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1.
Medicine (Baltimore) ; 100(7): e24790, 2021 Feb 19.
Artigo em Inglês | MEDLINE | ID: mdl-33607835

RESUMO

RATIONALE: Half-dose or reduced-fluence photodynamic therapy (PDT) with verteporfin has been well acknowledged to be the most effective and permanent treatment with very low rates of complications. However, we report a case of chronic central serous chorioretinopathy (CSC) who developed choroidal neovascularization (CNV) secondary to half-dose PDT within only 3 weeks. Such an occurrence following this short a course of treatment has not been reported previously. PATIENT CONCERNS: A 46-year-old Chinese man who had been diagnosed as acute more than 1 year ago revisited our department recently and complained of blurred vision again in his left eye. DIAGNOSES: Fluorescein fundus angiography (FFA) and indocyanine green angiography (ICGA) revealed patchy hyperfluorescent dots and optical coherence tomography (OCT) indicated irregular flat pigment epithelium detachment (PED) in the central macula. The patient was diagnosed with chronic CSC. INTERVENTIONS: The patient was treated by half-dose PDT with verteporfin. Three weeks later, the patient complained of sudden blurred vision and fundus examination showed macular hemorrhages with a best-corrected visual acuity (BCVA) of 20/250. OCT angiography (OCTA) showed a distinct area of flower-like CNV located within the deep retinal slab. Secondary CNV had developed after a quite short course of half-dose PDT treatment. Subsequently, the patient was administered by 2 intravitreal injections of aflibercept (2 mg). OUTCOMES: Two months after the second intravitreal injection, macular hemorrhages and secondary CNV were completely resolved, and the BCVA improved to 20/25. LESSONS: Patients of chronic CSC with irregular PED who undergo PDT should be warned of secondary CNV within a short course after treatment. If happened, it should be treated by intravitreal injections of anti-vascular endothelial growth factor agents as soon as possible.


Assuntos
Coriorretinopatia Serosa Central/tratamento farmacológico , Neovascularização de Coroide/induzido quimicamente , Fármacos Fotossensibilizantes/efeitos adversos , Verteporfina/efeitos adversos , Inibidores da Angiogênese/administração & dosagem , Neovascularização de Coroide/tratamento farmacológico , Angiofluoresceinografia , Humanos , Injeções Intravítreas , Masculino , Pessoa de Meia-Idade , Fármacos Fotossensibilizantes/administração & dosagem , Receptores de Fatores de Crescimento do Endotélio Vascular/administração & dosagem , Proteínas Recombinantes de Fusão/administração & dosagem , Tomografia de Coerência Óptica , Verteporfina/administração & dosagem
2.
Dermatol Online J ; 26(3)2020 Mar 15.
Artigo em Inglês | MEDLINE | ID: mdl-32609442

RESUMO

Gel nails are a common artificial nail option. Ultraviolet (UV) nail lamps are commonly used to cure gel nails. Ultraviolet A radiation is a known mutagen that penetrates into the nail bed. Although previously reported, the role of UV nail lamps in the carcinogenesis of both keratinocyte carcinoma and melanoma remains controversial. Herein, we report a patient taking the photosensitizing agent hydrochlorothiazide who developed numerous squamous cell carcinomas on the dorsal hands and feet with a 10-year history of UV nail light exposure every 2-3 weeks.


Assuntos
Carcinoma de Células Escamosas/etiologia , Neoplasias Induzidas por Radiação/etiologia , Neoplasias Cutâneas/etiologia , Raios Ultravioleta/efeitos adversos , Idoso , Indústria da Beleza , Feminino , Pé/efeitos da radiação , Mãos/efeitos da radiação , Humanos , Hidroclorotiazida/efeitos adversos , Hidroclorotiazida/uso terapêutico , Doença de Meniere/tratamento farmacológico , Unhas , Fármacos Fotossensibilizantes/efeitos adversos , Fármacos Fotossensibilizantes/uso terapêutico , Fatores de Risco
3.
Eur J Pharm Sci ; 144: 105213, 2020 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-31926941

