal nonsteroidal anti-inflammatory drugs (NSAIDs) and pancreatic stents both significantly reduce the incidence of post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis. Direct comparison of randomized controlled trials (RCTs) between them in high-risk patients is absent. We conducted this network meta-analysis to indirectly compare the efficacies of 100 mg rectal NSAIDs and pancreatic stents in preventing post-ERCP pancreatitis (PEP) in high-risk patients and help us decide which is preferred in clinical practice. METHODS: A comprehensive search was done to identify RCTs published in English full-text. Interventions included 100 mg rectal NSAIDs (diclofenac or indomethacin) and pancreatic stents. Only studies with high-risk patients of PEP were included. Meta-analyses of NSAIDs and pancreatic stents were conducted respectively. A network meta-analysis using the Bayesian method was performed. RESULTS: We included 14 RCTs, 8 on pancreatic stents and 6 on 100 mg rectal NSAIDs in high-risk patients. There was no direct comparison between them. After excluding an outlier study on NSAIDs (n = 144), meta-analyses showed they both significantly and statistically reduced the incidence of PEP in high-risk patients (pancreatic stents: n = 8 studies, random-effects risk ratio (RR)0.41, 95%CI 0.30-0.56, I = 0%; NSAIDs: n = 5 studies, random-effects RR 0.37, 95%CI 0.25-0.54, I = 0%). And network meta-analysis showed efficacy of 100 mg rectal NSAIDs was equal to pancreatic stents (random-effects RR 0.94, 95%CI 0.50-1.8). CONCLUSIONS: The efficacy of 100 mg rectal NSAIDs (diclofenac or indomethacin) seems equally significant to pancreatic stents in preventing PEP in high-risk patients. Considering the cost-effectiveness and safety, 100 mg diclofenac or indomethacin may be preferred.


Assuntos
Anti-Inflamatórios não Esteroides/uso terapêutico , Colangiopancreatografia Retrógrada Endoscópica , Pancreatite/prevenção & controle , Administração Retal , Anti-Inflamatórios não Esteroides/administração & dosagem , Humanos , Complicações Pós-Operatórias/prevenção & controle , Ensaios Clínicos Controlados Aleatórios como Assunto , Fatores de Risco , Stents
4.
Am J Vet Res ; 81(9): 739-746, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-33112166

RESUMO

OBJECTIVE: To determine the pharmacokinetics and efficacy of trazodone following rectal administration of a single dose to healthy dogs. ANIMALS: 6 healthy adult dogs. PROCEDURES: Each dog received a single dose of trazodone (approx 8 mg/kg) per rectum. Trazodone tablets were crushed into a powder, mixed with 5 mL of tap water, and injected into the rectum via a red rubber catheter. Sedation scores were assigned, and blood samples were collected for determination of plasma trazodone concentration at predetermined times before and after drug administration. Pharmacokinetic parameters were estimated by noncompartmental analysis. RESULTS: Plasma trazodone concentration remained below the detection limit for 1 dog even though it became moderately sedate. Median (interquartile [25th to 75th percentile] range [IQR]) maximum plasma trazodone concentration and volume of distribution and clearance corrected for bioavailability were 1.00 µg/mL (0.66 to 1.40 µg/mL), 10.3 L/kg (7.37 to 14.4 L/kg), and 639 mL/kg/h (594 to 719 mL/kg/h), respectively. Median time to maximum plasma trazodone concentration and elimination half-life were 15 minutes (range, 15 to 30 minutes) and 12 hours (IQR, 7.99 to 12.7 hours), respectively. All dogs became mildly or moderately sedate, and the extent of sedation was maximal at a median of 30 minutes (IQR, 30 to 60 minutes) after trazodone administration. No adverse effects were observed. CONCLUSIONS AND CLINICAL RELEVANCE: Rectal administration of trazodone may be a viable option for sedation and treatment of anxiety in dogs for which administration of sedatives and anxiolytics by other routes is contraindicated. Further research is necessary to better elucidate the pharmacokinetics and efficacy of trazodone following rectal administration and determine optimal dosing.


