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1.
Artigo em Inglês | MEDLINE | ID: mdl-33753426

RESUMO

BACKGROUND: The impact of COVID-19 on pregnant inflammatory bowel disease (IBD) patients is currently unknown. Reconfiguration of services during the pandemic may negatively affect medical and obstetric care. We aimed to examine the impacts on IBD antenatal care and pregnancy outcomes. METHODS: Retrospective data were recorded in consecutive patients attending for IBD antenatal care including outpatient appointments, infusion unit visits and advice line encounters. RESULTS: We included 244 pregnant women with IBD, of which 75 (30.7%) were on biologics in whom the treatment was stopped in 29.3% at a median 28 weeks gestation. In addition, 9% of patients were on corticosteroids and 21.5% continued on thiopurines. The care provided during 460 patient encounters was not affected by the pandemic in 94.1% but 68.2% were performed via telephone (compared with 3% prepandemic practice; p<0.0001). One-hundred-ten women delivered 111 alive babies (mean 38.2 weeks gestation, mean birth weight 3324 g) with 12 (11.0%) giving birth before week 37. Birth occurred by vaginal delivery in 72 (56.4%) and by caesarean section in 48 (43.6%) cases. Thirty-three were elective (12 for IBD indications) and 15 emergency caesarean sections. Breast feeding rates were low (38.6%). Among 244 pregnant women with IBD, 1 suspected COVID-19 infection was recorded. CONCLUSION: IBD antenatal care adjustments during the COVID-19 pandemic have not negatively affected patient care. Despite high levels of immunosuppression, only a single COVID-19 infection occurred. Adverse pregnancy outcomes were infrequent.


Assuntos
/complicações , Doenças Inflamatórias Intestinais/tratamento farmacológico , Doenças Inflamatórias Intestinais/epidemiologia , Cuidado Pré-Natal/estatística & dados numéricos , Corticosteroides/uso terapêutico , Adulto , Alopurinol/análogos & derivados , Alopurinol/uso terapêutico , Produtos Biológicos/uso terapêutico , Aleitamento Materno/estatística & dados numéricos , /epidemiologia , Cesárea/estatística & dados numéricos , Parto Obstétrico/estatística & dados numéricos , Feminino , Idade Gestacional , Humanos , Doenças Inflamatórias Intestinais/virologia , Gravidez , Resultado da Gravidez/epidemiologia , Estudos Retrospectivos , Reino Unido/epidemiologia , Suspensão de Tratamento
3.
Medicina (Kaunas) ; 57(1)2021 Jan 10.
Artigo em Inglês | MEDLINE | ID: mdl-33435164

RESUMO

This article aims to critically review the evidence on the available therapeutic strategies for the treatment of hyperuricemia. For this reason, several papers were reviewed. Xanthine oxidase inhibitors are the safest and most effective uric acid lowering drugs for the management of chronic hyperuricemia, while the efficacy of uricosuric agents is strongly modulated by pharmacogenetics. Emergent drugs (lesinurad, peglotidase) were found to be more effective for the acute management of refractory hyperuricemia, but their use is supported by a relatively small number of clinical trials so that further well-designed clinical research is needed to deepen their efficacy and safety profile.


Assuntos
Hiperuricemia/tratamento farmacológico , Uricosúricos/uso terapêutico , Xantina Oxidase/antagonistas & inibidores , Acetamidas/uso terapêutico , Alopurinol/uso terapêutico , Benzobromarona/uso terapêutico , Doença Crônica , Medicina Baseada em Evidências , Febuxostat/uso terapêutico , Supressores da Gota/uso terapêutico , Humanos , Naftalenos/uso terapêutico , Nitrilos/uso terapêutico , Fenilacetatos/uso terapêutico , Polietilenoglicóis/uso terapêutico , Probenecid/uso terapêutico , Propionatos/uso terapêutico , Piridinas/uso terapêutico , Tioglicolatos/uso terapêutico , Triazóis/uso terapêutico , Urato Oxidase/uso terapêutico
4.
Parasit Vectors ; 14(1): 36, 2021 Jan 09.
Artigo em Inglês | MEDLINE | ID: mdl-33422141

