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1.
Rev Med Suisse ; 17(720-1): 80-84, 2021 Jan 13.
Artigo em Francês | MEDLINE | ID: mdl-33443836

RESUMO

The main pharmacovigilance updates in 2020 are reviewed. Remdesivir in COVID-19: relatively safe but turns out to be less effective than expected. Hydroxychloroquine in COVID-19 : lack of efficacy and risk of arrhythmias. Cytokines storm in COVID-19: may impact pharmacokinetics. VEGF inhibitors: risk of aneurysm and artery dissection. Tofacitinib: dose-dependant risk of venous thromboembolic events. Ondansetron in the first trimester of pregnancy : a highly debated risk of orofacial cleft defects. Fingolimod : contraindicated during pregnancy due to suspected risk of congenital malformations. Ranitidine: global market withdrawal due to contamination with nitrosamines. Ulipristal for uterine fibroids : market withdrawal due to risk of severe liver injury. Ingenol mebutate : market withdrawal due to paradoxical risk of skin cancers.


Assuntos
Farmacovigilância , Monofosfato de Adenosina/análogos & derivados , Monofosfato de Adenosina/uso terapêutico , Alanina/análogos & derivados , Alanina/uso terapêutico , Fenda Labial/prevenção & controle , Contraindicações de Medicamentos , Síndrome da Liberação de Citocina/virologia , Feminino , Cloridrato de Fingolimode/efeitos adversos , Humanos , Hidroxicloroquina/efeitos adversos , Leiomioma/tratamento farmacológico , Norpregnadienos/uso terapêutico , Farmacocinética , Gravidez , Ranitidina/efeitos adversos , Retirada de Medicamento Baseada em Segurança , Neoplasias Cutâneas/induzido quimicamente
2.
Pan Afr Med J ; 35(Suppl 2): 150, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33193965

RESUMO

The new coronavirus 2019 epidemic declared in China on December 31, 2019 soon spread to the rest of the world, becoming the subject of an unprecedented health pandemic according to the World Health Organization's declaration of March 11, 2020. It is a disease that has the potential to cause multiple systemic infections. We report here the case of an acute polyradiculoneuritis of the Guillain-Barré type (GBS) indicative of a COVID-19 infection. This is a 41 year old patient seen for ascending, symmetrical and bilateral, progressive and acute tetraparesis with in a context of influenza syndrome and digestive infections treated 2 weeks earlier. During a COVID-19 infection, certain inflammatory cells stimulated by the virus produce inflammatory cytokines creating immune-mediated processes. The same mechanism is observed in GBS being also an immune-mediated disorder. The management of this disease in COVID-19 positive patients does not differ from that of patients who do not carry the virus. The risk of respiratory distress in COVID-19 positive patients becomes twice as great in patients with GBS who test positive for COVID-19 at the same time. Monitoring for hemodynamic disorders and respiratory distress in a neuro-intensive care unit may be fruitful.


Assuntos
Betacoronavirus/patogenicidade , Infecções por Coronavirus/complicações , Síndrome de Guillain-Barré/etiologia , Pneumonia Viral/complicações , Adulto , Fibrilação Atrial/complicações , Azitromicina/uso terapêutico , Betacoronavirus/isolamento & purificação , Cloroquina/efeitos adversos , Cloroquina/uso terapêutico , Técnicas de Laboratório Clínico , Terapia Combinada , Contraindicações de Medicamentos , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/terapia , Diagnóstico Precoce , Síndrome de Guillain-Barré/diagnóstico , Síndrome de Guillain-Barré/fisiopatologia , Síndrome de Guillain-Barré/terapia , Humanos , Masculino , Debilidade Muscular/etiologia , Nasofaringe/virologia , Transtornos do Olfato/etiologia , Oxigenoterapia , Pandemias , Pneumonia Viral/diagnóstico , Pneumonia Viral/terapia , Quadriplegia/etiologia , Respiração Artificial , Incontinência Urinária/etiologia
4.
Bull Cancer ; 107(11): 1108-1117, 2020 Nov.
Artigo em Francês | MEDLINE | ID: mdl-33012503