Assuntos
Ansiolíticos , Trazodona , Administração Oral , Administração Retal , Animais , Área Sob a Curva , Cães , Meia-Vida
5.
Niger J Clin Pract ; 23(9): 1183-1187, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32913154

RESUMO

Aims: This study compared the analgesic effect of apical peri-prostatic block with that of intra-rectal xylocaine gel for trans-rectal ultrasound guided prostate biopsy (TRUS-PBx) in Nigeria. Methods: This is a prospective randomized comparative study carried out over one year in University of Benin Teaching Hospital, Edo State, Nigeria. The participants were randomized into two groups; Group A had 10 mls of intra-rectal xylocaine gel instillation while Group B had apical infiltration of 10 mls of 1% xylocaine all before TRUS-PBx. Result: There was a statistically significant difference in the mean pain score during and one hour after TRUS-PBx between Group A and Group B of the study population respectively (p < 0.0001). Those that had intra-rectal xylocaine gel (Group A) had more pain during and after biopsy. There was no difference in the mean pain score during probe insertion between the two groups (p = 0.952). Conclusion: This study demonstrated the superiority of apical peri-prostatic nerve block over intra rectal xylocaine gel instillation during TRUS-PBx with respect to its anesthetic efficacy. Therefore, centers providing TRUS-PBx in Nigeria should consider apical peri-prostatic nerve block as their mode of anesthesia for the procedure due to its efficacy and high safety profile.


Assuntos
Biópsia por Agulha/métodos , Biópsia Guiada por Imagem/métodos , Lidocaína/administração & dosagem , Bloqueio Nervoso/métodos , Dor/prevenção & controle , Próstata/patologia , Neoplasias da Próstata/diagnóstico , Neoplasias da Próstata/patologia , Administração Retal , Idoso , Anestésicos Locais/administração & dosagem , Biópsia por Agulha/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , Nigéria , Dor/etiologia , Medição da Dor , Estudos Prospectivos , Próstata/diagnóstico por imagem , Próstata/inervação , Reto/patologia , Ultrassonografia de Intervenção
6.
Am J Gastroenterol ; 115(6): 934-940, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32496740

RESUMO

INTRODUCTION: The benefit of indomethacin suppositories for prophylaxis against post-ERCP pancreatitis (PEP) in high-risk patients was established in a landmark trial published in 2012. The aims of this study were to measure the adoption of indomethacin prophylaxis in widespread clinical practice, evaluate concurrent trends in pancreatic duct (PD) stent utilization, and estimate the impact of these changes on PEP in a high-risk population. METHODS: Data were extracted from a commercial database (Explorys, IBM Watson Health, Somers, NY) that aggregates electronic health records from 26 US healthcare systems from 2009 to 2018. Using Systematized Nomenclature of Medicine Clinical Terms, we identified a cohort of patients who underwent endoscopic retrograde cholangiopancreatography (ERCP) and were at high risk for PEP based on narrow criteria. PEP was defined as an emergency department or hospital admission 1-5 days after ERCP with an associated diagnosis of pancreatitis. RESULTS: Twenty six thousand eight hundred twenty ERCPs were performed on this high-risk cohort from 2009 to 2018. The overall PEP rate during the study period was 8.6%. There was no decrease in PEP rates from 2012 to 2018. Beginning in 2012, indomethacin usage increased linearly (P < 0.001), but remained below 50% in 2018. As indomethacin increased, utilization of PD stents declined abruptly from 2013 to 2014 (40.7%-8.5%) and trended to a nadir of 3.0%. DISCUSSION: Despite its low cost, widespread availability, and level I evidence of benefit in reducing the risk of PEP in high-risk patients, the adoption of rectal indomethacin during ERCP has been slow and the medication continues to be under-utilized. In parallel, the PD stent usage has declined dramatically. The lack of change in PEP rates during the study period could be attributable to the persistent low usage of rectal indomethacin or the decline in PD stent use. Further educational efforts and quality assurance measures are warranted to ensure that rectal indomethacin and PD stent placement are more appropriately used in clinical practice.