RESUMO

BACKGROUND: Zoonotic visceral leishmaniasis by Leishmania infantum is a first-order pathology in canine veterinary clinics in endemic areas. Moreover, canine infections are considered the main reservoir for human disease; despite their importance in the control of the disease within a One Health approach, no scientometric study has been published. Aims of the study included analyzing the impact of canine leishmaniasis (CanL) on the scientific literature, drugs or combinations used, trends in the period from 2000 to 2020 and efficacy criteria employed. METHODS: A Web of Science (WOS)-based analysis of publications on CanL and chemotherapy of the disease in the period 2000-2020 was carried out using a stepwise methodology. Data were analyzed by year, geographical origin, chemical groups, drugs and combinations, and efficacy criteria. RESULTS: Reports on CanL (n = 3324) represented < 16% of all publications on leishmaniasis (n = 20,968), and of these around 18% (n = 596) were related to chemotherapy. Publication records on CanL followed the distribution of the infection by L. infantum in endemic areas although Mediterranean countries were overrepresented in the reports on chemotherapy of CanL. Publications on the main antileishmanial drugs used in clinical practice showed a sustained tendency in the period analyzed. Pentavalent antimonials (SbV), alone or in combination with allopurinol, represented > 50% of all publications on chemotherapy of CanL despite the availability of more recently marketed drugs. CONCLUSIONS: Chemotherapy of CanL still relies on SbV and combinations and to a lesser extent on miltefosine (MIL). Reports on chemotherapy are scarce and mostly publicly funded, and the variability of experimental conditions hampers the direct comparison of the efficacy of drugs, combinations and schedules. The vast majority of reports on efficacy do not include any information on supportive therapy; this reduces the actual value of the studies if intended for the practical management of the disease. Complete reports on the chemotherapy (etiological + symptomatic) would add value to the trials performed.


Assuntos
Antiprotozoários/uso terapêutico , Doenças do Cão/tratamento farmacológico , Tratamento Farmacológico/métodos , Leishmaniose/tratamento farmacológico , Alopurinol/uso terapêutico , Anfotericina B/uso terapêutico , Animais , Doenças do Cão/epidemiologia , Cães , Combinação de Medicamentos , Humanos , Leishmania infantum , Leishmaniose/epidemiologia , Leishmaniose Visceral/epidemiologia , Leishmaniose Visceral/terapia , Fosforilcolina/análogos & derivados , Publicações
5.
Artigo em Inglês | MEDLINE | ID: mdl-33419128

RESUMO

BACKGROUND: Our study analyzes the frequency and risk factors of hyperuricemia and the use of allopurinol in a representative cohort of the older Polish adult population. METHODS: The analysis was a part of a cross-sectional PolSenior study on aging in Poland. The complete medication data were available in 4873 out of 4979 community dwelling respondents aged 65 and over. Serum uric acid concentrations were evaluated in 4028 participants (80.9% of the cohort). RESULTS: Hyperuricemia was observed in 28.2% of women and 24.7% of men. Ten risk factors of hyperuricemia were selected based on multivariable LASSO logistic regression analysis. Nine factors showed significant odds ratios: eGFR < 60 mL/min/1.73 m2 (OR = 4.10), hypertriglyceridemia (OR = 1.88), obesity (OR = 1.75), heart failure (1.70), CRP > 3.0 mg/dL (OR = 1.64), coronary artery disease (OR = 1.30), use of loop-diuretics (OR = 4.20), hydrochlorothiazide (OR = 2.96), and thiazide-like diuretics (OR = 2.81). Allopurinol was used by 2.8% of men and 1.8% of women. The therapy was considered effective in 46.7% of men and 53.3% of women. CONCLUSIONS: Hyperuricemia was present in 23.1% (95% CI: 21.8-24.4) of the older Polish population. The frequency of hyperuricemia increases with age, reaching 30.5% in men and 33.7% in women aged 90 years or more. Chronic kidney disease, obesity, heart failure, hypertriglyceridemia, and the use of diuretics were the strongest risk factors for hyperuricemia in older adults. The treatment with allopurinol was ineffective in more than half of participants.