RESUMO

INTRODUCTION: Cancer patients are particularly at risk for drug interactions. However, in oncology, this risk has not been studied in depth in France. The main objective of this study was to describe the proportion of drug interactions in patients with lung or digestive cancer. METHODS: The drug prescriptions of 93 patients were analyzed from may 27th, 2019 to July 07th, 2019 using two software programs (Thériaque™ and DDI Predictor™) in oncology patients hospitalized in our comprehensive cancer center. RESULTS: Of the 88 patients included in the study, 544 drug interactions were identified, in 66 patients (75.0%, 95% CI: 64.6-83.6). For 20/88 patients (22.7% CI: 14.5-32.9) a non-recommended combination or a theoretical contraindication was reported. Etoposide was the anticancer molecule most involved in combinations that are contraindicated or not recommended. No combinations defined as not recommended or contraindicated were observed in any of the 49 patients treated with chemotherapy during their hospitalization. The most common toxicities were alertness and metabolic disorders, including hyperkalemia. The use of three or more drugs was a risk factor for drug interactions (83 vs. 23%, P<0.001). CONCLUSION: Drug interactions remain a major concern in cancer hospitalized patients. It is important to continue and strengthen the collaboration between physicians and pharmacists in order to better prevent their occurrence.


Assuntos
Antineoplásicos/efeitos adversos , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Neoplasias do Sistema Digestório/tratamento farmacológico , Neoplasias Pulmonares/tratamento farmacológico , Adulto , Idoso , Idoso de 80 Anos ou mais , Antineoplásicos/uso terapêutico , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Contraindicações de Medicamentos , Interações Medicamentosas , Etoposídeo/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Polimedicação , Estudos Retrospectivos , Adulto Jovem
7.
Rheumatol Int ; 40(12): 2015-2021, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-32945944

RESUMO

The objective of this study is to describe the characteristics and outcomes of rheumatic and musculoskeletal disease (RMD) patients who were treated with rituximab and had suspected or confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. In this descriptive study, RMD patients who were treated with rituximab in the last 12 months at the Rheumatology Department of our hospital were screened for SARS-CoV-2 infection via telephone interview and a comprehensive review of clinical health records (01/02/2020-26/05/2020). Those with probable or confirmed SARS-CoV-2 infection were included. In total, 76 patients were screened. Of these, 13 (17.1%) had suspected or confirmed SARS-CoV-2 infection. With regard to these 13 patients, the median age at coronavirus disease (COVID-19) diagnosis was 68 years (range 28-76 years) and 8 (61.5%) were female. Five patients had rheumatoid arthritis, three had systemic vasculitis, two had Sjögren syndrome, and two had systemic lupus erythematosus. Additionally, seven patients (53.8%) had pulmonary involvement secondary to RMD. Eight patients (61.5%) developed severe disease leading to hospitalization, and seven developed bilateral pneumonia and respiratory insufficiency. Of the eight hospitalized patients, five (62.5%) fulfilled the acute respiratory distress syndrome criteria and three developed a critical disease and died. Our cohort had a high rate of severe disease requiring hospitalization (61.5%), with bilateral pneumonia and hyperinflammation leading to a high mortality rate (23.1%). Treatment with rituximab should be considered a possible risk factor for unfavorable outcomes in COVID-19 patients with RMD. However, further study is required to confirm this association.


Assuntos
Artrite Reumatoide/tratamento farmacológico , Infecções por Coronavirus/mortalidade , Fatores Imunológicos/efeitos adversos , Lúpus Eritematoso Sistêmico/tratamento farmacológico , Pneumonia Viral/mortalidade , Rituximab/efeitos adversos , Adulto , Idoso , Artrite Reumatoide/complicações , Betacoronavirus , Contraindicações de Medicamentos , Infecções por Coronavirus/diagnóstico , Feminino , Humanos , Fatores Imunológicos/administração & dosagem , Lúpus Eritematoso Sistêmico/complicações , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/diagnóstico , Estudos Retrospectivos , Rituximab/administração & dosagem , Índice de Gravidade de Doença
8.
J Stroke Cerebrovasc Dis ; 29(10): 105052, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32912529