RESUMO

Compared with the traditional treatment, photodynamic therapy (PDT) in the treatment of malignant tumors has the advantages of less damage to normal tissues, quick therapeutic effect, and ability to repeat treatments to the same site. However, most of the traditional photosensitizers (PSs) have severe skin photosensitization, poor tumor targeting, and low therapeutic effect in hypoxic tumor environment, which limit the application of PDT. Nanoparticle-based drug delivery systems can improve the targeting of PSs and release drugs with controllable photoactivity at predetermined locations, so as to achieve desired therapeutic effects with minimal side-effects. The present review summarizes the current nanoparticle platforms for PDT, and offers the description of different strategies including tumor-targeted delivery, controlled-release of PSs and the triggered photoactivity to achieve controllable PDT by nanoparticle-based drug delivery systems. The challenges and prospects for further development of intelligent PSs for PDT are also discussed.


Assuntos
Nanopartículas/uso terapêutico , Neoplasias/tratamento farmacológico , Fotoquimioterapia/métodos , Fármacos Fotossensibilizantes/química , Fármacos Fotossensibilizantes/farmacologia , Sistemas de Liberação de Medicamentos/métodos , Humanos , Fármacos Fotossensibilizantes/administração & dosagem , Fármacos Fotossensibilizantes/efeitos adversos
4.
JAMA Ophthalmol ; 138(3): 251-259, 2020 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-31917395

RESUMO

Importance: The EVEREST II trial showed that for patients with polypoidal choroidal vasculopathy (PCV), intravitreal ranibizumab in combination with verteporfin photodynamic therapy improves visual acuity relative to ranibizumab monotherapy. However, whether combination therapy is incrementally cost-effective relative to monotherapy during a lifetime is unclear. Objective: To assess the incremental cost-effectiveness of combination therapy compared with ranibizumab monotherapy in patients with PCV. Design, Setting, and Participants: This model-based, economic evaluation used 2018 unit cost data from a tertiary eye hospital in Singapore, first- and second-year outcomes and resource use data from a multicenter trial across various Asian countries (EVEREST II) to model a hypothetical cohort of patients with symptomatic PCV. Scenario analyses and deterministic and probabilistic sensitivity analyses were performed to examine uncertainty. Data were collected from October 2018 through April 2019 and analyzed from March through October 2019. Interventions: This model used data from the EVEREST II trial, in which all participants were given 0.5 mg of intravitreal ranibizumab once every 4 weeks for the first 3 months. Subsequent administration occurred as needed. For participants receiving combination therapy, standard fluence (50 J/cm3) photodynamic therapy with 6-mg/m2 verteporfin was administered once during the first 3 months and thereafter as needed. Main Outcomes and Measures: Incremental cost per quality-adjusted life-year (QALY) gained for combination therapy relative to monotherapy for patients with PCV. Results: In this model based on a cohort of 1000 patients aged 68 years, a patient with PCV incurred a total cost in Singapore dollars (SGD) of 92 327 (US $67 399) with combination therapy and SGD 92 371 (US $67 431) with monotherapy during a lifetime horizon, generating a modest cost savings of SGD 44 (US $32) per patient undergoing combination therapy. Lifetime QALYs were estimated to be 7.87 for combination therapy and 7.85 for monotherapy, for an incremental gain of 0.02 QALYs. Combination therapy remained cost-saving or cost-effective in all lifetime scenarios modeled, but during shorter time horizons and at lower monotherapy costs, it may not be cost-effective. Conclusions and Relevance: This study found combination therapy to be a dominant (more effective and less costly) strategy, being similar in costs and slightly more effective than ranibizumab monotherapy during a lifetime horizon. However, decreasing the time horizon to less than 10 years and/or reductions in the cost of monotherapy may result in combination therapy no longer being cost-effective.