Assuntos
Alopurinol , Hiperuricemia , Idoso , Idoso de 80 Anos ou mais , Alopurinol/uso terapêutico , Estudos Transversais , Feminino , Humanos , Hiperuricemia/tratamento farmacológico , Hiperuricemia/epidemiologia , Masculino , Polônia , Prevalência , Fatores de Risco , Ácido Úrico
6.
Medicine (Baltimore) ; 99(51): e23584, 2020 Dec 18.
Artigo em Inglês | MEDLINE | ID: mdl-33371088

RESUMO

ABSTRACT: To compare the difference between University of Wisconsin (UW) solution and histidine-tryptophan-ketoglutarate (HTK) solution in adult living donor liver transplantation (LDLT).This study included LDLT patients at the Liver Transplantation Center of West China Hospital of Sichuan University from November 2001 to June 2018. These patients were classified into 2 groups depending on the use of the different preservation solutions, and the confounding factors between the 2 groups were eliminated by propensity score matching. Finally, the incidence of complications; serum examination at postoperative days 1, 3, 5, 7, 14, 21, and 30; and the overall survival rate of the 2 groups were compared to observe whether there were any differences between the 2 preservation solutions.Of the 298 patients we screened, 170 were treated with UW solution and 128 with HTK solution. After propensity score matching, 106 pairs of patients were selected. In the comparison of the 2 groups, the length of intensive care unit stay in the UW group was significantly longer than that in the HTK group (P = .022), but there was no difference in the total length of hospital stay between the 2 groups (P = .277). No statistically significant difference was observed in the 2 groups in terms of the incidence of complications or postoperative examinations. However, the incidence of early allograft dysfunction in the HTK group was slightly lower than that in the UW group (HTK: UW = 14.1%: 20.7%), although the difference was not statistically significant. In terms of the overall survival rate, the 1, 3, and 5-year survival rates of the HTK group were 85.5%, 70.2%, and 65.1%, respectively, while the 1, 3, and 5-year survival rates of the UW group were 83.1%, 67.2%, and 59.8%, respectively, and there was no significant difference between the 2 groups.In conclusion, our study shows that UW solution and HTK solution are equivalent in perioperative safety, the recovery of transplanted liver function, the occurrence of postoperative complications and overall survival and can be safely and effectively applied in adult LDLT. If economic factors are taken into account, HTK can save costs to a certain extent.


Assuntos
Transplante de Fígado/métodos , Soluções para Preservação de Órgãos/uso terapêutico , Adenosina/uso terapêutico , Adulto , Alopurinol/uso terapêutico , China , Feminino , Glucose/uso terapêutico , Glutationa/uso terapêutico , Rejeição de Enxerto/epidemiologia , Humanos , Insulina/uso terapêutico , Tempo de Internação , Transplante de Fígado/mortalidade , Doadores Vivos , Masculino , Manitol/uso terapêutico , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Cloreto de Potássio/uso terapêutico , Procaína/uso terapêutico , Pontuação de Propensão , Rafinose/uso terapêutico , Análise de Sobrevida
7.
PLoS Negl Trop Dis ; 14(12): e0008947, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-33338041