RESUMO

BACKROUND AND PURPOSE: Role of peri-procedural heparin as an adjuvant treatment during mechanical thrombectomy (MT) for patients contra-indicated for alteplase remains a source of debate. METHODS: We included patients from the multicenter French register ETIS that underwent MT without administration of alteplase, and compared patients who received heparin during MT with patients who did not. Heparin impact on outcome were analyzed regarding final TICI score, NIHSS at day one, modified rankin scale (mRS) and intracranial hemorrhagic transformation on imaging at day one. RESULTS: Over 1031 patients, 751 were included between January 2015 and June 2018 in 6 different centers, and 223 (26.69%) received heparin. Heparin administration was associated with a significant deleterious effect on NIHSS at 24h [adjusted OR = 1.2; p = 0.02], mRS at 3 months [adjusted OR 1.58; p = 0.03], and on complete reperfusion [TICI 3 adjusted OR 0.68; p = 0.02]. Heparin administration was associated with a significant reduction of hemorrhagic transformation [adjusted OR 0.48; p = 0.00005]. CONCLUSIONS: Heparin administration during MT seems deleterious for reperfusion and functional outcome. Randomized trials are needed to identify the role of antithrombotic treatments, such as heparin, in the setting of acute ischemic stroke management.


Assuntos
Anticoagulantes/efeitos adversos , Isquemia Encefálica/terapia , Contraindicações de Medicamentos , Fibrinolíticos/efeitos adversos , Heparina/administração & dosagem , Acidente Vascular Cerebral/terapia , Trombectomia , Terapia Trombolítica/efeitos adversos , Ativador de Plasminogênio Tecidual/efeitos adversos , Idoso , Idoso de 80 Anos ou mais , Anticoagulantes/administração & dosagem , Isquemia Encefálica/diagnóstico , Feminino , França , Heparina/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , Sistema de Registros , Estudos Retrospectivos , Fatores de Risco , Acidente Vascular Cerebral/diagnóstico , Trombectomia/efeitos adversos , Fatores de Tempo , Resultado do Tratamento
9.
Bull Cancer ; 107(11): 1171-1185, 2020 Nov.
Artigo em Francês | MEDLINE | ID: mdl-32988609

RESUMO

Breast cancer is the most frequently diagnosed cancer in women and the first cause of cancer death in France. Among the different subtypes of breast cancer, the predominant form is characterized by positive hormone receptors (more than 70% of breast cancers). Hormone therapy thus plays a key role in the strategy of management of these cancers both in adjuvant and metastatic situations. The two types of adjuvant hormone therapy used are selective estrogen receptor modulators and aromatase inhibitors. Fulvestrant, an anti-estrogen, is used alone or in combination with other molecules in metastatic situations. Hot flashes are one of the symptoms most frequently reported by patients under hormone therapy. Hormone replacement therapy, which is currently the most effective treatment for hot flashes, is contraindicated in patients with a personal history of breast cancer. Various therapeutic classes of drugs have been tested in this indication but without real efficacy in the various studies carried out to date, and moreover associated with non-negligible side effects. The recent discovery of the implication of the kisspeptin system located at the hypothalamic level in the mechanism of genesis of hot flashes opens the way to possible new symptomatic treatments for hot flashes. Neurokinin 3 receptor antagonists have shown encouraging preliminary results in postmenopausal cancer-free patients and could be considered in patients in hormonal therapy for breast cancer. Broader additional studies are needed to confirm these initial results.


Assuntos
Antineoplásicos Hormonais/uso terapêutico , Inibidores da Aromatase/uso terapêutico , Neoplasias da Mama/química , Neoplasias da Mama/tratamento farmacológico , Fogachos/etiologia , Moduladores Seletivos de Receptor Estrogênico/uso terapêutico , Contraindicações de Medicamentos , Terapia de Reposição de Estrogênios/efeitos adversos , Feminino , Fulvestranto/uso terapêutico , Humanos , Kisspeptinas/fisiologia , Ovário/efeitos dos fármacos , Ovário/cirurgia , Receptores da Neurocinina-3/antagonistas & inibidores , Moduladores Seletivos de Receptor Estrogênico/administração & dosagem , Tamoxifeno/administração & dosagem , Tamoxifeno/uso terapêutico
10.
Pediatrics ; 146(4)2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32900875