Assuntos
Anti-Inflamatórios não Esteroides/uso terapêutico , Colangiopancreatografia Retrógrada Endoscópica/métodos , Indometacina/uso terapêutico , Ductos Pancreáticos/cirurgia , Pancreatite/prevenção & controle , Complicações Pós-Operatórias/prevenção & controle , Padrões de Prática Médica/estatística & dados numéricos , Stents/estatística & dados numéricos , Administração Retal , Adolescente , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Risco , Adulto Jovem
7.
Vet J ; 259-260: 105459, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32553240

RESUMO

The purpose of the present study was to investigate if rectal administration of imepitoin in healthy dogs leads to plasma concentrations comparable to those after oral administration. Significantly lower systemic exposure and maximal plasma concentration (Cmax) of imepitoin was achieved after rectal compared to oral administration (P≤0.001). Therefore, this study does not support the rectal administration of imepitoin in dogs.


Assuntos
Anticonvulsivantes/farmacocinética , Cães/metabolismo , Imidazóis/farmacocinética , Administração Oral , Administração Retal , Animais , Anticonvulsivantes/administração & dosagem , Anticonvulsivantes/sangue , Doenças do Cão/tratamento farmacológico , Epilepsia/tratamento farmacológico , Epilepsia/veterinária , Imidazóis/administração & dosagem , Imidazóis/sangue
8.
Am J Med Sci ; 360(2): 112-119, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32534720

RESUMO

Diabetic foot ulcer (DFU) is one of the most common and severe complications of diabetes mellitus, which is becoming increasingly prevalent throughout the world, with high mortality and morbidity. Because of the complex pathophysiological processes involved, DFU is difficult to treat effectively with traditional therapies. Ozone therapy, an emerging method, has been reported as potentially beneficial for closure of DFUs and may gradually move to the forefront of clinical practice. Possible mechanisms of action include antioxidant capacity, pathogen inactivation, vascular and endogenous growth factor modulation, and immune system activation. However, some researchers are skeptical about its safety, and clinical trials are lacking. This article reviews the current research and application of ozone therapy for DFUs.


Assuntos
Antibacterianos/uso terapêutico , Pé Diabético/tratamento farmacológico , Fatores Imunológicos/uso terapêutico , Oxidantes Fotoquímicos/uso terapêutico , Ozônio/uso terapêutico , Administração Retal , Administração Tópica , Transfusão de Sangue Autóloga , Pé Diabético/imunologia , Pé Diabético/metabolismo , Hemorreologia , Humanos , Peróxido de Hidrogênio/metabolismo , Peptídeos e Proteínas de Sinalização Intercelular/metabolismo , Interferons/imunologia , Interleucina-2/imunologia , Fator 2 Relacionado a NF-E2/metabolismo , Estresse Oxidativo , Espécies Reativas de Oxigênio/metabolismo , Fator de Necrose Tumoral alfa/imunologia
10.
AAPS PharmSciTech ; 21(3): 97, 2020 Mar 03.
Artigo em Inglês | MEDLINE | ID: mdl-32128636

RESUMO

Budesonide is a glucocorticoid for the treatment of ulcerative colitis (UC). The current study aims to develop a thermosensitive in situ and adhesive gel for rectal delivery of budesonide. HPMC K4M was selected as the adhesive agent based on the adhesive force and the effect on gel performance. The formulation of gel was optimized by using the central composite design-response surface methodology (CCD-RSM); a mathematical model was successfully developed to predict desired formulations as well as to analyze relationships between the amount of Pluronic F-127, Pluronic F-68, and HPMC K4M and the performances of gel. Based on CCD-RSM, a thermosensitive in situ and adhesive gel consisting of 0.002% budesonide, 0.74% HPMC, 4.87% F-68, and 19.0% F-127 was developed. Furthermore, the in vivo behavior of gel was evaluated in Sprague-Dawley rats. In comparison with budesonide solution, rectal administration of budesonide gel at 0.1 mg/kg in rats showed relative bioavailability of 230% with significant increase in rectum uptake.