RESUMO

Leishmaniasis is among the world's most neglected diseases. Dogs are the main reservoirs/hosts of Leishmania infantum, causative agent of both canine and human visceral leishmaniosis. Canine leishmaniasis (CanL) represents a public health problem as one of the most prevalent zoonotic diseases worldwide. Current therapeutics present drawbacks; thus, there is a need for more effective, safer, and cheaper drugs. The aim of this study was to evaluate and to compare the efficacy of oral administration of artesunate or meglumine antimoniate/allopurinol in dogs with clinical leishmaniasis. Forty-two dogs with naturally occurring clinical leishmaniasis were included in this open-label, simple randomized positive-control clinical field trial with 6 months of follow-up. Dogs received meglumine antimoniate 100 mg/kg/day and allopurinol 30 mg/kg/day for 28 days (control group, n = 26) or artesunate 25 mg/kg/day for 6 days (test group, n = 16). The animals were evaluated for their clinical evolution, parasite load (by qPCR) and humoral response at different time points: 0, 30, 90, and 180 days after treatment. Data analyses showed a significant improvement in both groups in clinical scores, parasitemia and antibody titers after treatment. Compared to the control group, the artesunate group showed significantly lower clinical score (P = 0.0001), lower parasitemia (P = 0.0001) and antibody titers after 6 months of follow-up. Compared to baseline values, a rapid, significant reduction (P < 0.012) in antibody levels, 2.28- versus 3.04-fold for the control versus artesunate groups, respectively, was observed 30 days after treatment. Antibody levels continued to decrease further in the artesunate group, where 58% of cases became seronegative at the 6-month follow-up. All qPCR-positive dogs were negative after treatment with artesunate, while 14.3% remained positive with the appearance of two new cases in the control group. Artesunate was well tolerated, and no side effects were recorded. Treatment failures were similar in both groups with 27.27% (6/22), including 18.18% (4/22) mortality in the control group, versus 26.66% (4/15), including 13.33% (2/15) mortality in the artesunate group. This is the first report showing the potential of artesunate in the treatment of dogs with clinical leishmaniasis. Artesunate showed higher efficacy than the current first-line treatment for CanL without any adverse effects. It could be a good alternative chemotherapy for CanL, and may be considered for further studies in human leishmaniases. Further clinical trials are needed to confirm these findings, to determine if there are relapses after treatment and if dogs remain infective to sandflies, to define the ideal therapeutic dosage and duration of treatment with artesunate.


Assuntos
Alopurinol/uso terapêutico , Antiprotozoários/uso terapêutico , Artesunato/uso terapêutico , Doenças do Cão/tratamento farmacológico , Leishmania infantum/efeitos dos fármacos , Leishmaniose Visceral/veterinária , Antimoniato de Meglumina/uso terapêutico , Animais , Doenças do Cão/parasitologia , Cães , Feminino , Leishmaniose Visceral/tratamento farmacológico , Leishmaniose Visceral/parasitologia , Masculino , Carga Parasitária/veterinária , Parasitemia/tratamento farmacológico , Zoonoses
8.
Ter Arkh ; 92(6): 60-68, 2020 Jul 09.
Artigo em Russo | MEDLINE | ID: mdl-33346494