RESUMO

This statement updates the recommendations of the American Academy of Pediatrics for the routine use of influenza vaccine and antiviral medications in the prevention and treatment of influenza in children during the 2020-2021 season.The American Academy of Pediatrics (AAP) recommends routine influenza immunization of all children without medical contraindications, starting at 6 months of age. Influenza vaccination is an important intervention to protect vulnerable populations and reduce the burden of respiratory illnesses during the severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2) pandemic. Any licensed, recommended, age-appropriate vaccine available can be administered, without preference for one product or formulation over another.Antiviral treatment of influenza with any licensed, recommended, age-appropriate influenza antiviral medication is recommended for children with suspected or confirmed influenza who are hospitalized, have severe or progressive disease, or have underlying conditions that increase their risk of complications of influenza. Antiviral treatment may be considered for any previously healthy, symptomatic outpatient not at high risk for influenza complications in whom an influenza diagnosis is confirmed or suspected, if treatment can be initiated within 48 hours of illness onset, and for children whose siblings or household contacts either are younger than 6 months or have a high-risk condition that predisposes them to complications of influenza.


Assuntos
Vacinas contra Influenza , Influenza Humana/prevenção & controle , Antivirais/uso terapêutico , Criança , Pré-Escolar , Contraindicações de Medicamentos , Hospitalização/estatística & dados numéricos , Humanos , Esquemas de Imunização , Hospedeiro Imunocomprometido , Lactente , Vacinas contra Influenza/administração & dosagem , Vacinas contra Influenza/efeitos adversos , Influenza Humana/tratamento farmacológico , Influenza Humana/epidemiologia , Influenza Humana/mortalidade , Vacinação em Massa , Fatores de Risco , Estados Unidos/epidemiologia , Cobertura Vacinal , Vacinas Atenuadas/efeitos adversos , Vacinas de Produtos Inativados/efeitos adversos
11.
Emerg Med Clin North Am ; 38(4): 903-917, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32981625

RESUMO

Care of the critically ill pregnant patient is anxiety-provoking for those unprepared, as the emergency physician must consider not only the welfare of the immediate patient, but of the fetus as well. Familiarity with the physiologic changes of pregnancy and how they affect clinical presentation and management is key. Although some medications may be safer in pregnancy than others, stabilizing the pregnant patient is paramount. Emergency physicians should target pregnancy-specific oxygen and ventilation goals and hemodynamics and should be prepared to perform a perimortem cesarean section, should the mother lose pulses, to increase chances for maternal and fetal survival.


Assuntos
Complicações na Gravidez/terapia , Ressuscitação/métodos , Manuseio das Vias Aéreas , Gasometria , Cesárea , Contraindicações de Medicamentos , Estado Terminal , Serviço Hospitalar de Emergência , Feminino , Monitorização Fetal , Parada Cardíaca/etiologia , Parada Cardíaca/terapia , Humanos , Hipnóticos e Sedativos/administração & dosagem , Intubação Intratraqueal , Troca Materno-Fetal , Ventilação não Invasiva , Circulação Placentária , Gravidez/fisiologia , Complicações na Gravidez/diagnóstico , Insuficiência Respiratória/terapia , Choque/terapia
12.
Medicine (Baltimore) ; 99(30): e20762, 2020 Jul 24.
Artigo em Inglês | MEDLINE | ID: mdl-32791667

RESUMO

OBJECTIVES: Septic shock is the major cause of childhood mortality. However, the application of corticosteroids remains controversial. This work aimed to analyze the source of controversy based on existing data and recent randomized controlled trials by meta-analysis and to assess whether it can avoid these factors to guide clinical treatment. METHODS: We searched the public databases up to 8 June 2019 and included only randomized controlled trials. The primary outcome was mortality. Sensitivity analysis, subgroup analysis, and dose-response meta-analysis were performed in this work. RESULTS: We included twelve studies consisting of 701 children in the meta-analysis. For primary outcome, the fixed-effect model showed steroids could significantly reduce the mortality compared to the control (Odds Ratio: 0.67; 95% confidence interval: 0.46-0.98; P = .041). However, the random-effect model showed a negative result (Odds Ratio: 0.69; 95% confidence interval: 0.32-1.51; P = .252). None of the subgroup results rejected the null hypothesis that the overall effect equaled zero. Dose-response effect analysis showed that increased dosage at a low dosage might reduce the mortality, while at a high dosage, increasing the dose might increase the mortality. Moreover, the grading of recommendations assessment, development, and evaluation level of evidence is low for mortality. CONCLUSIONS: Corticosteroid application is not recommended for septic shock children under current medical conditions.


Assuntos
Corticosteroides/uso terapêutico , Choque Séptico/tratamento farmacológico , Criança , Contraindicações de Medicamentos , Humanos
14.
Orv Hetil ; 161(32): 1310-1321, 2020 08.
Artigo em Húngaro | MEDLINE | ID: mdl-32750019

RESUMO

Due to the COVID-19 pandemic caused by infection with the novel, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), transplant medicine also had to face a new, hitherto unknown challenge. To be prepared for any possibility, we consider it important to summarize the current knowledge regarding COVID-19 of liver and kidney transplant patients. Very early reports from Spanish and French registry recorded fatality rates of 18.6% and 13%, respectively, in renal patients which suggests a moderately worse outcome compared to the general population. In patients with positive PCR test but not showing clinical signs, the reduction of immunosuppression is not advised. In the case of gastrointestinal or respiratory signs with fever, the discontinuation of mycophenolate or mTOR inhibitors is recommended with decrease of the trough levels of calcineurin inhibitors to the lowest effective limit. Stop (kidney transplanted patients) or decrease (liver transplanted patients) immunosuppression and maintain corticosteroids when pulmonal injury develops and consider anti-IL1 and anti-IL6 monoclonal antibody use when hyperinflammatory syndrome is evolving. No proven effective treatment for SARS-CoV-2 exists currently. The use of lopinavir/ritonavir should be avoided because of the severe drug interaction with calcineurin inhibitors. The efficacy and tolerability of hidroxychloroquin remains to be also questionable; enroll patients into clinical trial with remdesivir or favipiravir if available. COVID-19 is characterized by virus-induced endothelial dysfunction, procoagulant state and renin-angiotensin-aldosteron system imbalance. Early thromboprofilaxis combination with low-molecular-weight heparin and low-dose aspirin is strongly recommended with the maintenance of angiotensin-converting enzyme inhibitor (ACEI) or angiotensin-II-receptor blocker (ARB) therapy when they were prescribed earlier. Orv Hetil. 2020; 161(32): 1310-1321.


Assuntos
Infecções por Coronavirus/complicações , Transplante de Rim , Transplante de Fígado , Pneumonia Viral/complicações , Transplantados , Corticosteroides/uso terapêutico , Betacoronavirus , Inibidores de Calcineurina/efeitos adversos , Contraindicações de Medicamentos , Combinação de Medicamentos , Interações Medicamentosas , Humanos , Imunossupressão , Lopinavir/efeitos adversos , Pandemias , Ritonavir/efeitos adversos
15.
Headache ; 60(8): 1558-1568, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32648592

RESUMO

OBJECTIVE: To summarize the current literature on non-steroidal anti-inflammatory drug and corticosteroid use during the coronavirus disease 2019 (COVID-19) pandemic, recognizing that these are commonly used treatments in the field of headache medicine. BACKGROUND: The use of non-steroidal anti-inflammatory drugs and corticosteroids in patients during the COVID-19 pandemic has been a controversial topic within the medical community and international and national health organizations. Lay press and social media outlets have circulated opinions on this topic despite the fact that the evidence for or against the use of these medications is sparse. In the field of headache medicine, these medications are used commonly and both patients and clinicians may have questions or hesitations pertaining to their use during the COVID-19 pandemic. METHODS: A detailed search of the scientific and popular literature was performed. RESULTS: There is limited literature pertaining to the safety of non-steroidal anti-inflammatory drugs and corticosteroids during the COVID-19 pandemic. To date, there are no clear scientific data that preclude the use of non-steroidal anti-inflammatory drugs in the general population who may acquire COVID-19 or in those acutely infected with the virus. Several health organizations have concluded that treatment with corticosteroids during active infection should be avoided due to concerns of prolonged viral shedding in the respiratory tract and the lack of survival benefit based on the data from past coronaviruses and influenza virus; specific exceptions exist including treatment for underlying asthma or chronic obstructive pulmonary disease, septic shock, and acute respiratory distress syndrome. CONCLUSION: Scientific information regarding the COVID-19 pandemic is constantly evolving, and limited or contradictory information can lead to confusion for both patients and clinicians. It is recommended that prior to prescribing non-steroidal anti-inflammatory drugs and steroids for the treatment of headache, clinicians have open discussions with their patients about the potential risks and benefits of using these medications during the COVID-19 pandemic. This manuscript summarizes the currently available evidence and understanding about these risks and benefits to help clinicians navigate such discussions.


Assuntos
Corticosteroides/efeitos adversos , Anti-Inflamatórios não Esteroides/efeitos adversos , Cefaleia/tratamento farmacológico , Pandemias , /efeitos dos fármacos , Corticosteroides/uso terapêutico , /genética , Animais , Anti-Inflamatórios não Esteroides/farmacologia , Anti-Inflamatórios não Esteroides/uso terapêutico , /prevenção & controle , Contraindicações de Medicamentos , Suscetibilidade a Doenças/induzido quimicamente , Cães , Humanos , Hipernatremia/induzido quimicamente , Imunossupressores/efeitos adversos , Imunossupressores/uso terapêutico , Meios de Comunicação de Massa , Modelos Animais , Neutrófilos/efeitos dos fármacos , Guias de Prática Clínica como Assunto , Edema Pulmonar/induzido quimicamente , Ratos , Receptores Virais/biossíntese , Receptores Virais/genética , Medição de Risco , /fisiologia , Regulação para Cima/efeitos dos fármacos , Eliminação de Partículas Virais/efeitos dos fármacos
16.
Gastroenterol Hepatol ; 43(8): 457-463, 2020 Oct.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-32646657

RESUMO

SARS-CoV-2 infection has produced a pandemic with serious consequences for our health care system. Although liver transplant patients represent only a minority of the population, the hepatologists who follow these patients have tried to coordinate efforts to produce a protocol the management of immunosuppression during SARS-CoV-2 infection. Although there are no solid studies to support general recommendations, experiences with other viral infections (hepatitis C, cytomegalovirus) suggest that management of immunosuppression without mycophenolate mofetil or m-Tor inhibitors (drugs that are also associated with leukopenia and lymphopenia) may be beneficial. It is also important to pay attention to possible drug interactions, especially in the case of tacrolimus, with some of the treatments with antiviral effect given in the context of COVID 19 (lopinavir/ritonavir, azithromycin). Finally, the immunosuppressive effect of immunomodulating drugs (tocilizumab and similar) administered to patients with severe lung disease should be taken into account. The mechanisms of action of the different immunosuppressive drugs are reviewed in this article, as well as their potential effect on SARS-CoV-2 infection, and suggests guidelines for the management of immunosuppression.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Imunossupressão/efeitos adversos , Imunossupressores/efeitos adversos , Transplante de Fígado , Pandemias , Pneumonia Viral/epidemiologia , Imunidade Adaptativa , Antivirais/farmacologia , Betacoronavirus/imunologia , Betacoronavirus/fisiologia , Inibidores de Calcineurina/efeitos adversos , Inibidores de Calcineurina/farmacologia , Inibidores de Calcineurina/uso terapêutico , Contraindicações de Medicamentos , Infecções por Coronavirus/tratamento farmacológico , Infecções por Coronavirus/imunologia , Suscetibilidade a Doenças , Interações Medicamentosas , Everolimo/efeitos adversos , Everolimo/farmacologia , Everolimo/uso terapêutico , Glucocorticoides/efeitos adversos , Glucocorticoides/farmacologia , Glucocorticoides/uso terapêutico , Humanos , Imunidade Inata , Hospedeiro Imunocomprometido , Imunossupressão/métodos , Imunossupressores/farmacologia , Imunossupressores/uso terapêutico , Ácido Micofenólico/efeitos adversos , Ácido Micofenólico/farmacologia , Ácido Micofenólico/uso terapêutico , Pneumonia Viral/imunologia , Complicações Pós-Operatórias/imunologia , Complicações Pós-Operatórias/prevenção & controle , Sirolimo/efeitos adversos , Sirolimo/farmacologia , Sirolimo/uso terapêutico , Serina-Treonina Quinases TOR/antagonistas & inibidores
17.
Rev Saude Publica ; 54: 68, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32638884

RESUMO

Chloroquine (CQ) and its analog hydroxychloroquine (HCQ) were recently included in several clinical trials as potential prophylactic and therapeutic options for SARS-COV-2 infection/covid-19. However, drug effectiveness in preventing, treating, or slowing the progression of the disease is still unknown. Despite some initial promising in vitro results, rigorous pre-clinical animal studies and randomized clinical trials have not been performed yet. On the other hand, while the potential effectiveness of CQ/HCQ is, at best, hypothetical, their side effects are factual and most worrisome, particularly when considering vulnerable groups of patients being treated with these drugs. in this comment, we briefly explain the possible mechanisms of action of CQ/HCQ for treating other diseases, possible actions against covid-19, and their potent side effects, in order to reinforce the necessity of evaluating the benefit-risk balance when widely prescribing these drugs for SARS-COV-2 infection/covid-19. We conclude by strongly recommending against their indiscriminate use.


Assuntos
Antimaláricos/farmacologia , Betacoronavirus , Cloroquina/farmacologia , Infecções por Coronavirus/tratamento farmacológico , Hidroxicloroquina/farmacologia , Pneumonia Viral/tratamento farmacológico , Antimaláricos/efeitos adversos , Antimaláricos/farmacocinética , Betacoronavirus/efeitos dos fármacos , Cloroquina/efeitos adversos , Cloroquina/farmacocinética , Contraindicações de Medicamentos , Humanos , Hidroxicloroquina/efeitos adversos , Hidroxicloroquina/farmacocinética , Pandemias , Medição de Risco
19.
Semin Thromb Hemost ; 46(7): 819-822, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32512586
20.
Transplant Proc ; 52(5): 1291-1293, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32505502

RESUMO

Yellow fever (YF) is a vaccine-preventable disease, but live attenuated YF vaccine (YFV) is contraindicated in immunosuppressed patients due to the risk of life-threatening YFV-associated side effects. This study aimed to evaluate 1. the knowledge of renal transplant recipients (RTRs) about the contraindication and risks of YFV; 2. the prevalence of inadvertent vaccination of RTRs against YF; and 3. the outcome of these patients. A cross-sectional telephone contact study was conducted with 200 RTRs selected from the outpatient clinic of our transplantation unit. There were 116 successful telephone contacts (58%). A total of 11 vaccinated patients were identified: 5 received YFV in the pretransplant period and 6 in the post-transplant period. All patients received the full dose of the vaccine. Among those vaccinated after transplant, only 1 reported a mild adverse event (nausea) after receiving the vaccine. All vaccinated patients who were post-transplant did not know about vaccine contraindications as a result of their clinical condition. Among the unvaccinated patients, this rate was 12.4%. YFV is the main tool for disease prevention and control as there is no specific antiviral treatment for YF. Our results confirm the evidence that transplant recipients tolerate YFV well. However, data are not strong enough to recommend this vaccine in transplant recipients. Counseling RTRs on the contraindications of YFV is important to prevent inadvertent use of this vaccine in this population.


Assuntos
Transplante de Rim/efeitos adversos , Complicações Pós-Operatórias/prevenção & controle , Vacinação/psicologia , Vacina contra Febre Amarela/uso terapêutico , Febre Amarela/prevenção & controle , Adulto , Contraindicações de Medicamentos , Estudos Transversais , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/imunologia , Complicações Pós-Operatórias/virologia , Febre Amarela/imunologia , Febre Amarela/virologia , Vacina contra Febre Amarela/imunologia
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