Assuntos
Adesivos/administração & dosagem , Anti-Inflamatórios/administração & dosagem , Budesonida/administração & dosagem , Sistemas de Liberação de Medicamentos/métodos , Adesivos/metabolismo , Administração Retal , Animais , Anti-Inflamatórios/metabolismo , Disponibilidade Biológica , Budesonida/metabolismo , Avaliação Pré-Clínica de Medicamentos/métodos , Feminino , Géis , Masculino , Poloxâmero/administração & dosagem , Poloxâmero/metabolismo , Ratos , Ratos Sprague-Dawley , Reto/efeitos dos fármacos , Reto/metabolismo
12.
Rev. esp. enferm. dig ; 112(3): 183-188, mar. 2020. tab, graf
Artigo em Inglês | IBECS | ID: ibc-195792

RESUMO

BACKGROUND AND AIMS: several studies have shown that rectal indomethacin decreases the risk of acute pancreatitis after endoscopic retrograde cholangiopancreatography (ERCP). However, in recent studies, its effectiveness is being questioned, especially in average risk patients. Our principal aim was to evaluate the efficacy of rectal indomethacin prophylaxis in the development of post-ERCP pancreatitis (PEP). METHODS: a retrospective cohort study was conducted at a third-level university hospital. Data was collected from every patients who underwent ERCP between January 2014 and June 2016. After February 2015, all patients received 100 mg of rectal indomethacin prior to ERCP. We analyzed groups, with indomethacin and without indomethacin, in unselected patients. RESULTS: a total of 524 patients were analyzed, with a mean age of 71.1 ± 17.0 (standard deviation [SD]) years. Of the total number of patients, 393 (75%) had an average risk; 277 received rectal indomethacin prior to ERCP, while 247 did not. In the group with indomethacin, 12 patients developed PEP (4.33%) versus ten in the indomethacin-free group (4.04%) (OR 1.33; 95% confidence interval [CI], 0.52-3.40; p = 0.56). Severe-moderate PEP developed in seven patients (2.52%) in the indomethacin group and in two patients (0.81%) in the indomethacin-free group (p = 0.24). Previous sphincterotomy was a protective factor (OR 0.02; 95% CI, 0.02-0.2; p = 0.001) and age < 45 years was a risk factor: (OR 3.43; 95% CI, 1.14-10.32; p = 0.03). CONCLUSIONS: rectal indomethacin does not appear to decrease the risk of developing PEP in unselected patients


No disponible


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Colangiopancreatografia Retrógrada Endoscópica/efeitos adversos , Colangiopancreatografia Retrógrada Endoscópica/métodos , Anti-Inflamatórios não Esteroides/administração & dosagem , Indometacina/administração & dosagem , Pancreatite/prevenção & controle , Estudos Retrospectivos , Administração Retal , Estudos de Coortes , Fatores de Risco
14.
Epilepsia ; 61(3): 455-464, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32065672

