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2.
BMC Infect Dis ; 20(1): 717, 2020 Sep 29.
Artigo em Inglês | MEDLINE | ID: mdl-32993529

RESUMO

BACKGROUND: Fungal peritonitis (FP) is a rare complication of peritoneal dialysis. We herein describe the second case in Asia of Histoplasma capsulatum peritonitis associated with continuous ambulatory peritoneal dialysis (CAPD). CASE PRESENTATION: An 85-year-old woman with end-stage renal disease (ESRD) who had been on CAPD for 3 years and who had a history of 3 prior episodes of peritonitis presented with intermittent abdominal pain for 2 weeks and high-grade fever for 3 days. Elevated white blood cell (WBC) count and rare small oval budding yeasts were found in her peritoneal dialysis (PD) fluid. From this fluid, a white mold colony was observed macroscopically after 7 days of incubation, and numerous large, round with rough-walled tuberculate macroconidia along with small smooth-walled microconidia were observed microscopically upon tease slide preparation, which is consistent with H. capsulatum. The peritoneal dialysis (PD) catheter was then removed, and it also grew H. capsulatum after 20 days of incubation. The patient was switched from CAPD to hemodialysis. The patient was successfully treated with intravenous amphotericin B deoxycholate (AmBD) for 2 weeks, followed by oral itraconazole for 6 months with satisfactory result. The patient remains on hemodialysis and continues to be clinically stable. CONCLUSION: H. capsulatum peritonitis is an extremely rare condition that is associated with high morbidity and mortality. Demonstration of small yeasts upon staining of PD fluid, and isolation of slow growing mold in the culture of clinical specimen should provide important clues for diagnosis of H. capsulatum peritonitis. Prompt removal of the PD catheter and empirical treatment with amphotericin B or itraconazole is recommended until the culture results are known.


Assuntos
Histoplasma/isolamento & purificação , Histoplasmose/diagnóstico , Histoplasmose/etiologia , Diálise Peritoneal Ambulatorial Contínua/efeitos adversos , Peritonite/diagnóstico , Peritonite/etiologia , Administração Intravenosa , Administração Oral , Idoso de 80 Anos ou mais , Anfotericina B/administração & dosagem , Anfotericina B/uso terapêutico , Antifúngicos/administração & dosagem , Antifúngicos/uso terapêutico , Ásia , Ácido Desoxicólico/administração & dosagem , Ácido Desoxicólico/uso terapêutico , Combinação de Medicamentos , Feminino , Histoplasmose/tratamento farmacológico , Histoplasmose/microbiologia , Humanos , Itraconazol/administração & dosagem , Itraconazol/uso terapêutico , Falência Renal Crônica/terapia , Peritonite/tratamento farmacológico , Peritonite/microbiologia , Resultado do Tratamento
3.
BMC Infect Dis ; 20(1): 681, 2020 Sep 17.
Artigo em Inglês | MEDLINE | ID: mdl-32943003

RESUMO

BACKGROUND: The purpose of this case report was to report a case of Cryptococcus laurentii infection in the left knee of a previously healthy 29 year old male patient. CASE PRESENTATION: After an initial misdiagnosis and 7 months of failed treatment, the patient received nearly a month of treatment with voriconazole (200 mg IV q12 h) and knee irrigation with amphotericin B until the infection was controlled. The treatment continued with fluconazole for nearly 7 months and approximately 5 weeks of antibiotic treatment for a skin bacterial coinfection. In the end, the patient's symptoms disappeared completely, the left knee recovered well, and there was no recurrence of infection. CONCLUSION: The key points of successful treatment in this case were the thorough debridement, the adequate course of knee irrigation with antifungal drugs and more than 6 months of oral antifungal drugs that were able to eradicate the infection.


Assuntos
Antifúngicos/uso terapêutico , Criptococose/tratamento farmacológico , Criptococose/microbiologia , Joelho/microbiologia , Administração Oral , Adulto , Anfotericina B/uso terapêutico , Antifúngicos/administração & dosagem , Artrite Infecciosa/microbiologia , Criptococose/cirurgia , Cryptococcus/isolamento & purificação , Desbridamento , Erros de Diagnóstico , Fluconazol/uso terapêutico , Infecção Focal/tratamento farmacológico , Infecção Focal/microbiologia , Infecção Focal/cirurgia , Humanos , Joelho/diagnóstico por imagem , Joelho/cirurgia , Masculino , Dermatopatias Bacterianas/tratamento farmacológico , Voriconazol/uso terapêutico
4.
Medicine (Baltimore) ; 99(31): e21431, 2020 Jul 31.
Artigo em Inglês | MEDLINE | ID: mdl-32756151