RESUMO

AIM: To evaluate a 12-week course of combined alloturinol-lowering therapy with a prophylactic anti-inflammatory dose of movalis for the frequency of exacerbations and the quality of life of patients with gout. MATERIALS AND METHODS: Allopurinol was administered orally, 1 time per day. Every 3 weeks, the dosage of the drug was increased by 50 mg to 300 mg per day under the control of the level of serum uric acid (sUA). The total daily dose of the drug movalis, used in the form of different dosage forms, was 7.515 mg. The clinical effectiveness of the treatment was evaluated after 3, 6, 9 and 12 weeks according to physical examination, the dynamics of joint pain at rest, during movement and palpation, according to the visual analogue scale (VAS) in millimeters, Likert scale, EuroQol-5D-5L questionnaire, care for oneself, habitual daily activities, the presence of anxiety and depression, assessment of satisfaction with treatment (on a scale of 1 to 5, where 1 is the complete absence of improvement or worsening, and 5 is a very good result); took into account the period of remission, as well as the time before the onset of relapse of gouty arthritis. An adverse event (AE) was recorded. RESULTS AND DISCUSSION: On the background of treatment with movalis 7.5 mg per day more than two-thirds of patients showed no worsening of the articular syndrome with an increase in the dose of allopurinol to 300 mg per day. By the 12th week of observation, a significant difference was found between the severity of gouty arthritis characteristics in the direction of improving mobility, self-care, normal daily activities, reducing soreness, reducing anxiety and depression (p0.05). In addition, the ESR and sUA levels were significantly different initially and at the final observation point (p0.05), which indicates a positive effect on the inflammatory process. A 3-month course of combination therapy was not accompanied by significant increases in blood pressure, changes in creatinine clearance in blood serum. There were no adverse events from the gastrointestinal tract. 90.9% of patients rated the treatment result as very good. AE in the form of a skin allergic rash was observed in one patient; it did not require interruption of treatment and completely stopped without consequences after completion of the course. CONCLUSION: 12 a week-long combined therapy of the allopurinol-reducing drug with the anti-inflammatory dose movalis prevents the exacerbation of the articular syndrome and improves the quality of life of patients with gout.


Assuntos
Supressores da Gota/uso terapêutico , Gota , Hiperuricemia , Alopurinol/efeitos adversos , Alopurinol/uso terapêutico , Quimioterapia Combinada , Gota/tratamento farmacológico , Supressores da Gota/efeitos adversos , Humanos , Hiperuricemia/tratamento farmacológico , Meloxicam/uso terapêutico , Preparações Farmacêuticas , Qualidade de Vida , Ácido Úrico
18.
Georgian Med News ; (304-305): 48-56, 2020.
Artigo em Russo | MEDLINE | ID: mdl-32965249

RESUMO

The aim of the study was to assess the impact of complex urate-lowering therapy with the addition of a synbiotic on the level of cytokines in the blood and the quality of life of patients with chronic gouty arthritis.; The results of treatment of 68 patients (main group) and 62 patients (comparison group) with chronic gouty arthritis are presented. Patients of the main group took allopurinol at a dose of 300 mg per day with titration of the dose in the direction of increasing it by 100 mg once a month and additionally received a synbiotic 1 capsule three times a day. Patients in the comparison group received only allopurinol treatment. The duration of treatment was 3 months. The control group consisted of 25 practically healthy men of the corresponding age.; An addition of a synbiotic to the treatment regimen demonstrates an increase of urate-lowering effect of allopurinol (a decrease in the level of uricemia by 18.7% versus 13.3%, p <0.01), which was combined with a more pronounced anti-inflammatory effect: a decrease in the level of CRP by 75% against 26, 3% (p <0.01) and IL-1ß, IL-6, IL-8, IL-10 and TNFα (all p <0.001). According to the questionnaire on the SF-36 scale, in the main group in most subscales there was a statistically significant improvement in the dynamics of the indicators. According to the results of a survey according to the GSRS scale at the visit month 3, in the patients of the main group, the indicators of all subscales statistically significantly changed in the direction of improvement, except for the scale of gastroesophageal reflux syndrome.; The addition of a synbiotic to complex therapy for patients with gout allows morefaster achievement of target levels of uric acid in the blood, contributes to a more rapid normalization of blood CRP and the cytokine profile compared with allopurinol monotherapy. The tendency influence on the clinical manifestations of dysbiotic changes in patients with gout has an additional effect on the quality of life.