RESUMO

OBJECTIVE: The study assesses the bioavailability of diazepam after intranasal administration (diazepam nasal spray) in healthy volunteers. Comparative agents were diazepam rectal gel, which served as the regulatory reference product; and oral diazepam, a product with decades of clinical use. Tolerability of diazepam nasal spray was also assessed. METHODS: This was a phase 1, open-label, randomized, single-dose, three-treatment, three-period, six-sequence crossover study in 48 healthy adult subjects that consisted of a screening period, a baseline period, and an open-label treatment period. Interperiod intervals were at least 28 days. RESULTS: Forty-eight healthy volunteer subjects were enrolled, two of whom discontinued before receiving study medication. For all routes of administration, the onset of diazepam absorption was rapid, with measurable concentrations of drug present by the first sample time point. The tmax (time to reach maximum plasma concentration) was similar for diazepam nasal spray and diazepam rectal gel, both of which were slower than oral diazepam in fasted individuals. Variability (as defined by % coefficient of variation of geometric mean) in peak plasma concentration and area under the curve0-∞ was lowest with oral diazepam, followed by diazepam nasal spray, with diazepam rectal gel showing the greatest variability. Overall, 131 treatment-emergent adverse events (TEAEs) were considered mild (42 subjects, 91.3%), four TEAEs were considered moderate (four subjects, 8.3%), and no TEAEs were considered severe. The most commonly reported TEAE was somnolence at 56.5% (26/46) during diazepam nasal spray treatment, 89.1% (41/46) with the rectal diazepam gel treatment, and 82.6% (38/46) with oral diazepam treatment. No nasal irritation was observed for the majority of the subjects at any time point after administration, with no score higher than 2 ("minor bleeding that stops within 1 minute"). SIGNIFICANCE: Diazepam nasal spray shows predicable pharmacokinetics and represents a potential novel therapeutic approach to control bouts of increased seizure activity (cluster seizures, acute repetitive seizures).


Assuntos
Diazepam/administração & dosagem , Diazepam/farmacocinética , Administração Intranasal , Administração Oral , Administração Retal , Adolescente , Adulto , Disponibilidade Biológica , Feminino , Géis , Voluntários Saudáveis , Humanos , Masculino , Pessoa de Meia-Idade , Sprays Nasais , Sonolência , Adulto Jovem
15.
Arch Ital Urol Androl ; 91(4): 251-255, 2020 Jan 14.
Artigo em Inglês | MEDLINE | ID: mdl-31937091

RESUMO

OBJECTIVES: Chronic prostatitis syndrome is a bothering and poorly understood condition. Many patients report genitourinary pain and Lower Urinary Tract Symptoms as a main complaint. Many different pharmacological or behavioural therapies are prescribed in daily clinical practice, but efficacy data are still lacking. The aim of our study was to test the efficacy and safety of a transrectal delivered association of Boswellia resin extract and propolis derived polyphenols for the relief of prostatitis - like symptoms. MATERIALS AND METHODS: Patients affected by chronic/recurrent prostatitis - like symptoms were prospectively enrolled in our study from December, 2016 to December, 2018. Patients were screened at baseline through clinical examination and validated questionnaires administration: Chronic Prostatitis Symptom Index (CPSI), International Prostate Symptom Score (IPSS), International Index of Erectile Function (IIEF). Inclusion criteria were: age ≥ 18; prostatitis symptoms persisting for at least 3 of the last 6 months; CPSI pain domain score ≥ 5; previous negative Meares-Stamey test. Treatment consisted on the administration of 1 suppository containing Boswellia resin extract and propolis derived polyphenols, once a day for 20 days. The primary endpoint of the study was the improvement of quality of life after treatment, defined by a reduction of ≥ 2 points, or ≥ 25%, of mean CPSI pain domain score, compared to baseline. Secondary endpoints were the improvement of post-treatment CPSI total score and the analysis of treatment - related adverse events. All patients were re-evaluated 1 month after treatment. RESULTS: 40 patients were enrolled in our study. Median age (Inter - Quartile Range IQR) was 51.5 (41.5-63.2) years. Mean baseline CPSI scores were: 22.15 (total score), 9.67 (pain domain), 5.15 (micturition domain) and 7.35 (quality of life domain), respectively. No significant adverse events were reported. At 1 month follow-up, CPSI scores appeared modified as follows: 16.40 (total score, p = 0.001); 6.92 (pain domain; p = 0.001; 4.02 (micturition domain, p = 0.09); 5.45 (quality of life domain, p = 0.002). Mean CPSI pain domain score reduction was -2.75 points (-28.5%). Mean CPSI total score reduction was -5.75 points (-26%). CONCLUSIONS: The association of Boswellia resin extract and propolis derived polyphenols can reduce genitourinary pain and then improve quality of life of men affected by bothersome prostatitis - like symptoms.