RESUMO

RATIONALE: The use of autologous hematopoietic stem cell transplantation (AHSCT) for autoimmune diseases has become the first indication for transplant in nonmalignant disease. Mucormycosis is a rare invasive infection with increasing incidence in patients treated with AHSCT. We report the first case of pulmonary mucormycosis following AHSCT for systemic sclerosis (SSc). PATIENT CONCERNS: A 24-year-old woman with rapidly progressive diffuse cutaneous SSc presented with an acute respiratory distress syndrome 6 days after AHSCT. DIAGNOSES: The results of clinical and computed tomography scan were consistent with pulmonary mucormycosis and the diagnosis was confirmed by a positive Mucorales Polymerase Chain Reaction on a peripheral blood sample. INTERVENTIONS AND OUTCOMES: Early antifungal therapy by intravenous amphotericin B provided rapid improvement within 4 days and sustained recovery after 2 years of follow-up. LESSONS: With the progressively increasing use of AHSCT and other stem cell therapy for treatment of severe SSc and other autoimmune diseases, the potential onset of rare post-transplant fungal infections, such as mucormycosis, requires careful patient monitoring and better awareness of early initiation of adequate therapy.


Assuntos
Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Mucormicose/etiologia , Esclerodermia Difusa/etiologia , Escleroderma Sistêmico/terapia , Transplante Autólogo/efeitos adversos , Doença Aguda , Administração Intravenosa , Assistência ao Convalescente , Anfotericina B/administração & dosagem , Anfotericina B/uso terapêutico , Antifúngicos/administração & dosagem , Antifúngicos/uso terapêutico , Feminino , Transplante de Células-Tronco Hematopoéticas/métodos , Humanos , Pneumopatias Fúngicas/diagnóstico por imagem , Pneumopatias Fúngicas/microbiologia , Pneumopatias Fúngicas/patologia , Mucorales/genética , Síndrome do Desconforto Respiratório do Adulto/etiologia , Esclerodermia Difusa/patologia , Transplante Autólogo/métodos , Resultado do Tratamento , Adulto Jovem
5.
Cochrane Database Syst Rev ; 8: CD002845, 2020 08 24.
Artigo em Inglês | MEDLINE | ID: mdl-32845024

RESUMO

BACKGROUND: Anti-fungals are available for oral and intra-vaginal treatment of uncomplicated vulvovaginal candidiasis. OBJECTIVES: The primary objective of this review is to assess the relative effectiveness (clinical cure) of oral versus intra-vaginal anti-fungals for the treatment of uncomplicated vulvovaginal candidiasis. Secondary objectives include the assessment of the relative effectiveness in terms of mycological cure, in addition to safety, side effects, treatment preference, time to first relief of symptoms, and costs. SEARCH METHODS: We searched CENTRAL, MEDLINE, Embase, and two trials registers on 29 August 2019 together with reference checking and citation searching. SELECTION CRITERIA: We included randomised controlled trials published in any language comparing at least one oral anti-fungal with one intra-vaginal anti-fungal in women (aged 16 years or over) with a mycological diagnosis (positive culture, microscopy for yeast, or both) of uncomplicated vulvovaginal candidiasis. We excluded trials if they solely involved participants who were HIV positive, immunocompromised, pregnant, breast feeding or diabetic. DATA COLLECTION AND ANALYSIS: We used standard methodological procedures as recommended by Cochrane. MAIN RESULTS: This review includes 26 trials (5007 participants). Eight anti-fungals are represented. All but three trials included participants with acute vulvovaginal candidiasis. Trials were conducted in Europe: UK (3), Croatia (2). Finland (2), the Netherlands (2), Germany (1), Italy (1), Sweden (1) and one trial across multiple European countries, USA (7) Thailand (2), Iran (2), Japan (1) and Africa (Nigeria) (1). The duration of follow-up varied between trials. The overall risk of bias of the included trials was high. There was probably little or no difference shown between oral and intra-vaginal anti-fungal treatment for clinical cure at short-term follow-up (OR 1.14, 95% CI 0.91 to 1.43; 13 trials; 1859 participants; moderate-certainty evidence) and long-term follow-up (OR 1.07, 95% CI 0.77 to 1.50; 9 trials; 1042 participants; moderate-certainty evidence). The evidence suggests that if the rate of clinical cure at short-term follow-up with intra-vaginal treatment is 77%, the rate with oral treatment would be between 75% and 83%; if the rate of clinical cure at long term follow-up with intra-vaginal treatment is 84%, the rate with oral treatment would be between 80% and 89%. Oral treatment probably improves mycological cure over intra-vaginal treatment at short term (OR 1.24, 95% CI 1.03 to 1.50: 19 trials; 3057 participants; moderate-certainty evidence) and long-term follow-up (OR 1.29, 95% CI 1.05 to 1.60; 13 trials; 1661 participants; moderate-certainty evidence). The evidence suggests that if the rate of mycological cure at short-term follow-up with intra-vaginal treatment is 80%, the rate with oral treatment would be between 80% and 85%; if the rate of mycological cure at long-term follow-up with intra-vaginal treatment is 66%, the rate with oral treatment would be between 67% and 76%. In terms of patient safety, there is a low risk of participants withdrawing from the studies due to adverse drug effects for either treatment (23 trials; 4637 participants; high-certainty evidence). Due to the low certainty of evidence, it is undetermined whether oral treatments reduced the number of side effects compared with intra-vaginal treatments (OR 1.04, 95% CI 0.84 to 1.29; 16 trials; 3155 participants; low-certainty evidence). The evidence suggests that if the rate of side effects with intra-vaginal treatment is 12%, the rate with oral treatment would be between 10% and 15%. We noted that the type of side effects differed, with intra-vaginal treatments being more often associated with local reactions, and oral treatments being more often associated with systemic effects including gastro-intestinal symptoms and headaches. Oral treatment appeared to be the favoured treatment preference over intra-vaginal treatment or no preference (12 trials; 2206 participants), however the data were poorly reported and the certainty of the evidence was low. There was little or no difference in time to first relief of symptoms between oral and intra-vaginal treatments: four trials favoured the oral treatment, four favoured intra-vaginal, one study reported no difference and one was unclear. The measurements varied between the 10 trials (1910 participants) and the certainty of the evidence was low. Costs were not reported in any of the trials. AUTHORS' CONCLUSIONS: Oral anti-fungal treatment probably improves short- and long-term mycological cure over intra-vaginal treatment for uncomplicated vaginal candidiasis. Oral treatment was the favoured treatment preference by participants, though the certainty of this evidence is low. The decision to prescribe or recommend an anti-fungal for oral or intra-vaginal administration should take into consideration safety in terms of withdrawals and side effects, as well as cost and treatment preference. Unless there is a previous history of adverse reaction to one route of administration or contraindications, women who are purchasing their own treatment should be given full information about the characteristics and costs of treatment to make their own decision. If health services are paying the treatment cost, decision-makers should consider whether the higher cost of some oral anti-fungals is worth the gain in convenience, if this is the patient's preference.