Assuntos
Inibidores da Angiogênese/administração & dosagem , Inibidores da Angiogênese/economia , Neovascularização de Coroide/tratamento farmacológico , Neovascularização de Coroide/economia , Custos de Medicamentos , Fotoquimioterapia/economia , Fármacos Fotossensibilizantes/administração & dosagem , Fármacos Fotossensibilizantes/economia , Ranibizumab/administração & dosagem , Ranibizumab/economia , Verteporfina/administração & dosagem , Verteporfina/economia , Idoso , Inibidores da Angiogênese/efeitos adversos , Ásia , Neovascularização de Coroide/diagnóstico , Neovascularização de Coroide/fisiopatologia , Redução de Custos , Análise Custo-Benefício , Feminino , Humanos , Injeções Intravítreas , Masculino , Fotoquimioterapia/efeitos adversos , Fármacos Fotossensibilizantes/efeitos adversos , Qualidade de Vida , Anos de Vida Ajustados por Qualidade de Vida , Ranibizumab/efeitos adversos , Recuperação de Função Fisiológica , Fatores de Tempo , Resultado do Tratamento , Verteporfina/efeitos adversos , Acuidade Visual/efeitos dos fármacos
6.
J Cosmet Dermatol ; 19(1): 10-21, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31654468

RESUMO

BACKGROUND: Photodynamic therapy (PDT) has emerged as the effective new method to treat acne vulgaris. However, no meta-analysis has been published on PDT for acne vulgaris currently. OBJECTIVE: The current meta-analysis and systematic review were carried out to assess the safety and effect of PDT on treating acne vulgaris. METHODS: The electronic databases, including EMBASE, Cochrane Library, and MEDLINE, were systemically retrieved to identify relevant articles for meta-analysis. The primary outcome included mean percentage reduction in the inflammatory lesion count (MPRILC), while the secondary outcome included the total effective response (TER). RESULTS: Altogether 13 randomized controlled trials (RCTs) involving 701 subjects had been enrolled into the current meta-analysis. PDT had certain effect on acne vulgaris in terms of the outcomes of MPRILC (MD: 15.97, 95% CI: 11.93 to 20.00, P < .00001) and TER (RR: 1.55, 95% CI: 1.38-1.74, P < .00001). Totally, 6 articles had been evaluated to have a low bias risk overall. Results of sensitivity and subgroup analyses were similar to meta-analysis results, reflecting the result reliability in this meta-analysis. CONCLUSIONS: PDT is beneficial for improving the clinical efficacy of inflammatory acne vulgaris, which can be widely used to treat inflammatory acne vulgaris in clinic.


Assuntos
Acne Vulgar/tratamento farmacológico , Fotoquimioterapia/métodos , Fármacos Fotossensibilizantes/administração & dosagem , Acne Vulgar/imunologia , Humanos , Fotoquimioterapia/efeitos adversos , Fármacos Fotossensibilizantes/efeitos adversos , Reprodutibilidade dos Testes , Resultado do Tratamento
7.
J Clin Neurosci ; 72: 304-309, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31493996

RESUMO

The effect of 5-aminolevulinic acid (5-ALA) on a postoperative increase in liver enzymes (PILE) has not been clearly investigated in patients with elevated preoperative liver enzymes. The aim of this study was to evaluate the safety of 5-ALA in brain tumor patients with elevated preoperative liver enzymes by investigating the incidence, severity, and duration of PILE. This retrospective study was conducted in patients with a brain tumor who received 5-ALA preoperatively and had a preoperative increase in liver enzymes. Laboratory data on serum alanine transaminase (ALT), aspartate transaminase (AST), alkaline phosphatase (ALP), and total bilirubin (TB) levels were collected preoperatively and through postoperative day (POD) 30. The incidence and severity of PILE was evaluated based on the Common Terminology Criteria for Adverse Events. Among 134 patients, 61 (45.5%) developed 97 episodes (grade 1/2/3: 80/10/7) of PILE. Postoperative increases in ALT, AST, ALP, and TB were observed in 41 (30.6%), 33 (24.6%), 6 (4.5%), and 17 (12.7%) patients respectively. Five (3.7%) and two (1.5%) patients showed grade 3 increases in ALT and AST respectively. The maximum liver enzyme levels shown in 97 episodes resolved to preoperative baseline or normal (n = 70), grade 1 (n = 24), and grade 2 (n = 3) levels within POD 30. The incidence of PILE after 5-ALA-guided brain tumor surgery in patients with increased preoperative liver enzymes was 45.5%. However, most PILEs were temporary and the incidence of severe PILE was low, suggesting that administering 5-ALA is relatively safe even in patients with elevated preoperative liver enzymes.