Assuntos
Boswellia/química , Extratos Vegetais/administração & dosagem , Polifenóis/administração & dosagem , Própole/química , Prostatite/tratamento farmacológico , Administração Retal , Adulto , Doença Crônica , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Dor Pélvica/tratamento farmacológico , Dor Pélvica/etiologia , Projetos Piloto , Extratos Vegetais/efeitos adversos , Polifenóis/efeitos adversos , Polifenóis/isolamento & purificação , Estudos Prospectivos , Qualidade de Vida , Supositórios , Resultado do Tratamento
16.
Expert Opin Pharmacother ; 21(6): 645-651, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31990585

RESUMO

INTRODUCTION: Severe falciparum malaria stills accounts for around half a million childhood deaths per year in sub-Saharan Africa. Prompt treatment of sick children close to home starting with artesunate given rectally by appropriately trained people can be lifesaving. AREAS COVERED: Rectal artesunate (RAS) has been developed for use in the WHO approved strategy of pre-referral intervention. This review covers the formulation, pharmacokinetics, safety, efficacy, and implementation of this drug. There is little RCT evidence and the only RCT has been controversial. It is unlikely that there will be further randomized studies in the field. There is a concern that the administration of a single dose of artesunate without adequate follow up therapy may encourage the emergence of artemisinin resistance. EXPERT OPINION: Artesunate is an essential drug and RAS is a very useful, potentially lifesaving formulation designed to be quickly administered in remote areas to severely unwell children by non-medical personnel. However, its use needs to be monitored and onward referral for definitive antimalarial treatment ensured.


Assuntos
Antimaláricos/uso terapêutico , Artesunato/uso terapêutico , Malária Falciparum/tratamento farmacológico , Administração Retal , África ao Sul do Saara , Antimaláricos/administração & dosagem , Antimaláricos/efeitos adversos , Antimaláricos/farmacocinética , Artesunato/administração & dosagem , Artesunato/efeitos adversos , Artesunato/farmacocinética , Criança , Monitoramento de Medicamentos , Serviços Médicos de Emergência , Feminino , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto , Índice de Gravidade de Doença , Resultado do Tratamento
17.
Curr Drug Deliv ; 17(2): 126-139, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31899675

RESUMO

OBJECTIVE: Current study focuses on the formulation and characterization of lipophilic and hydrophilic gel formulations of nifedipine to treat anal fissure via anodermal application. METHODS: Lipophilic gels were prepared with Aerosil grades as gelling agents in bulk oils. Polyethylene glycols, hydroxypropyl methylcellulose, and Carbopol® 974P were used as gelling agents in water and propylene glycol for forming hydrophilic gels. The effect of repeated Freeze-Thaw Cycles (FT-C) on microstructures of the gels was investigated by examining viscosity, rheology and textural properties. Aerosil 200 containing lipophilic gels exhibited thixotropic behavior with plastic flow properties and higher viscosities. RESULT: Accordingly, their compressibility and adhesiveness increased. FT-C caused notable changes in microstructures and textural properties of the lipophilic gels excluding the formulation containing Aerosil 200-in-isopropyl myristate. Among the hydrophilic gels, the viscosity of Carbopol® 974P gels increased depending on the amount of polymer, triethanolamine and water; these gels featured plastic flow without thixotropic behavior. Their compressibility and adhesiveness were higher than other gel formulations with stable post-FT-C characteristics. The higher flux values of nifedipine were observed from water containing Carbopol® 974P gel. CONCLUSION: The results of the stability tests showed that the Carbopol® 974P gel had a longer shelf life than the Aerosil 200-in-isopropyl myristate gel.