Assuntos
Antifúngicos/administração & dosagem , Azóis/administração & dosagem , Candidíase Vulvovaginal/tratamento farmacológico , Doença Aguda , Administração Intravaginal , Administração Oral , Antifúngicos/economia , Azóis/economia , Viés , Análise Custo-Benefício , Feminino , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto
6.
Rev Soc Bras Med Trop ; 53: e20200013, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32491099

RESUMO

Fusarium spp. has been associated with a broad spectrum of emerging infections collectively termed fusariosis. This review includes articles published between 2005 and 2018 that describe the characteristics, clinical management, incidence, and emergence of these fungal infections. Fusarium solani and F. oxysporum are globally distributed and represent the most common complexes. Few therapeutic options exist due to intrinsic resistance, especially for the treatment of invasive fusariosis. Therefore, the use of drug combinations could be an important alternative for systemic antifungal resistance. Increase in the number of case reports on invasive fusariosis between 2005 and 2018 is evidence of the emergence of this fungal infection.


Assuntos
Antifúngicos/administração & dosagem , Doenças Transmissíveis Emergentes/parasitologia , Fusariose/parasitologia , Fusarium/classificação , Brasil/epidemiologia , Doenças Transmissíveis Emergentes/tratamento farmacológico , Doenças Transmissíveis Emergentes/epidemiologia , Farmacorresistência Fúngica , Fusariose/tratamento farmacológico , Fusariose/epidemiologia , Humanos , Incidência
7.
Clin Drug Investig ; 40(8): 687-693, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32514939

RESUMO

Patient harm from inadvertent administration of amphotericin B (Fungizone™) instead of liposomal amphotericin (AmBisome®) has been described in the literature and has been the subject of patient safety alerts in the UK. Safe use of intravenous amphotericin depends on the knowledge and awareness of practitioners of the availability and differences between the different presentations of intravenous amphotericin. Knowledge is a weak barrier to error. Recommendations to reduce the risk of error following adverse drug events in the UK, USA and The Netherlands have largely focused on actions to be taken at an organisational level, such as drug supply, storage, dose checking and specifying brand and generic names on prescriptions. None have considered or addressed the contributory factors relating to the products themselves, namely the similarity between the presentations of AmBisome and Fungizone, both of which are manufactured as 50 mg vials despite their different dose recommendations. The need to use multiple vials of Ambisome to prepare infusions for adult patients is contrary to the usual practice of using only one or two vials to prepare doses of injectable medicines for adult patients, increasing the risk of error not only with injectable amphotericin formulations but potentially also with the preparation of other injectable medicines. Whilst the development of robust local risk reduction strategies are important, external factors, such as the design of medicines, should also be identified and highlighted to manufacturers and regulatory authorities as potential contributors to error and harm.