Assuntos
Ácido Aminolevulínico/efeitos adversos , Neoplasias Encefálicas/cirurgia , Fígado/efeitos dos fármacos , Fármacos Fotossensibilizantes/efeitos adversos , Complicações Pós-Operatórias/etiologia , Adulto , Alanina Transaminase/sangue , Fosfatase Alcalina/sangue , Ácido Aminolevulínico/administração & dosagem , Aspartato Aminotransferases/sangue , Feminino , Humanos , Fígado/enzimologia , Masculino , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos/métodos , Fármacos Fotossensibilizantes/administração & dosagem
8.
Nutr Cancer ; 72(1): 24-32, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31074648

RESUMO

Furocoumarins are a group of phototoxic compounds found in numerous edible plants. Data from cohort studies have suggested that consumption of certain furocoumarin-rich foods may increase skin cancer risk. However, no study has specifically tested this hypothesis by estimating furocoumarin intake and assessing its relationship with skin cancer. This study aimed to estimate average daily furocoumarin intake of US adults using the National Health and Nutrition Examination Survey (NHANES) 2003-2012 and to examine the relationship between furocoumarin intake and melanoma history. A database of the contents of seven furocoumarins in 29 popular foods was linked to dietary data in NHANES 2003-2012. Mean total intake of the selected furocoumarins among US adults was 81.4 µg/day (standard error = 5.5). A total of 75 participants reported a history of melanoma. Using non- and low consumers (<50th percentile) as a reference, and after adjusting for potential confounders, OR (with 95% confidence interval) of melanoma history for the top 10 percent, 80-90th percentiles, and 50-80th percentiles were 1.75 (0.43-7.20), 1.66 (0.39-7.16), and 0.90 (0.45-1.78), respectively. Furocoumarins are widely consumed among US adults, and a trend towards higher odds of melanoma history was observed among those with higher furocoumarin intake, although this relationship was not statistically significant.


Assuntos
Dieta/efeitos adversos , Furocumarinas/efeitos adversos , Melanoma/epidemiologia , Inquéritos Nutricionais/estatística & dados numéricos , Fármacos Fotossensibilizantes/efeitos adversos , Neoplasias Cutâneas/epidemiologia , Adulto , Idoso , Feminino , Humanos , Masculino , Melanoma/induzido quimicamente , Melanoma/patologia , Pessoa de Meia-Idade , Neoplasias Cutâneas/induzido quimicamente , Neoplasias Cutâneas/patologia , Estados Unidos/epidemiologia , Adulto Jovem
9.
Int J Urol ; 26(11): 1064-1068, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31512303

RESUMO

OBJECTIVE: To analyze perioperative blood pressure in patients undergoing transurethral resection of bladder tumor with photodynamic diagnosis. METHODS: A total of 109 consecutive patients who underwent photodynamic diagnosis-assisted transurethral resection of bladder tumor at Kanazawa University, Kanazawa, Ishikawa, Japan, were included in this study and considered as the photodynamic diagnosis group. Clinical data were collected, and perioperative systolic bladder pressure and vasopressor usage were analyzed. In contrast, consecutive patients who previously underwent conventional transurethral resection of bladder tumor (without the use of oral 5-aminolevulinic acid) were used as the control group. RESULTS: The systolic blood pressure before anesthesia, lowest systolic blood pressure from the anesthesia induction to the start of operation and lowest systolic blood pressure during operation were significantly lower in the photodynamic diagnosis group. The rate of vasopressor use was significantly higher in the photodynamic diagnosis group. On multivariate analysis, we found that general anesthesia and regular use of renin-angiotensin system inhibitor were associated with an increased risk of hypotension (lowest systolic blood pressure from the anesthesia induction to the start of operation <80 mmHg). CONCLUSIONS: Oral intake of 5-aminolevulinic acid can obviously cause a drop in intraoperative blood pressure in patients undergoing transurethral resection of bladder tumor. Therefore, urologists and anesthesiologists should consider withdrawal of renin-angiotensin system inhibitors and monitor the blood pressure during photodynamic diagnosis-assisted transurethral resection of bladder tumor.