Assuntos
Nifedipino/química , Adesividade , Administração Retal , Composição de Medicamentos , Liberação Controlada de Fármacos , Fissura Anal/tratamento farmacológico , Géis , Interações Hidrofóbicas e Hidrofílicas , Miristatos/química , Reologia , Dióxido de Silício/química , Viscosidade
18.
Arq. bras. med. vet. zootec. (Online) ; 72(1): 56-64, Jan.-Feb. 2020. graf
Artigo em Inglês | LILACS, VETINDEX | ID: biblio-1088913

RESUMO

Ozone (O3) therapy has been used for medical procedures for centuries; however, there are no extensive studies on its utilization in horses. This study aimed to evaluate the application of transrectal O3 on horses by physical and laboratorial evaluation, and production of reactive oxygen species (ROS). Sixteen healthy horses were separated in two groups: a control group (CG) and a group treated with O3 (TG). The TG animals received 1L of an oxygen and O3 mixture transrectally. The initial dose was 10µg/ml for the first two applications, 15µg/ml for the following two applications, and 20µg/ml for the next six applications. The CG animals received 1L of oxygen transrectally. In TG animals no variations in the physical examination were detected; furthermore, TG animals did not exhibit changes in biochemical evaluation results, fibrinogen concentrations, or ROS production. TG animals had increased red blood cell counts, hemoglobin concentrations, and packet cell volume values in comparison to the baseline and CG values. We could infer that O3 affected the red blood cell counts and improved rhetological properties of the blood. The transrectal application of O3 in horses is safe and can indirectly improve the oxygenation and metabolism of tissues.(AU)


A utilização medicinal do ozônio (O3) é secular, contudo não existem estudos expressivos de sua utilização em equinos. O objetivo deste estudo foi avaliar o efeito da aplicação transretal de O3 em equinos por meio da avaliação física, laboratorial, e produção de espécies reativas de oxigênio (EROs). Dezesseis equinos hígidos foram separados em dois grupos: grupo controle (GC) e grupo tratado com O3 (GT). O GT recebeu por via retal 1L da mistura de oxigênio e ozônio, sendo a dose inicial de 10µg/ml por duas aplicações, 15µg/ml por mais duas aplicações e 20µg/ml por seis aplicações. O GC recebeu 1L de oxigênio via transretal. No GT não foram observadas alterações no exame físico, bem como não foram observadas alterações na avaliação bioquímica, concentração de fibrinogênio e produção de EROs. O GT apresentou aumento no número de hemácias, na concentração de hemoglobina, e nos valores de hematócrito em relação aos valores basais e GC. Podemos inferir que o O3 alterou os valores de eritrócitos e melhorou as propriedades reológicas do sangue. Conclui-se que a aplicação transretal de 03 em equinos é segura e pode melhorar indiretamente a oxigenação e metabolismo dos tecidos.(AU)


Assuntos
Animais , Ozônio/uso terapêutico , Administração Retal , Espécies Reativas de Oxigênio , Cavalos/sangue , Antioxidantes
19.
Eur J Pharm Sci ; 142: 105141, 2020 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-31706017

RESUMO

Doxycycline hiclate is a broad spectrum antibiotic widely used in human and veterinary medicine. The inability to perform the parenteral administration of drugs and the lack of oral preparations can be mentioned as difficulties in the treatment of animals in the domestic environment. In this scenario, the aim of this study was to investigate the bioavailability of the drug by rectal route, to propose a potential suppository formulation containing 25 mg of doxycycline as an alternative to the available injectable formulations. Hydrophilic and lipophilic suppositories were prepared, in polyethylene glycol (S-PEG) or cocoa butter (S-CBT), respectively. The suppositories were prepared and evaluated concerning visual characteristics, content, average weight, melting range, content uniformity and in vitro release. A stability study was performed and the two most stable formulations were submitted to a pharmacokinetic study in rabbits. The bioavailability of the suppositories was compared to the data of the intravenous (i.v.) formulation. PEG suppository showed 49.13% bioavailability and CBT 51.43% with Cmax equal to 2.06 ±â€¯2.96 µg.mL-1 and 1.54 ±â€¯0.28 µg.mL-1, respectively. The data obtained suggest that rectal administration may become another method of administration of doxycycline in the treatment of bacterial infections.