Assuntos
Anfotericina B/efeitos adversos , Antifúngicos/efeitos adversos , Anfotericina B/administração & dosagem , Antifúngicos/administração & dosagem , Composição de Medicamentos , Humanos , Erros de Medicação/prevenção & controle
8.
J Mycol Med ; 30(3): 101003, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32586733

RESUMO

OBJECTIVE: In order to improve the effect of ketoconazole, poly-lactic acid (PLA) nanoparticles containing ketoconazole were prepared, characterized and tested against dermatophytes and Candida spp planktonic and biofilm cells. METHODS: The ketoconazole-PLA nanoparticles obtained by nanoprecipitation were characterized using dynamic light scattering, scanning electron microscopy, transmission electron microscopy, and differential scanning calorimetry. In addition, quantification of encapsulated ketoconazole and the in vitro release profile were determined. Antifungal susceptibility tests against dermatophytes Trichophyton rubrum, Trichophyton mentagrophytes, and Microsporum gypseum and yeasts Candida albicans, C. dubliniensis, C. krusei, C. parapsilosis, and C. tropicalis were performed. RESULTS: Spherical nanoparticles, with a mean diameter of 188.5nm and an encapsulation efficiency of 45% ketoconazole, were obtained. The nanoparticles containing ketoconazole had superior antifungal activity against all tested fungi strains than free ketoconazole. Inhibition of yeast biofilm formation was also achieved. CONCLUSION: Ketoconazole-PLA nanoparticles resulted in better antifungal activity of ketoconazole nanoparticles than free drug against dermatophytes and Candida species, indicating a promising tool for the development of therapeutic strategies.


Assuntos
Antifúngicos/administração & dosagem , Arthrodermataceae/efeitos dos fármacos , Candida/efeitos dos fármacos , Portadores de Fármacos , Cetoconazol/administração & dosagem , Nanopartículas/química , Poliésteres/química , Antifúngicos/farmacocinética , Arthrodermataceae/fisiologia , Biofilmes/efeitos dos fármacos , Candida/fisiologia , Portadores de Fármacos/síntese química , Portadores de Fármacos/química , Portadores de Fármacos/farmacocinética , Composição de Medicamentos/métodos , Sistemas de Liberação de Medicamentos/métodos , Liberação Controlada de Fármacos , Humanos , Cetoconazol/farmacocinética , Teste de Materiais , Testes de Sensibilidade Microbiana , Resultado do Tratamento
9.
BMC Infect Dis ; 20(1): 377, 2020 May 27.
Artigo em Inglês | MEDLINE | ID: mdl-32460728

RESUMO

BACKGROUND: Candida diddensiae, a yeast found in olive oil, is considered non-pathogenic to humans. Here, we describe the first case of fungemia caused by C. diddensiae in a hospitalized patient with underlying diseases. CASE PRESENTATION: A 62-year-old woman was admitted because of multiple contusions due to repeated falls and generalized weakness. She presented with chronic leukopenia due to systemic lupus erythematosus, and multiple cranial nerve neuropathies due to a recurring chordoma. She was given a lipid emulsion containing total parenteral nutrition (TPN) starting on the day of admission. Broad-spectrum antibiotics had been administered during her last hospital stay and from day 8 of this hospitalization. However, no central venous catheter was used during this hospital stay. Blood cultures obtained on hospital days 17, 23, and 24 yielded the same yeast, which was identified as C. diddensiae via sequence analyses of the internal transcribed spacer region and D1/D2 regions of the 26S ribosomal DNA of the rRNA gene. In vitro susceptibility testing showed that the minimum inhibitory concentration of fluconazole for all isolates was 8 µg/mL. On day 23, TPN was discontinued and fluconazole therapy was started. Blood cultures obtained on day 26 were negative. The fluconazole therapy was replaced with micafungin on day 26 and the patient exhibited improvements. CONCLUSION: The use of lipid TPN may potentially contribute to the occurrence of nosocomial fungemia by C. diddensiae, an unusual Candida species.


Assuntos
Infecção Hospitalar/microbiologia , Fungemia/microbiologia , Antibacterianos , Antifúngicos/administração & dosagem , Candida/efeitos dos fármacos , Candida/genética , Candida/isolamento & purificação , Candida/fisiologia , Cateteres Venosos Centrais , Infecção Hospitalar/tratamento farmacológico , DNA Ribossômico/genética , Feminino , Fluconazol/administração & dosagem , Fungemia/tratamento farmacológico , Hospitais , Humanos , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Nutrição Parenteral Total
10.
AAPS PharmSciTech ; 21(5): 140, 2020 May 17.
Artigo em Inglês | MEDLINE | ID: mdl-32419032

RESUMO

The present study is aimed at enhancing the skin penetration of ketoconazole by formulating it as transethosome. Ketoconazole-loaded transethosome formulations were prepared by conventional thin film evaporation and hydration method and were optimized using concentration of edge activator (span 80), ethanol and sonication time as factors and particle size, polydispersity index and entrapment efficiency as responses. The optimized formulation was further evaluated for in vitro diffusion, anti-fungal activity, ex vivo penetration and in vivo pharmacodynamic activity. The results of in vitro drug diffusion and ex vivo skin penetration studies demonstrated that the amount of drug diffused and penetrated through the skin was increased. Optimized transethosomes showed enhanced in vitro antifungal and in vivo pharmacodynamic activities against Candida albicans in Wistar albino rats when compared to conventional liposomes. Therefore, the developed ketoconazole encapsulated transethosome formulation is capable of enhancing the skin penetration of the drug by overcoming the stratum corneum barrier function and acting as an effective drug delivery system for ketoconazole through the skin for its anti-fungal activity.


Assuntos
Antifúngicos/administração & dosagem , Antifúngicos/química , Administração Cutânea , Animais , Antifúngicos/farmacocinética , Candidíase/tratamento farmacológico , Candidíase/microbiologia , Composição de Medicamentos , Sistemas de Liberação de Medicamentos , Excipientes , Cetoconazol/administração & dosagem , Cetoconazol/química , Lipossomos , Tamanho da Partícula , Ratos , Ratos Wistar , Absorção Cutânea
11.
J Infect Chemother ; 26(8): 847-850, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32414688

RESUMO

Aspergillus empyema is treated with either systemic administration of antifungal drugs or surgery, but the mortality rate is very high. Here, we report a case of Aspergillus empyema successfully treated using combined intrathoracic and intravenous administration of voriconazole (VRCZ). Treatment success was achieved by monitoring VRCZ plasma trough concentration. The patient was a 71-year-old Japanese woman diagnosed with Aspergillus empyema whom we started on intravenous administration of VRCZ. Although penetration of VRCZ into the pleural effusion was confirmed, the level was below 1 µg/mL, which is the minimum inhibitory concentration for Aspergillus fumigatus determined by antifungal susceptibility testing in pleural effusion culture. Therefore, we initiated combination therapy with intrathoracic and intravenous administration of VRCZ. VRCZ 200 mg was first dissolved in 50-100 mL of saline and administered into the thoracic cavity via a chest tube. The chest tube was clamped for 5-6 h, and then VRCZ solution was excreted though the chest tube. When a single dose of the VRCZ was administered into the intrathoracic space, the plasma concentration before intravenous administration increased from 1.45 µg/mL on day 27 to 1.53 µg/mL on day 28. Although intravenous administration was continued, the VRCZ plasma trough concentration decreased to 1.36 µg/mL on day 29. We therefore decided on an intrathoracic administration schedule of 2-3 times a week. Intrathoracic administration was performed 14 times in total until fenestration surgery on day 64. Our case suggests that combined intrathoracic and intravenous administration of VRCZ may be a valid treatment option for Aspergillus empyema.


Assuntos
Antifúngicos/administração & dosagem , Aspergilose/tratamento farmacológico , Aspergillus fumigatus/isolamento & purificação , Empiema/tratamento farmacológico , Voriconazol/administração & dosagem , Administração Intravenosa , Idoso , Tubos Torácicos , Monitoramento de Medicamentos , Quimioterapia Combinada , Empiema/microbiologia , Feminino , Humanos , Derrame Pleural/microbiologia , Resultado do Tratamento
12.
Brasilia; s.n; 22 abr. , 2020. 24 p.
Não convencional em Português | LILACS, BRISA/RedTESA, PIE | ID: biblio-1095198

RESUMO

O objetivo da revisão sistemática foi investigar a eficácia e a segurança de tratamentos com antivirais para COVID-19, SARS e MERS. Ao todo, 22 estudos foram incluídos: 1 ensaio clínico, 16 séries de casos e 5 relatos de caso. Os antivirais mais utilizados foram lopinavir / ritonavir, oseltamivir, ribavirina e arbidol. Todos os estudos usaram outras terapias, como antibióticos, imunoglobulina, interferon, glicocorticoides, metilprednisolona e medicamentos antiparasitários e antifúngicos, além da terapia antiviral para pacientes com COVID-19. No único ECR incluído, os pacientes que receberam lopinavir / ritonavir tiveram um processo de recuperação semelhante aos pacientes que receberam tratamento padrão. Os desfechos de mortalidade em 28 dias e carga viral de RNA não foram significativamente diferentes entre os dois grupos. Dentre os achados dos demais estudos, vale destacar que estudos de séries e relatos de casos não avaliam a eficácia de medicamentos, e que em geral as amostras foram pequenas. O estudo de Guan, com 1099 pacientes, chegou a conclusão que oseltamivir foi ineficaz na diminuição da taxa de admissão na UTI, na necessidade de ventilação e na taxa de mortalidade entre os pacientes. O estudo de Shang, com 416 pacientes, indicou que medicamentos antivirais não têm efeito na taxa de mortalidade de pacientes com COVID-19. O estudo de Li, com cinco crianças com COVID-19, indicou que os agentes antivirais não alteraram o resultado ou a duração da internação. A revisão cita outros estudos que foram publicados com os pacientes ainda sob tratamento, sem o desfecho final dessas populações. Quanto a busca por ensaios clínicos para SARS e MERS, foram encontrados protocolos, mas nenhum resultado publicado.


Assuntos
Humanos , Pneumonia Viral/tratamento farmacológico , Ribavirina/uso terapêutico , Infecções por Coronavirus/tratamento farmacológico , Progressão da Doença , Ritonavir/uso terapêutico , Antirretrovirais/administração & dosagem , Oseltamivir/uso terapêutico , Lopinavir/uso terapêutico , Betacoronavirus/efeitos dos fármacos , Antifúngicos/administração & dosagem , Antiparasitários/administração & dosagem , Avaliação da Tecnologia Biomédica , Terapias em Estudo/instrumentação
13.
Am J Otolaryngol ; 41(4): 102493, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32334921

RESUMO

OBJECTIVE: We evaluated the graft success rates and hearing gains of tympanic membrane (TM) perforations with otomycosis undergoing endoscopic cartilage myringoplasty and local applications of antimycotic cream. STUDY DESIGN: A prospective case series. MATERIALS AND METHODS: In total, 74 persistent perforations with otomycosis who underwent cartilage myringoplasty were included. The pre-, intra-, and post-operative antimycotic cream were applied. The outcomes were the hearing gains and graft take rates at 6 months. RESULTS: At 6 months, the graft take rate was 83.8% (62/74). 6.8% developed postoperative purulent otorrhea and re-perforations; 9.5% recurrent otomycosis with re-perforations; and 4.1% mild postoperative otorrhea that resolved without re-perforation. The mean preoperative air-bone gap (ABG) was 32.31 ± 5.47 dB and the mean postoperative ABG 17.24 ± 4.95 dB, thus significantly different (p < .05). Of the 74 patients, 11(14.9%) had ABG closures within 10 dB, 48 (64.9%) had closures within 20 dB, and 15 (20.3%) had closures within 30 dB. We encountered no instances of graft lateralization or significant blunting during follow-up. CONCLUSIONS: Endoscopic cartilage myringoplasty effectively treats persistent perforations with otomycosis; however, pre-, intra-, and post-operative local applications of antimycotic cream are recommended.


Assuntos
Cartilagem da Orelha/cirurgia , Endoscopia/métodos , Miringoplastia/métodos , Otomicose/cirurgia , Perfuração da Membrana Timpânica/cirurgia , Adulto , Antifúngicos/administração & dosagem , Feminino , Audição , Humanos , Masculino , Pessoa de Meia-Idade , Otomicose/tratamento farmacológico , Otomicose/fisiopatologia , Resultado do Tratamento
14.
Int J Nanomedicine ; 15: 2027-2044, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32273700

RESUMO

Purpose: As one of the classic anti-Canidia albicans (CA) and vulvovaginal candidiasis (VVC) drugs, nystatin (NYS) is limited by poor water solubility and easy aggregation. Traditional NYS vaginal delivery formulations do not fully adapt to the specific environment of the vaginal cavity. The use of exopolysaccharides (EPS) has great application potential in emulsifiers, but its use has not been reported in nanoemulsions. In this work, an EPS/NYS nanoemulsion (ENNE) was developed to improve the activities of NYS against CA and VVC. Methods: The ENNE was prepared by ultrasonic method using EPS as an emulsifier, liquid paraffin oil as an oil phase, PEG400 as a co-emulsifier, and NYS as the loaded drug. ENNE preparation was optimized by response surface method. After optimization, in vitro and in vivo analysis of the anti-CA activity; animal experiments; staining with propidium iodide (PI), periodic acid-schiff (PAS), and hematoxylin-eosin (H&E); and cytokine experiments were performed to investigate the therapeutic ability against VVC. Results: The optimal formulation and preparation parameters of ENNE were determined as follows: EPS content of 1.5%, PEG400 content of 3.2%, NYS content of 700 µg/mL, paraffin oil content of 5.0%, ultrasonic time of 15 min, and ultrasonic amplitude of 35%. The ENNE showed an encapsulated structure with an average particle size of 131.1 ± 4.32 nm. ENNE exhibited high storage and pH stability, as well as slow release. The minimum inhibitory concentration (MIC) of ENNE against CA was only 0.125 µg/mL and the inhibition zone was 19.0 ± 0.5 mm, for greatly improved anti-CA effect. The prepared ENNE destroyed the membrane of CA cells, and exhibited good anti-CA effect in vivo and therapeutic ability against VVC. Conclusion: The results of this study will promote the application of EPS in nanotechnology, which should lead to new and effective local drug formulations for treating VVC.


Assuntos
Antifúngicos/administração & dosagem , Candidíase Vulvovaginal/tratamento farmacológico , Emulsões/química , Nanoestruturas/administração & dosagem , Nistatina/administração & dosagem , Administração Intravaginal , Animais , Antifúngicos/farmacologia , Candida albicans/efeitos dos fármacos , Citocinas , Emulsificantes/química , Emulsões/administração & dosagem , Feminino , Camundongos Endogâmicos ICR , Testes de Sensibilidade Microbiana , Nanoestruturas/química , Nistatina/farmacologia , Tamanho da Partícula , Polietilenoglicóis/química , Polissacarídeos Bacterianos/química , Ultrassom/métodos
15.
Chest ; 158(1): e9-e13, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32243945

RESUMO

As of March 24, 2020, novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been responsible for 379,661 infection cases with 16,428 deaths globally, and the number is still increasing rapidly. Herein, we present four critically ill patients with SARS-CoV-2 infection who received supportive care and convalescent plasma. Although all four patients (including a pregnant woman) recovered from SARS-CoV-2 infection eventually, randomized trials are needed to eliminate the effect of other treatments and investigate the safety and efficacy of convalescent plasma therapy.


Assuntos
Antivirais , Infecções por Coronavirus , Estado Terminal/terapia , Pandemias , Pneumonia Viral , Complicações Infecciosas na Gravidez , Adulto , Idoso , Antifúngicos/administração & dosagem , Antivirais/administração & dosagem , Antivirais/classificação , Betacoronavirus/isolamento & purificação , Técnicas de Laboratório Clínico/métodos , Infecções por Coronavirus/complicações , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/fisiopatologia , Infecções por Coronavirus/terapia , Oxigenação por Membrana Extracorpórea/métodos , Feminino , Humanos , Imunização Passiva/métodos , Masculino , Pessoa de Meia-Idade , Pneumonia Viral/complicações , Pneumonia Viral/diagnóstico , Pneumonia Viral/microbiologia , Pneumonia Viral/fisiopatologia , Pneumonia Viral/terapia , Gravidez , Complicações Infecciosas na Gravidez/fisiopatologia , Complicações Infecciosas na Gravidez/terapia , Complicações Infecciosas na Gravidez/virologia , Radiografia Torácica/métodos , Respiração Artificial/métodos , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento
16.
J Mycol Med ; 30(2): 100949, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32234349

RESUMO

Onychomycosis is one of the most prevalent and severe nail fungal infections, which is affecting a wide population across the globe. It leads to variations like nail thickening, disintegration and hardening. Oral and topical drug delivery systems are the most desirable in treating onychomycosis, but the efficacy of the results is low, resulting in a relapse rate of 25-30%. Due to systemic toxicity and various other disadvantages associated with oral therapy like gastrointestinal, hepatotoxicity, topical therapy is commonly used. Topical therapy improves patient compliance and reduces the cost of treatment. However, due to poor penetration of topical therapy across the nail plate, research is focused on different chemical, mechanical and physical methods to improve drug delivery. Penetration enhancers like Thioglycolic acid, Hydroxypropyl-ß-cyclodextrin (HP-ß-CD), Sodium lauryl sulfate (SLS), carbocysteine, N-acetylcysteine etc. have shown results enhancing the drug penetration across the nail plate. Results with physical techniques such as iontophoresis, laser and Photodynamic therapy are quite promising, but the long-term suitability of these devices is in need to be determined. In this article, a brief analysis of the treatment procedures, factors affecting drug permeation across nail plate, chemical, mechanical and physical devices used to increase the drug delivery through nails for the onychomycosis management has been achieved.


Assuntos
Onicomicose/terapia , Administração Oral , Administração Tópica , Antifúngicos/administração & dosagem , Antifúngicos/farmacocinética , Química Farmacêutica/métodos , Terapia Combinada , Portadores de Fármacos/química , Portadores de Fármacos/farmacologia , Sistemas de Liberação de Medicamentos , Humanos , Iontoforese/métodos , Iontoforese/tendências , Terapia a Laser/métodos , Terapia a Laser/tendências , Unhas/efeitos dos fármacos , Unhas/metabolismo , Unhas/efeitos da radiação , Onicomicose/tratamento farmacológico , Onicomicose/epidemiologia , Onicomicose/microbiologia , Permeabilidade/efeitos dos fármacos , Permeabilidade/efeitos da radiação , Fotoquimioterapia/métodos , Fotoquimioterapia/tendências
17.
Clin Drug Investig ; 40(6): 575-582, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32314298

RESUMO

BACKGROUND: The predominance of onychomycosis has been increasing recently. New medications and treatment modalities are being researched for better saturation of the antifungal agents through the nail plate topically because of the low resilience of some patients for the oral antifungal agents. Treatment of onychomycosis, mainly moderate to severe, can be very challenging, expensive, and time consuming. OBJECTIVE: The objective of this clinical trial is to compare the efficacy and safety of a manually operated ablative CO2 laser combined with a topical antifungal agent in patients with onychomycosis. STUDY DESIGN: We conducted an open-label controlled prospective study of 160 eligible patients randomized into control and treatment groups with a 1:1 allocation in the department of dermatology in five different hospitals in Shanghai. It was a 6-month study where both groups were treated with a topical antifungal agent, with the treatment group also receiving ablation by the traditional CO2 laser once a month for the first 3 months. RESULTS: The clinical efficacy and mycological cure rate were significantly higher (p < 0.001) for the treatment group. Three (3.75%) patients from the control group and 18 (25%) patients from the treatment group achieved complete nail clearance along with negative potassium hydroxide and negative culture (primary endpoint) results at 24 weeks. Mycological clearance with at least moderate nail clearance (secondary endpoint) for the treatment group was also significantly higher (p < 0.001) for the laser treatment group. The laser treatment was mildly painful but tolerable by the patients. No drug interactions for both groups were encountered. CONCLUSIONS: The ablative CO2 laser is a primitive yet effective modality to be considered for the delivery of topical antifungal agents for the management of mild-to-severe onychomycosis. The laser has good tolerance in patients and is a common equipment found in most dermatology units even those without the latest medical technology.


Assuntos
Antifúngicos/uso terapêutico , Terapia a Laser , Onicomicose/terapia , Administração Tópica , Adulto , Antifúngicos/administração & dosagem , Dióxido de Carbono , China , Terapia Combinada , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Onicomicose/tratamento farmacológico , Estudos Prospectivos , Adulto Jovem
19.
Clin Podiatr Med Surg ; 37(2): 401-407, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32146992

RESUMO

Onychomycosis is especially common among diabetic patients. The purpose of this study was to investigate the efficacy of 10% efinaconazole solution among diabetic subjects, without restriction by nail plate involvement or glycemic control. Forty subjects were enrolled, with 36 reaching their final 50-week follow-up visit. Mycological cure was attained by 21 subjects (58.33%); 8 subjects (20%) attained either clinical cure (0% clinical involvement) or treatment success (≤10% clinical involvement). Glycemic control did not affect clinical outcome. The medication was well tolerated, with 4 local adverse events and no significant adverse events. The medication may represent a useful option for diabetic patients.


Assuntos
Antifúngicos/administração & dosagem , Complicações do Diabetes/complicações , Dermatoses do Pé/tratamento farmacológico , Onicomicose/tratamento farmacológico , Triazóis/administração & dosagem , Administração Tópica , Adulto , Idoso , Glicemia , Feminino , Dermatoses do Pé/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Onicomicose/etiologia , Resultado do Tratamento
20.
J Mycol Med ; 30(2): 100938, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32111505

RESUMO

Onychomycosis are fungal nail infections comprising of about 50% of onychopathies and are commonly caused by dermatophytes. The treatment of this dermatomycosis requires a long period of time and is associated with high rates of recurrence. In view of the need to evaluate the antifungal performance of promising preclinical compounds, we developed, in this study, a practical and accessibleex vivo model for establishing a Trichophyton rubrum onychomycosis framework using porcine hooves. This model has as its main advantage the similar structural and three-dimensional characteristics that the porcine hooves have with the human nail. The proposed model allowed to evaluate the antifungal activity of a new antifungal compound and a reference drug (terbinafine), both already incorporated into a nail lacquer for topical use. Treatments with compound 3-selenocyanate-indole (Se4a) and with terbinafine incorporated into this nail lacquer completely inhibited fungal growth, corresponding to the profile of in vitro activity observed against T. rubrum. This study concludes that the ex vivo porcine hoof model is an effective alternative method for preclinical screening of drugs or new topical compounds developed to combat onychomycosis. Further studies are needed to compare the permeability of porcine hooves with human nails permeability.


Assuntos
Antifúngicos/administração & dosagem , Avaliação Pré-Clínica de Medicamentos/métodos , Casco e Garras/patologia , Onicomicose/tratamento farmacológico , Técnicas de Cultura de Órgãos , Suínos , Administração Tópica , Animais , Antifúngicos/farmacologia , Cianatos/química , Casco e Garras/efeitos dos fármacos , Humanos , Laca , Testes de Sensibilidade Microbiana/métodos , Modelos Biológicos , Onicomicose/patologia , Permeabilidade/efeitos dos fármacos , Compostos de Selênio/química , Terbinafina/administração & dosagem , Terbinafina/farmacologia , Trichophyton/efeitos dos fármacos , Trichophyton/crescimento & desenvolvimento
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