Assuntos
Artrite Gotosa/tratamento farmacológico , Gota , Simbióticos , Alopurinol/uso terapêutico , Humanos , Masculino , Qualidade de Vida
20.
Cochrane Database Syst Rev ; 9: CD008652, 2020 09 02.
Artigo em Inglês | MEDLINE | ID: mdl-32877573

RESUMO

BACKGROUND: This is the second update of this systematic review. High blood pressure represents a major public health problem. Worldwide, approximately one-fourth of the adult population has hypertension. Epidemiological and experimental studies suggest a link between hyperuricaemia and hypertension. Hyperuricaemia affects 25% to 40% of those with untreated hypertension; a much lower prevalence has been reported in those with normotension or in the general population. However, whether lowering serum uric acid (UA) might lower blood pressure (BP), is an unanswered question. OBJECTIVES: To determine whether UA-lowering agents reduce BP in people with primary hypertension or prehypertension, compared with placebo. SEARCH METHODS: The Cochrane Hypertension Information Specialist searched the following databases for randomised controlled trials up to May 2020: the Cochrane Hypertension Specialised Register, CENTRAL 2018, Issue 12, MEDLINE (from 1946), Embase (from 1974), the World Health Organization International Clinical Trials Registry Platform, and ClinicalTrials.gov. We also searched LILACS (1982 to May 2020), and contacted authors of relevant papers regarding further published and unpublished work. The searches had no language or date restrictions. SELECTION CRITERIA: To be included in this updated review, the studies had to meet the following criteria: 1) randomised or quasi-randomised, with a group assigned to receive a UA-lowering agent and another group assigned to receive placebo; 2) double-blind, single-blind, or open-label; 3) parallel or cross-over trial design; 4) cross-over trials had to have a washout period of at least two weeks; 5) minimum treatment duration of four weeks; 6) participants had to have a diagnosis of essential hypertension or prehypertension plus hyperuricaemia (serum UA greater than 6 mg/dL in women, 7 mg/dL in men, and 5.5 mg/dL in children or adolescents); 7) outcome measures included change in 24-hour ambulatory systolic or diastolic BP, or both; or clinic-measured systolic or diastolic BP, or both. DATA COLLECTION AND ANALYSIS: The two review authors independently collected the data using a data extraction form, and resolved any disagreements via discussion. We assessed risk of bias using the Cochrane 'Risk of bias' tool. We assessed the certainty of the evidence using the GRADE approach. MAIN RESULTS: In this review update, we screened 722 records, selected 26 full-text reports for evaluation. We identified no ongoing studies and did not add any new studies. We included three randomised controlled trials (RCTs), enrolling 211 people with hypertension or prehypertension, plus hyperuricaemia. Low-certainty evidence from three RCTs found inconclusive results between those who received UA-lowering drugs and placebo, in 24-hour ambulatory systolic (MD -6.2 mmHg, 95% CI -12.8 to 0.5) or diastolic BP (-3.9 mmHg, 95% CI -9.2 to 1.4). Low-certainty evidence from two RCTs found that UA-lowering drugs reduced clinic-measured systolic BP (-8.43 mmHg, 95% CI -15.24 to -1.62) but results for clinic-measured diastolic BP were inconclusive (-6.45 mmHg, 95% CI -13.60 to 0.70). High-certainty evidence from three RCTs found that serum UA levels were reduced by 3.1 mg/dL (95% CI 2.4 to 3.8) in the participants that received UA-lowering drugs. Low-certainty evidence from three RCTs found inconclusive results regarding the occurrence of adverse events between those who received UA-lowering drugs and placebo (RR 1.86, 95% CI 0.43 to 8.10). AUTHORS' CONCLUSIONS: In this updated Cochrane Review, the current RCT data are insufficient to know whether UA-lowering therapy lowers BP. More studies are needed.


Assuntos
Alopurinol/uso terapêutico , Hipertensão/tratamento farmacológico , Hiperuricemia/tratamento farmacológico , Uricosúricos/uso terapêutico , Adolescente , Adulto , Pressão Sanguínea/efeitos dos fármacos , Criança , Humanos , Hipertensão/complicações , Hiperuricemia/complicações , Pacientes Desistentes do Tratamento/estatística & dados numéricos , Placebos/uso terapêutico , Pré-Hipertensão/tratamento farmacológico , Ensaios Clínicos Controlados Aleatórios como Assunto
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