Assuntos
Doxiciclina/farmacocinética , Administração Retal , Animais , Antibacterianos/administração & dosagem , Antibacterianos/farmacocinética , Infecções Bacterianas/tratamento farmacológico , Disponibilidade Biológica , Química Farmacêutica/métodos , Doxiciclina/administração & dosagem , Masculino , Polietilenoglicóis/química , Coelhos
20.
Lancet Gastroenterol Hepatol ; 5(2): 132-141, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31780277

RESUMO

BACKGROUND: Although rectal indometacin 100 mg is effective in reducing the frequency and severity of pancreatitis after endoscopic retrograde cholangiopancreatography (ERCP) in high-risk patients, the optimal dose is unknown, and pancreatitis incidence remains high. The aim of this study was to compare the efficacy of two dose regimens of rectal indometacin on the frequency and severity of pancreatitis after ERCP in high-risk patients. METHODS: In this randomised, double-blind, comparative effectiveness trial, we enrolled patients from six tertiary medical centres in the USA. Eligible patients were those at high risk for the development of pancreatitis after ERCP. We randomly assigned eligible patients (1:1) immediately after ERCP to receive either two 50 mg indometacin suppositories and a placebo suppository (standard-dose group) or three 50 mg indometacin suppositories (high-dose group). 4 h after the procedure, patients assigned to the high-dose group received an additional 50 mg indometacin suppository, whereas patients in the standard-dose group received an additional placebo suppository. The randomisation schedule, stratified according to study centre and with no other restrictions, was computer generated by an investigator who was uninvolved in the clinical care of any participants, distributed to the sites, and kept by personnel not directly involved with the study. These same personnel were responsible for packaging the drug and placebo in opaque envelopes. Patients, study personnel, and treating physicians were masked to study group assignment. The primary outcome of the study was the development of pancreatitis after ERCP. Analyses were done on an intention-to-treat basis. This trial is registered with ClinicalTrials.gov, number NCT01912716, and enrolment is complete. FINDINGS: Between July 9, 2013, and March 22, 2018, 1037 eligible patients were enrolled and randomly assigned to receive either standard-dose (n=515) or high-dose indometacin (n=522). Pancreatitis after ERCP occurred in 141 (14%) of 1037 patients-76 (15%) of 515 patients in the standard-dose indometacin group and 65 (12%) of 522 patients in the high-dose indometacin group (risk ratio [RR] 1·19, 95% CI 0·87-1·61; p=0·32). We observed 19 adverse events that were potentially attributable to study drug. Clinically significant bleeding occurred in 14 (1%) of 1037 patients-six (1%) of 515 patients in the standard-dose indometacin group and eight (2%) of 522 patients in the high-dose indometacin group (p=0·79). Three (1%) of 522 patients in the high-dose indometacin group developed acute kidney injury versus none in the standard-dose group (p=0·25). A non-ST elevation myocardial infarction occurred in the standard-dose indometacin group 2 days after ERCP. A transient ischaemic attack occurred in the high-dose indometacin group 5 days after ERCP. All 19 adverse events, in addition to the 141 patients who developed pancreatitis after ERCP, were considered serious as all required admission to hospital. We observed no allergic reactions or deaths at 30 day follow-up. INTERPRETATION: Dose escalation to rectal indometacin 200 mg did not confer any advantage compared with the standard 100 mg regimen, with pancreatitis incidence remaining high in high-risk patients. Current practice should continue unchanged. Further research should consider the pharmacokinetics of non-steroidal anti-inflammatory drugs to determine the optimal timing of their administration to prevent pancreatitis after ERCP. FUNDING: American College of Gastroenterology.


Assuntos
Colangiopancreatografia Retrógrada Endoscópica/efeitos adversos , Indometacina/administração & dosagem , Pancreatite/prevenção & controle , Administração Retal , Anti-Inflamatórios não Esteroides/administração & dosagem , Relação Dose-Resposta a Droga , Método Duplo-Cego , Feminino , Seguimentos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Pancreatite/epidemiologia , Pancreatite/etiologia , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de Doença , Resultado do Tratamento , Estados Unidos/epidemiologia
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA