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1.
Neurosurg Clin N Am ; 30(4): 499-508, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31471057

RESUMO

Medical therapy for Cushing disease is primarily used to control hypercortisolism in patients whose disease persists or with recurrent disease after pituitary surgery, including those awaiting the salutary effects of radiation therapy. In can also be used to control hypercortisolism preoperatively, and in patients who decline surgery or whose tumor location is unknown. Steroidogenesis inhibitors, centrally acting agents, and glucocorticoid receptor antagonists are currently available to treat hypercortisolism, and several novel agents are in development. Given the absence of head-to-head clinical trials, choice between treatments has to be individualized based on careful consideration of patient, tumor, and disease characteristics.


Assuntos
Hipersecreção Hipofisária de ACTH/tratamento farmacológico , Cabergolina/uso terapêutico , Etomidato/uso terapêutico , Humanos , Cetoconazol/uso terapêutico , Metirapona/uso terapêutico , Mitotano/uso terapêutico , Hipersecreção Hipofisária de ACTH/complicações , Somatostatina/análogos & derivados , Somatostatina/uso terapêutico , Temozolomida/uso terapêutico , Resultado do Tratamento
2.
J Vet Intern Med ; 33(5): 2235-2238, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31448839

RESUMO

A 11-year-old male neutered Shih Tzu was referred to a tertiary facility with a history of weight loss, decreased appetite, polydipsia, and lethargy. The dog had a 10-year history of nonspecific allergic dermatitis and was being treated with 16 mg/kg of ketoconazole q12h for Malassezia dermatitis. Vague gastrointestinal signs, hypocholesterolemia, and lack of a stress leukogram increased suspicion for hypoadrenocorticism (HA). An adrenocorticotropic hormone (ACTH) stimulation test identified hypocortisolemia on pre- and post-ACTH samples and ketoconazole was discontinued. After a short course of corticosteroid treatment, an ACTH stimulation test was repeated and pre-ACTH cortisol concentration was within the reference range, and the post-ACTH cortisol concentration was mildly increased. The temporal association between return of adequate adrenocortical cortisol production and discontinuation of ketoconazole led to the conclusion that the dog had developed iatrogenic HA secondary to ketoconazole treatment.


Assuntos
Insuficiência Adrenal/veterinária , Doenças do Cão/induzido quimicamente , Doença Iatrogênica/veterinária , Cetoconazol/efeitos adversos , Insuficiência Adrenal/induzido quimicamente , Insuficiência Adrenal/diagnóstico , Hormônio Adrenocorticotrópico/administração & dosagem , Hormônio Adrenocorticotrópico/farmacologia , Animais , Antifúngicos/administração & dosagem , Antifúngicos/efeitos adversos , Antifúngicos/uso terapêutico , Dermatomicoses/tratamento farmacológico , Dermatomicoses/veterinária , Doenças do Cão/diagnóstico , Cães , Hidrocortisona/sangue , Cetoconazol/administração & dosagem , Cetoconazol/uso terapêutico , Malassezia , Masculino
3.
J Toxicol Sci ; 44(6): 405-414, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31168027

RESUMO

Several studies have demonstrated the chemopreventive role of ketoconazole in animal models of liver injury. However, the underlying molecular mechanisms of this hepatoprotective effect are poorly understood. The present study assessed the potential of ketoconazole to enhance resistance to carbon tetrachloride-induced hepatotoxicity in vivo in a rat model. Ketoconazole pretreatment adult male rats were intraperitoneally injected with carbon tetrachloride for 24 hr and various hepatic parameters were analyzed. We observed decreased serum transaminases activity, reduced nuclear RelA/p65 expression, and suppressed production of pro-inflammatory cytokines in the liver tissue. Histopathological examination demonstrated ketoconazole pretreatment to extensively prevent liver injury. In addition, it significantly increased nuclear factor-erythroid 2 p45-related factor 2 (Nrf2) protein expression, glutathione (GSH) to oxidized glutathione (GSSG) ratio, and antioxidant enzymes gene expression. These results suggest that ketoconazole pretreatment ameliorates carbon tetrachloride-induced acute liver injury in rats, signifying its anti-inflammatory and antioxidant functions.


Assuntos
Anti-Inflamatórios/uso terapêutico , Doença Hepática Induzida por Substâncias e Drogas/tratamento farmacológico , Cetoconazol/uso terapêutico , Animais , Anti-Inflamatórios/farmacologia , Tetracloreto de Carbono , Doença Hepática Induzida por Substâncias e Drogas/metabolismo , Doença Hepática Induzida por Substâncias e Drogas/patologia , Citocinas/metabolismo , Glutationa/metabolismo , Cetoconazol/farmacologia , Fígado/efeitos dos fármacos , Fígado/metabolismo , Fígado/patologia , Masculino , Fator 2 Relacionado a NF-E2/metabolismo , Estresse Oxidativo/efeitos dos fármacos , Ratos Sprague-Dawley
4.
Eur J Endocrinol ; 181(1): K1-K9, 2019 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-31048558

RESUMO

Context: Cabergoline has been shown to have some effect in the treatment of moderate Cushing's disease, but its effectiveness in Cushing's syndrome of ectopic or occult origin remains to be investigated. Case series: In this case series, cabergoline was used in combination with steroidogenesis inhibitors in nine patients with severe Cushing's syndrome of ectopic or occult origin. Cabergoline's effectiveness enabled rapid withdrawal of the steroidogenesis inhibitors and long-term control of the hypercortisolism in three of the cases. Review of the literature: In the literature, we found only 11 cases of ectopic or occult Cushing's syndrome treated with dopamine receptor agonists, alone or in combination. Yet of these 11 cases, 10 responded. Conclusions: Although limited, the existing experience highlights the potential value of cabergoline in the treatment of ectopic or occult Cushing's syndrome.


Assuntos
Cabergolina/uso terapêutico , Síndrome de Cushing/tratamento farmacológico , Agonistas de Dopamina/uso terapêutico , Síndrome de ACTH Ectópico/complicações , Síndrome de ACTH Ectópico/diagnóstico , Adulto , Idoso , Tumor Carcinoide/complicações , Tumor Carcinoide/diagnóstico por imagem , Tumor Carcinoide/patologia , Síndrome de Cushing/etiologia , Síndrome de Cushing/metabolismo , Feminino , Humanos , Hidrocortisona/metabolismo , Cetoconazol/uso terapêutico , Neoplasias Hepáticas/complicações , Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias Hepáticas/patologia , Neoplasias Pulmonares/complicações , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/patologia , Masculino , Pessoa de Meia-Idade , Tumores Neuroendócrinos/complicações , Tumores Neuroendócrinos/diagnóstico por imagem , Tumores Neuroendócrinos/patologia , Neoplasias Intraductais Pancreáticas/complicações , Neoplasias Intraductais Pancreáticas/diagnóstico por imagem , Neoplasias Intraductais Pancreáticas/patologia , Neoplasias Retais/complicações , Neoplasias Retais/diagnóstico por imagem , Neoplasias Retais/patologia , Inibidores da Síntese de Esteroides/uso terapêutico , Neoplasias do Timo/complicações , Neoplasias do Timo/diagnóstico por imagem , Neoplasias do Timo/patologia , Resultado do Tratamento
5.
BMJ Case Rep ; 12(2)2019 Feb 06.
Artigo em Inglês | MEDLINE | ID: mdl-30733248

RESUMO

Cushing's syndrome is known to present with a characteristic set of clinical manifestations and complications, well described in literature. However, hypercoagulability remains an under recognised entity in Cushing's syndrome. A 31-year-old woman from Southern India presented with history of fever, left upper quadrant pain and progressive breathing difficulty for 3 weeks. Clinical examination revealed discriminatory features of Cushing's syndrome. Laboratory investigations showed biochemical features of endogenous ACTH-dependent Cushing's syndrome. Imaging of the abdomen revealed splenic collection, left-sided empyema and extensive arterial thrombosis. Gadolinium enhanced dynamic MRI of the pituitary gland revealed no evidence of an adenoma while a Ga-68 DOTATATE positron emission tomography CT scan ruled out an ectopic Cushing's. A diagnosis of endogenous Cushing's syndrome causing a prothrombotic state with extensive arterial thrombosis was made. She was initiated on oral anticoagulation and oral ketoconazole for medical adrenal suppression. She subsequently underwent bilateral adrenalectomy and was well at follow-up.


Assuntos
Doenças da Aorta/diagnóstico por imagem , Síndrome de Cushing/diagnóstico , Trombofilia/diagnóstico , Trombose/diagnóstico por imagem , Hormônio Adrenocorticotrópico/sangue , Adulto , Anticoagulantes/uso terapêutico , Doenças da Aorta/etiologia , Artéria Celíaca/diagnóstico por imagem , Angiografia por Tomografia Computadorizada , Síndrome de Cushing/complicações , Síndrome de Cushing/tratamento farmacológico , Feminino , Artéria Hepática/diagnóstico por imagem , Humanos , Hidrocortisona/sangue , Hidrocortisona/urina , Infarto/diagnóstico por imagem , Infarto/etiologia , Cetoconazol/uso terapêutico , Nefropatias/diagnóstico por imagem , Nefropatias/etiologia , Artéria Mesentérica Superior/diagnóstico por imagem , Artéria Esplênica/diagnóstico por imagem , Infarto do Baço/diagnóstico por imagem , Infarto do Baço/etiologia , Trombofilia/tratamento farmacológico , Trombofilia/etiologia , Trombose/tratamento farmacológico , Trombose/etiologia
6.
J Dermatolog Treat ; 30(8): 757-759, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30668183

RESUMO

Background: Treatment of alopecia areata (AA) involves use of high potency topical corticosteroids under occlusion that, even very effective, can lead to several adverse effects. Objective: We report 10 cases of patients with AA that, after using high potency topical corticosteroids, have developed tinea versicolor of the neck area. Methods: Ten patients with AA, aged 18-38 years, were prescribed with clobetasone propionate 0.05% cream under occlusion every other day but, after 3-4 months of treatment, they returned to our facility complaining the appearance of multiple white or red-brown round or oval macules in the neck area. Results: Diagnosis of pityriasis versicolor was confirmed by direct microscopy examination of skin scrapings in 10% potassion hydroxide (KOH) solution. All patients received systemic antifungal therapy associated with the daily use of ketoconazole shampoo. Conclusion: Tinea versicolor of the neck should be included among a rare but possible side effect of prolonged application of high potency topical steroids on the scalp. These cases reinforce the importance of careful dermatologic examination and recommend preventive measures in patients with alopecia areata that are using these drugs.


Assuntos
Alopecia em Áreas/tratamento farmacológico , Esteroides/uso terapêutico , Tinha Versicolor/diagnóstico , Administração Tópica , Adolescente , Adulto , Antifúngicos/uso terapêutico , Clobetasol/efeitos adversos , Clobetasol/uso terapêutico , Esquema de Medicação , Feminino , Humanos , Cetoconazol/uso terapêutico , Masculino , Pessoa de Meia-Idade , Pescoço , Tinha Versicolor/tratamento farmacológico , Tinha Versicolor/etiologia , Adulto Jovem
7.
J Dermatolog Treat ; 30(8): 760-771, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30668185

RESUMO

Introduction: Although labeling changes and market withdrawal have been implemented for oral ketoconazole (KTZ) due to serious adverse effects (AEs), topical KTZ is generally thought to be effective and safe for the treatment of superficial fungal infections. New dermatologic indications for the use of topical KTZ have arisen such as onychomycosis, blepharitis, and hair loss. This article aims to review the literature on topical KTZ's efficacy and AEs, as well as provide an overview on current insights regarding its mechanism of action and upcoming developments. Methods: A PubMed search was done to include randomized controlled trials (RCTs) focusing on the use of topical KTZ in human subjects. Results: Forty studies with 4566 patients were included in this review. Topical KTZ is clinically effective for the treatment of Malassezia-related conditions such as seborrheic dermatitis (SD) and pityriasis versicolor (PV) with a reported efficacy of 63-90% and 71-89%, respectively. Conclusions: Topical KTZ demonstrates high clinical efficacy for Malassezia-related conditions. More efficacious alternatives are now available for Tinea and Candida. Although topical KTZ is safe, clinicians should be aware that allergic contact dermatitis may occur. Further studies should be completed to investigate the use of topical KTZ for hair loss and inflammatory dermatoses.


Assuntos
Antifúngicos/uso terapêutico , Dermatite Seborreica/tratamento farmacológico , Cetoconazol/uso terapêutico , Tinha Versicolor/tratamento farmacológico , Administração Tópica , Alopecia/diagnóstico , Alopecia/etiologia , Antifúngicos/efeitos adversos , Humanos , Cetoconazol/efeitos adversos , Malassezia/fisiologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Tinha Versicolor/microbiologia , Resultado do Tratamento
8.
Drug Dev Ind Pharm ; 45(4): 689-693, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30632818

RESUMO

We investigated the effect of azole antifungal drugs (ketoconazole, voriconazole, and itraconazole) on the pharmacokinetics of apatinib in rats. The rats in ketoconazole, voriconazole, and itraconazole groups received single-dose apatinib 30 mg/kg after the oral administration of ketoconazole, voriconazole, and itraconazole, respectively. Co-administration of ketoconazole or voriconazole significantly increased the apatinib Cmax and AUC(0-t) and decreased the clearance. Co-administration of itraconazole did not significantly affect the pharmacokinetics parameters of apatinib. It could be concluded that both ketoconazole and voriconazole significantly increase the exposure of apatinib, and affect the pharmacokinetics of apatinib in rat. Apatinib can be co-administered with itraconazole, but ketoconazole and voriconazole should be avoided if possible or be underwent therapeutic drug monitoring of apatinib. A further clinical study should be conducted to investigate the inhibitory effect of azole antifungal drugs on the apatinib plasma concentration.


Assuntos
Antifúngicos/farmacologia , Antineoplásicos/farmacologia , Piridinas/farmacologia , Animais , Antineoplásicos/uso terapêutico , Avaliação Pré-Clínica de Medicamentos , Interações Medicamentosas , Monitoramento de Medicamentos , Itraconazol/farmacologia , Itraconazol/uso terapêutico , Cetoconazol/farmacologia , Cetoconazol/uso terapêutico , Masculino , Micoses/tratamento farmacológico , Piridinas/uso terapêutico , Ratos , Ratos Sprague-Dawley , Neoplasias Gástricas/tratamento farmacológico , Voriconazol/farmacologia , Voriconazol/uso terapêutico
11.
Eur J Endocrinol ; 179(5): L1-L2, 2018 Oct 12.
Artigo em Inglês | MEDLINE | ID: mdl-30320504

RESUMO

We read with interest the paper of Young et al. in which the authors recommend avoiding ketoconazole in the treatment of Cushing's syndrome when patients display increased liver enzymes (>2-fold the upper limit of normal (ULN)). We found in a small series of patients that We read with interest the paper of Young et al. in which the authors recommend avoiding ketoconazole in the treatment of Cushing's syndrome when patients display increased liver enzymes (>2-fold the upper limit of normal (ULN)). Although limited, our experience suggests that liver function tests may improve during ketoconazole treatment and that, in a life-threatening situation such as severe Cushing's syndrome, increased liver enzymes should not preclude ketoconazole prescription.


Assuntos
Síndrome de Cushing/tratamento farmacológico , Cetoconazol/uso terapêutico , Fígado/enzimologia , Adulto , Síndrome de Cushing/enzimologia , Quimioterapia Combinada , Inibidores Enzimáticos/uso terapêutico , Feminino , Humanos , Cetoconazol/efeitos adversos , Masculino , Metirapona/uso terapêutico , Pessoa de Meia-Idade , Resultado do Tratamento
12.
BMC Res Notes ; 11(1): 667, 2018 Sep 14.
Artigo em Inglês | MEDLINE | ID: mdl-30217237

RESUMO

OBJECTIVE: The purpose of our study was to describe the histological diagnosed of the Basidiobolomycosis cases from 1990 to 2017 (28 years) in the only Pathology Anatomy Laboratory in Togo. RESULTS: A total of 12 cases of suspected Basidiobolomycosis have been identified. The sex ratio (M/F) was 2. The average age of the patients was 24.8 ± 1.6 years. Six patients (6/12) had a pathological history: HIV infection (n = 4 cases) and tuberculosis (n = 2 cases). The clinical manifestations were localized to pure skin (n = 9 cases), skin and mucous digestive (n = 2 cases) and disseminated (n = 1 cases). Direct mycological examination and culture in 4 patients was positive in 3 patients. The samples examined consisted of 11 cutaneous biopsies measuring 1-3 cm and a biopsy of the intestinal mucosa. Histology showed granulomatous inflammation of the dermohypodermal site with numerous giant cells associated with eosinophilic polynuclear cells, in which there are 5-7 mm non-septate, irregular mycelial filaments. Patients were treated with ketoconazole at a dose of 10 mg/kg daily. The progression of the patients' condition was favorable after 4 weeks of treatment with a regression of the closets size. Patients were completely healed after 8 weeks of treatment, without recurrence after 6 months. No deaths have been recorded.


Assuntos
Entomophthorales/isolamento & purificação , Zigomicose , Adulto , Antifúngicos/uso terapêutico , Feminino , Infecções por HIV , Humanos , Cetoconazol/uso terapêutico , Masculino , Togo , Adulto Jovem , Zigomicose/complicações , Zigomicose/diagnóstico , Zigomicose/tratamento farmacológico
13.
Invest New Drugs ; 36(6): 1085-1092, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30191523

RESUMO

Introduction Ketoconazole is CYP-17 inhibitor with demonstrated activity in men with castration-resistant prostate cancer (CRPC). Lenalidomide is an antiangiogenic and immunomodulatory agent with broad antitumor activity. We hypothesized that the modulation of the cellular immune response to apoptosis caused by ketoconazole may be increased with the addition of lenalidomide. Methods This is an open-label, non-randomized, single-arm phase II study evaluating the efficacy and safety of the combination of ketoconazole and lenalidomide in patients with CRPC. Treatment schema included standard ketoconazole 400 mg orally three times daily plus hydrocortisone orally (20 mg in the morning and 10 mg at night) in combination with lenalidomide 25 mg orally daily for 21 days in a 28-day cycle and aspirin 75 mg daily. The primary endpoint of this study was response (either by ≥ 50% PSA decline or objective disease assessed by RECIST v1.0). Exploratory endpoints included changes in T cell, dendritic cell (DC) marker counts, and their correlation with PSA response to treatment. Results A total of 34 CRPC patients, median age 69 years, 76% ECOG 0 and 76% with metastases participated in the study. Patients received a median of 2 cycles (range 1-35); nine patients (26%) received >10 cycles of treatment. PSA responses were observed in 17 patients (50%) with 11 patients (32%) achieving a PSA decline of >90%. Among the 9 patients with measurable disease, 2 patients (22%) had PR and 2 other (22%) had SD as best response. Median time to failure (TTF) was 2.7 months (range 0.2-32.8); and 8 patients were treated for ≥ 15 months. Most common adverse events included fatigue (76%), skin reactions (62%), lymphopenia (44%) and anemia (44%). One possible treatment-related death was noted. For 16 patients with available serial correlative data, there was a significant increase in the dendritic cells subsets BDCA-1 (+146.7, -20.1 to +501.1%, p = 0.018) and BDCA-3 (39.8%, -100 to 282.6%, p = 0.001) after 8 weeks of treatment. No association between immune cell counts and PSA response at 8 weeks was observed. Conclusion The combination of ketoconazole and lenalidomide was well tolerated but did not meet the primary endpoint of response, despite durable responses were observed in a selected group of patients. Although ketoconazole has now been replaced with more active novel agents, the combination of novel CYP-17 inhibitors with agents capable of modulating the immune system warrants further prospective investigation. NCT00460031.


Assuntos
Cetoconazol/uso terapêutico , Lenalidomida/uso terapêutico , Neoplasias de Próstata Resistentes à Castração/tratamento farmacológico , Idoso , Idoso de 80 Anos ou mais , Humanos , Cetoconazol/administração & dosagem , Cetoconazol/efeitos adversos , Lenalidomida/administração & dosagem , Lenalidomida/efeitos adversos , Masculino , Pessoa de Meia-Idade , Antígeno Prostático Específico/metabolismo , Tempo para o Tratamento , Resultado do Tratamento
14.
Vet Dermatol ; 29(6): 476-e160, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30251451

RESUMO

BACKGROUND: Malassezia pachydermatis is an opportunistic yeast involved in skin and ear canal infections of dogs and cats. Reports suggest that strains of M. pachydermatis resistant to commonly used antifungal agents may be emerging. Therefore, new therapeutic strategies should be explored. OBJECTIVES: The synergistic effect of oxythiamine (OT) and ketoconazole (KTC) was analysed using a reference strain and field isolates (n = 66) of M. pachydermatis. Hydrogel formulations containing these components also were evaluated. METHODS AND MATERIALS: The minimum inhibitory concentrations (MICs) and minimum fungicidal concentrations (MFCs) of OT, KTC and their mixtures were determined by a broth macrodilution method. The antifungal effects of hydrogel formulations were determined by a plate diffusion method. RESULTS: The MIC and MFC values of OT were in the range 0.08 × 103 to 10 × 103  mg/L. All M. pachydermatis strains showed higher susceptibility to KTC (MICs and MFCs in the range 0.04-0.32 mg/L). Formulations that combined OT and KTC showed a synergistic effect for all tested isolates (n = 66). Hydrogels that contained OT at a concentration of 10 × 103 or 20 × 103  mg/L and KTC at the concentration of 0.1 × 103  mg/L showed a stronger effect than a commercially available product with KTC alone (20 × 103  mg/L). CONCLUSIONS AND CLINICAL IMPORTANCE: Synergy of these drugs may allow for successful topical treatment which utilizes lower doses of KTC without changing its therapeutic effectiveness. Hydrogel formulations proved to be attractive drug carriers for potential topical use.


Assuntos
Antifúngicos/uso terapêutico , Dermatomicoses/veterinária , Doenças do Cão/microbiologia , Cetoconazol/uso terapêutico , Malassezia , Otite Externa/veterinária , Oxitiamina/uso terapêutico , Animais , Antifúngicos/administração & dosagem , Dermatomicoses/tratamento farmacológico , Doenças do Cão/tratamento farmacológico , Cães , Sinergismo Farmacológico , Quimioterapia Combinada , Hidrogel de Polietilenoglicol-Dimetacrilato/administração & dosagem , Cetoconazol/administração & dosagem , Malassezia/efeitos dos fármacos , Testes de Sensibilidade Microbiana/veterinária , Otite Externa/tratamento farmacológico , Otite Externa/microbiologia , Oxitiamina/administração & dosagem
15.
Nat Rev Urol ; 15(10): 643-651, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-30154429

RESUMO

Ketoconazole is a nonselective steroid 17α-hydroxylase/17,20 lyase (CYP17A1) inhibitor that has been used, off-label, as a second-line therapy for castration-resistant prostate cancer (CRPC). The drug has shown clinical efficacy without survival benefit. Despite not improving survival, ketoconazole has beneficial characteristics, such as its low cost, a relatively favourable toxicity profile compared with chemotherapy, and its efficacy both before and after chemotherapy. The approval of several new, highly effective treatments, including abiraterone acetate, enzalutamide, and apalutamide, warrants re-evaluation of the role of ketoconazole and other classic agents in achieving the optimal timing and sequencing of available agents to prolong survival and maintain patients' quality of life. In the current CRPC treatment landscape, we believe that ketoconazole can be considered in patients with nonmetastatic CRPC and in those with metastatic CRPC who do not respond to, tolerate, or have access to chemotherapy and other standard therapeutic options.


Assuntos
Antineoplásicos/uso terapêutico , Inibidores do Citocromo P-450 CYP3A/uso terapêutico , Cetoconazol/uso terapêutico , Neoplasias da Próstata/tratamento farmacológico , Humanos , Masculino , Falha de Tratamento
16.
J Pak Med Assoc ; 68(5): 715-720, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-29885168

RESUMO

OBJECTIVE: To evaluate the efficacy and safety of myrtus communis L. solution in the treatment of dandruff and to compare it with ketoconazole. METHODS: This double-blind randomised clinical trial was conducted at Shiraz University of Medical Sciences, Shiraz, Iran, from December 2015 to August 2016, and comprised patients with dandruff aged 18-60 years visiting the dermatology out-patient clinic. The subjects were randomised into two equal groups. The treatment group received myrtus communis L. solution and a placebo shampoo, while the control group received ketoconazole shampoo and a placebo solution. The total duration of the study for each subject was one month and subjects in both groups used their respective interventions 8 times during that period. The parameters studied were pruritus, erythema, severity of scaling, and the extent of scalp involvement. All subjects underwent scalp scaling tests at the beginning, after 10 days and at the end of the 30th day. SPSS 21 was used for data analysis. RESULTS: Of the 90 individuals, there were 45(50%) in each of the two groups. However, 74(82%) subjects completed the third visit and, of them, there were 37(50%) in each group. Both groups showed significant improvement in all outcome measures (p<0.001). There were no significant differences between the groups in terms of efficacy, satisfaction rate and side effects (p>0.05 for each outcome). CONCLUSIONS: Myrtus solution was found to be effective in the treatment of dandruff.


Assuntos
Antifúngicos/uso terapêutico , Caspa/tratamento farmacológico , Cetoconazol/uso terapêutico , Myrtus , Fitoterapia , Preparações de Plantas/uso terapêutico , Adulto , Antifúngicos/efeitos adversos , Caspa/complicações , Método Duplo-Cego , Eritema/etiologia , Feminino , Preparações para Cabelo/uso terapêutico , Humanos , Cetoconazol/efeitos adversos , Masculino , Satisfação do Paciente , Fitoterapia/efeitos adversos , Preparações de Plantas/efeitos adversos , Prurido/etiologia , Índice de Gravidade de Doença , Adulto Jovem
18.
ACS Nano ; 12(7): 6851-6859, 2018 07 24.
Artigo em Inglês | MEDLINE | ID: mdl-29851454

RESUMO

The existing approaches to onychomycosis demonstrate limited success since the commonly used oral administration and topical cream only achieve temporary effective drug concentration at the fungal infection sites. An ideal therapeutic approach for onychomycosis should have (i) the ability to introduce antifungal drugs directly to the infected sites; (ii) finite intradermal sustainable release to maintain effective drug levels over prolonged time; (iii) a reporter system for monitoring maintenance of drug level; and (iv) minimum level of inflammatory responses at or around the fungal infection sites. To meet these expectations, we introduced ketoconazole-encapsulated cross-linked fluorescent supramolecular nanoparticles (KTZ⊂c-FSMNPs) as an intradermal controlled release solution for treating onychomycosis. A two-step synthetic approach was adopted to prepare a variety of KTZ⊂c-FSMNPs. Initial characterization revealed that 4800 nm KTZ⊂c-FSMNPs exhibited high KTZ encapsulation efficiency/capacity, optimal fluorescent property, and sustained KTZ release profile. Subsequently, 4800 nm KTZ⊂c-FSMNPs were chosen for in vivo studies using a mouse model, wherein the KTZ⊂c-FSMNPs were deposited intradermally via tattoo. The results obtained from (i) in vivo fluorescence imaging, (ii) high-performance liquid chromatography quantification of residual KTZ, (iii) matrix-assisted laser desorption/ionization mass spectrometry imaging mapping of KTZ distribution in intradermal regions around the tattoo site, and (iv) histology for assessment of local inflammatory responses and biocompatibility, suggest that 4800 nm KTZ⊂c-FSMNPs can serve as an effective treatment for onychomycosis.


Assuntos
Antifúngicos/uso terapêutico , Reagentes para Ligações Cruzadas/química , Corantes Fluorescentes/química , Dermatoses do Pé/tratamento farmacológico , Cetoconazol/uso terapêutico , Nanopartículas/química , Onicomicose/tratamento farmacológico , Animais , Antifúngicos/química , Feminino , Cetoconazol/química , Substâncias Macromoleculares/química , Camundongos , Camundongos Nus , Estrutura Molecular , Tamanho da Partícula , Propriedades de Superfície
19.
J Eur Acad Dermatol Venereol ; 32(12): 2264-2274, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-29797669

RESUMO

BACKGROUND: Tinea capitis is the most common cutaneous fungal infection in children. OBJECTIVES: This review aims to evaluate the differences that exist between medications for the treatment of tinea capitis, to determine whether there are any significant adverse effects associated and to define the usefulness of sample collection methods. METHODS: We conducted a systematic literature search of available papers using the databases PubMed, OVID, Cochrane Libraries and ClinicalTrials.gov. Twenty-one RCTs and 17 CTs were found. RESULTS: Among the different antifungal therapies (oral and combination thereof), continuous itraconazole and terbinafine had the highest mycological cure rates (79% and 81%, respectively), griseofulvin and terbinafine had the highest clinical cure rates (46% and 58%, respectively) and griseofulvin and terbinafine had the highest complete cure rate (72% and 92%, respectively). Griseofulvin more effectively treated Microsporum infections; terbinafine and itraconazole more effectively cured Trichophyton infections. Only 1.0% of children had to discontinue medication based on adverse events. T. tonsurans was the most common organism found in North America, and hairbrush collection method is the most efficient method of sample collection. Additionally, using a hairbrush, toothbrush or cotton swab to identify the infecting organism(s) is the least invasive and most efficient method of tinea capitis sample collection in children. CONCLUSIONS: Current dosing regimens of reported drugs are effective and safe for use in tinea capitis in children.


Assuntos
Antifúngicos/uso terapêutico , Griseofulvina/uso terapêutico , Itraconazol/uso terapêutico , Terbinafina/uso terapêutico , Tinha do Couro Cabeludo/diagnóstico , Tinha do Couro Cabeludo/tratamento farmacológico , Administração Cutânea , Administração Oral , Antifúngicos/administração & dosagem , Criança , Quimioterapia Combinada , Fluconazol/uso terapêutico , Griseofulvina/administração & dosagem , Humanos , Itraconazol/administração & dosagem , Cetoconazol/uso terapêutico , Microsporum/isolamento & purificação , Manejo de Espécimes/métodos , Terbinafina/administração & dosagem , Tinha do Couro Cabeludo/microbiologia , Trichophyton/isolamento & purificação
20.
Acta Trop ; 185: 69-76, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-29733808

RESUMO

Leishmaniasis is a group of parasitic disease caused by protozoa of Leishmania genus. Leishmania major accounts for the cutaneous leishmaniasis (CL). The current treatments of this disease are expensive with high toxicity and are associated to difficulties of healing and parasite resistance. Miltefosine and ketoconazole have been found to be effective against CL. In this study, miltefosine- and ketoconazole-loaded nanoniosomes were prepared by the thin film-hydration method, and their anti-leishmanial effects against Leishmania major promastigotes and amastigotes were evaluated. The particle size and zeta potential of the nanoniosomes were determined. Release from the formulations showed enhanced and controlled dissolution of the drugs. The miltefosine- and ketoconazole-loaded nanoniosomes inhibited the growth of promastigote and amastigote forms of Leishmania major in vitro after 48 h of incubation and had IC50 values of 53.39 ±â€¯0.02 and 86.38 ±â€¯0.07 µg mL-1, respectively. The formulations provided improved anti-leishmanial activities for the treatment of cutaneous leishmaniasis.


Assuntos
Antiprotozoários/uso terapêutico , Cetoconazol/uso terapêutico , Leishmania major/efeitos dos fármacos , Leishmaniose Cutânea/tratamento farmacológico , Nanoestruturas , Fosforilcolina/análogos & derivados , Animais , Antiprotozoários/farmacologia , Cetoconazol/farmacologia , Fosforilcolina/farmacologia , Fosforilcolina/uso terapêutico
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