Assuntos
Ácido Aminolevulínico/efeitos adversos , Hipotensão/induzido quimicamente , Complicações Intraoperatórias/induzido quimicamente , Fármacos Fotossensibilizantes/efeitos adversos , Neoplasias da Bexiga Urinária/cirurgia , Administração Oral , Idoso , Idoso de 80 Anos ou mais , Ácido Aminolevulínico/administração & dosagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fármacos Fotossensibilizantes/administração & dosagem , Estudos Retrospectivos
10.
Acta Neurochir (Wien) ; 161(11): 2289-2298, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31473825

RESUMO

BACKGROUND: Besides 5-aminolevulinic acid (5-ALA), liver enzyme elevation after brain tumor surgery can be caused by anesthesia and medications. In this retrospective study, we determined whether preoperative 5-ALA administration is associated with postoperative elevation of liver enzymes (PELE) in brain tumor patients and identified predictive factors for PELE in patients treated with 5-ALA. METHODS: In 179 patients undergoing brain tumor surgery with preoperative normal values of liver enzymes, laboratory data on serum alanine transaminase (ALT), aspartate transaminase (AST), alkaline phosphatase (ALP), and total bilirubin (T.bil) levels were collected preoperatively and through postoperative day (POD) 45. RESULTS: Ninety-nine PELEs (ALT, 56; AST, 34; ALP, 5; and TB, 4) were observed in 62 (34.6%) patients. Four (4.2%) patients treated with 5-ALA showed grade 3 elevation of transaminases based on the Common Terminology Criteria for Adverse Effects. Preoperative 5-ALA treatment was predictive of PELE (odds ratio [95% confidence interval], 2.30 [1.14-4.67]; P = 0.021). In patients treated with 5-ALA (n = 95), 70 PELEs (ALT, 39; AST, 22; ALP, 5; and TB, 4) were observed in 41 (43.2%) patients and significant predictive factors for PELE were preoperative ALT level (1.10 [1.04-1.17]; P = 0.001) and body mass index (BMI, 1.29 [1.08-1.56]; P = 0.006). In patients treated with 5-ALA, 13 and 36 patients, of 39 patients whose maximum postoperative ALT levels > 40 U/L, showed the normal value of serum ALT on PODs 14 and 45, respectively. Only three patients showed ALT elevation > 40 U/L on PODs 15-45, with a downward trend. CONCLUSIONS: The use of 5-ALA for brain tumor surgery in patients with preoperative normal values of liver enzymes was associated with increased transient PELE, but a low incidence of severely elevated liver transaminases levels. When 5-ALA is administered to patients with the upper normal value of preoperative serum ALT and overweight, attention is paid to PELE.


Assuntos
Ácido Aminolevulínico/efeitos adversos , Neoplasias Encefálicas/cirurgia , Fígado/efeitos dos fármacos , Procedimentos Neurocirúrgicos/métodos , Fármacos Fotossensibilizantes/efeitos adversos , Complicações Pós-Operatórias/sangue , Adulto , Alanina Transaminase/sangue , Fosfatase Alcalina/sangue , Ácido Aminolevulínico/farmacologia , Aspartato Aminotransferases/sangue , Índice de Massa Corporal , Feminino , Humanos , Fígado/enzimologia , Masculino , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos/efeitos adversos , Fármacos Fotossensibilizantes/farmacologia , Complicações Pós-Operatórias/etiologia
11.
Middle East Afr J Ophthalmol ; 26(2): 95-100, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31543667

RESUMO

PURPOSE: The purpose of the study is to determine the safety and efficacy of corneal collagen cross-linking for keratoconus in pediatric patients with and without vernal keratoconjunctivitis (VKC). METHODS: This is a retrospective analysis of 89 eyes of 58 patients <18 years of age that underwent corneal collagen cross-linking for progressive keratoconus; inclusion criteria included a minimum of 2-year follow-up after cross-linking. The main outcomes measures included keratometry, pachymetry, vision, and complications following epithelial-off cross-linking with the Dresden protocol. RESULTS: VKC patients were more likely to be male; 81.6% of the non-VKC patients and 96.3% of VKC patients were male (P = 0.038). Comparing pretreatment to the 2-year follow-up, there was no statistically significant change in the mean steep or flat keratometry, corneal thickness, and uncorrected visual acuity or best spectacle-corrected visual acuity in either group. There were no statistically significant differences in the mean visual, keratometric, or adverse event outcomes between the two groups. The proportion exhibiting progression of ectasia at 2 years was 18.5% in the VKC group and 16.7% in the non-VKC group (P = 0.83). CONCLUSIONS: Cross-linking appears to be as safe and effective in pediatric patients with vernal keratoconjunctivits as in those without, with similar outcomes, adverse events, and progression of keratoconus after treatment. The proportion of patients exhibiting progression appears to be higher in pediatric patients than adults, and there is an association between male sex and diagnosis of VKC.


Assuntos
Conjuntivite Alérgica/tratamento farmacológico , Substância Própria/metabolismo , Reagentes para Ligações Cruzadas , Ceratocone/tratamento farmacológico , Fotoquimioterapia/métodos , Fármacos Fotossensibilizantes/uso terapêutico , Riboflavina/uso terapêutico , Adolescente , Criança , Colágeno/metabolismo , Conjuntivite Alérgica/metabolismo , Paquimetria Corneana , Topografia da Córnea , Dilatação Patológica , Progressão da Doença , Feminino , Seguimentos , Humanos , Ceratocone/metabolismo , Masculino , Fármacos Fotossensibilizantes/efeitos adversos , Exame Físico , Estudos Retrospectivos , Riboflavina/efeitos adversos , Raios Ultravioleta , Acuidade Visual
12.
Curr Cardiol Rep ; 21(9): 92, 2019 07 27.
Artigo em Inglês | MEDLINE | ID: mdl-31352643

RESUMO

PURPOSE OF REVIEW: We reviewed the hypothesised mechanisms of skin cancerogenesis for thiazide diuretics; conducted an updated meta-analysis of studies focusing on their association with skin cancer risk; critically appraised the quality of available studies and identified knowledge gaps; and discussed implications for health professionals and patients. RECENT FINDINGS: Thiazide diuretics possess well-described photosensitizing properties and a causal association with skin cancer is biologically plausible. The epidemiological evidence is stronger for squamous cell cancer; however, diversity in design among studies, methodological concerns potentially affecting the validity of results, and scarcity of data on dose-relation relationship suggest caution in drawing conclusions. Only few, unbalanced, and/or heterogeneous data exist to date for melanoma and basal cell cancer. Patients effectively treated with thiazide diuretics are currently not advised to stop treatment, but encouraged to limit exposure to sunlight and regularly check their skin. While endorsing these recommendations, we believe that well-designed studies are urgently needed to overcome persistent knowledge gaps.


Assuntos
Fármacos Fotossensibilizantes/efeitos adversos , Neoplasias Cutâneas/induzido quimicamente , Inibidores de Simportadores de Cloreto de Sódio/efeitos adversos , Humanos , Risco
13.
Photodiagnosis Photodyn Ther ; 27: 428-432, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31349099

RESUMO

Basal cell cancer (BCC) is an epithelial neoplasm that arises from basal cells, which constitute the lower layer of the epidermis. Global statistics have shown the progressive increase in the incidence of skin cancer in several countries. The cumulative exposure to solar radiation (ultraviolet B) in the first two decades of life represents the critical risk for the disease. Preclinical and clinical trials have shown photodynamic therapy (PDT) as a promising innovation for treatment of skin cancers, especially to the non-melanoma group. The authors reviewed trials with photodynamic therapy in superficial basal cell carcinoma with different photosensitizers to better evaluate how PDT modifies the natural history of sBCC. We conclude trials should not assess only the immediate efficacy but the main goal of long-term effectiveness of the protocols in order to generate best evidence for clinical practice.


Assuntos
Carcinoma Basocelular/tratamento farmacológico , Fotoquimioterapia/métodos , Fármacos Fotossensibilizantes/uso terapêutico , Neoplasias Cutâneas/tratamento farmacológico , Vias de Administração de Medicamentos , Humanos , Fármacos Fotossensibilizantes/administração & dosagem , Fármacos Fotossensibilizantes/efeitos adversos , Ensaios Clínicos Controlados Aleatórios como Assunto , Espécies Reativas de Oxigênio/metabolismo
16.
Photodiagnosis Photodyn Ther ; 27: 408-414, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31310826

RESUMO

BACKGROUND: Photodynamic therapy is an effective treatment for actinic keratosis. 5-aminolevulinic acid nanoemulsion (BF-200 ALA) and methyl-5-aminolevulinate (MAL) are both prodrugs for the treatment of actinic keratosis with photodynamic therapy. A comparison of the efficacy and safety between the drugs is critical for clinical practice. OBJECTIVES: To investigate if photodynamic therapy in combination with BF-200 ALA is superior to photodynamic therapy with MAL for actinic keratosis. METHODS: We performed a meta-analysis to investigate the combination of photodynamic therapy with BF-200 ALA and with MAL. The PubMed, Cochrane Library, Web of Science and EMBASE databases were searched to select eligible randomized controlled trials. Our search was conducted on April 1, 2019, and included the search terms "5-aminolevulinic acid nanoemulsion or BF-200 ALA", "methyl-5-aminolevulinate or methyl aminolaevulinate" and "actnic keratosis". Cochrane Risk of Bias Tool was used to estimate the risk of bias. RESULTS: The meta-analysis consisted of 5988 actinic keratosis lesions in five eligible randomized controlled trials, with a total of 2953 actinic keratosis lesions treated with BF-200 ALA and 3035 actinic keratosis lesions treated with MAL. BF-200 ALA in combination with photodynamic therapy showed significantly higher overall complete clearance rates (RR: 1.07, 95% CI 1.02-1.12, p = 0.01) and 3 month complete clearance rates (RR: 1.09, 95% CI 1.06-1.12, p < 0.00001) compared to MAL. A subgroup analysis was performed for photodynamic therapy combined with BF-200 ALA, revealing increased complete clearance rates of grade II-III lesions in comparison with MAL (RR: 1.24, 95% CI 1.05-1.46, p = 0.01). Compared with MAL, the pooled relative risk for the meta-analysis for recurrence was 0.67 (95% CI 0.48-0.92, p = 0.01) at 12 month after BF-200 ALA treatment. CONCLUSION: Photodynamic therapy with BF-200 ALA has a 9% better chance of complete clearance at 3 months and a 24% better chance of grade II-III lesions after treatment than with MAL for patients with actinic keratosis.


Assuntos
Ácido Aminolevulínico/análogos & derivados , Fotoquimioterapia/métodos , Fármacos Fotossensibilizantes/uso terapêutico , Ácido Aminolevulínico/administração & dosagem , Ácido Aminolevulínico/efeitos adversos , Ácido Aminolevulínico/uso terapêutico , Emulsões , Humanos , Ceratose Actínica/tratamento farmacológico , Nanopartículas , Fármacos Fotossensibilizantes/administração & dosagem , Fármacos Fotossensibilizantes/efeitos adversos , Ensaios Clínicos Controlados Aleatórios como Assunto
17.
Photodiagnosis Photodyn Ther ; 27: 385-387, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31301435

RESUMO

Kerion refers to the severe inflammatory reaction which occurs in some cases of fungal infection of the hair or hair follicles. Successful treatment is a challenge for the small number of kerion patients who show poor efficacy of oral antifungal agents. In recent years, photodynamic therapy (PDT) has been proven to be a useful treatment for a variety of fungal infections. In this case report, a 9-year-old Chinese girl presented with erythema, pustular and tender plaques on her scalp for 2 month. The diagnosis of kerion was made based on clinical features and positive mycological findings. After the disease relapsed with oral administration of itraconazole for 6 weeks, she was successfully cured by three sessions of ALA-PDT combined with itraconazole. This case report suggests that ALA-PDT provides a good alternative and adjutant choice for kerion with safety, less side effects, and good repeatability.


Assuntos
Ácido Aminolevulínico/uso terapêutico , Dermatomicoses/tratamento farmacológico , Itraconazol/uso terapêutico , Fotoquimioterapia/métodos , Fármacos Fotossensibilizantes/uso terapêutico , Ácido Aminolevulínico/efeitos adversos , Criança , Quimioterapia Combinada , Feminino , Humanos , Fotoquimioterapia/efeitos adversos , Fármacos Fotossensibilizantes/efeitos adversos , Couro Cabeludo
18.
Photodiagnosis Photodyn Ther ; 27: 255-267, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31226444

RESUMO

BACKGROUND: Oral cavity squamous cell carcinoma is a common cancer of the head and neck region. Due to the frequency of diagnoses, high rate of mortality, mutilating nature of classic therapy and numerous complications, new methods of treatment are being sought. One promising solution for treatment which is utilized in many fields of oncology is photodynamic therapy. The purpose of this article is to present a general overview of the use of photodynamic therapy in preclinical in vitro studies. MATERIALS AND METHODS: A literature search for articles corresponding to the topic of this review was performed using the PubMed and MEDLINE databases using the following keywords: 'oral cavity squamous cell carcinoma,' 'photodynamic therapy,' 'photosensitizer(s),' 'in vitro,' 'cell culture(s),' 'spheroids,' 'CAM model', and 'in vivo.' RESULTS: Most of the previous work found in the literature search concerns research on the use of various photosensitizers and the determination of their level of phototoxicity against cell lines. CONCLUDING REMARKS: Research on the photodynamic effect in cell lines may be useful in establishing the mechanisms and effectiveness of the photodynamic method as a starting point for clinical trials. Studies on spheroidal models allows for testing photodynamic therapy under more clinical-like conditions. The Chick Chorioallantoic Membrane Assay provides information about the vascular changes after treatment.


Assuntos
Carcinoma de Células Escamosas/tratamento farmacológico , Neoplasias Bucais/tratamento farmacológico , Fotoquimioterapia/métodos , Fármacos Fotossensibilizantes/uso terapêutico , Humanos , Técnicas In Vitro , Fármacos Fotossensibilizantes/administração & dosagem , Fármacos Fotossensibilizantes/efeitos adversos
19.
Photodiagnosis Photodyn Ther ; 27: 198-202, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31176762

RESUMO

BACKGROUND: Daylight photodynamic therapy (dl-PDT) is an effective and almost painless treatment for patients with actinic keratoses (AKs) but carries important limitations due to seasonal conditions. PDT with Protoporphyrin IX (PPIX) peaks adjusted wavelengths might overcome these shortcomings. The aim of this study was to determine safety and efficacy of ALA-PDT with a new irradiation procedure. METHODS: Patients with AKs on the head received ALA-PDT with a new irradiation device. Emitted wavelengths are adjusted to PPIX absorption peaks (457 nm, 523 nm, 593 nm, 631 nm; 20.000 lx). PDT protocol was adapted for both 1 h of incubation and irradiation time. Outcome was assessed by AK area and severity index (AKASI) and lesion count (LC) prior to and 3 months after treatment. Safety was monitored by blood pressure and pulse measurements throughout treatment. Pain was determined by use of a visual analog scale (VAS). RESULTS: Overall, 39 patients were included and showed a significant AKASI reduction (P < 0.0001) 3 months after PDT (mean AKASI of 2 ±â€¯1.6) compared to baseline (5.2 ±â€¯1.9). Mean reduction rate was 63.7% ±24.2%, accordingly. Eight patients (20.5%) achieved AKASI 100, eleven (28.2%) AKASI 75 and thirty (76.9%) AKASI 50, respectively. There were no significant changes in blood pressure and pulse throughout treatment. Median VAS for pain during irradiation was 0 (0-1), 1 (0-1) and 0 (0-1) at the beginning, in the meantime and at the end, respectively. CONCLUSIONS: ALA-PDT with a new irradiation procedure is a safe, effective and almost painless treatment option for patients with AKs on the head.


Assuntos
Ácido Aminolevulínico/uso terapêutico , Ceratose Actínica/tratamento farmacológico , Fotoquimioterapia/métodos , Fármacos Fotossensibilizantes/uso terapêutico , Idoso , Idoso de 80 Anos ou mais , Ácido Aminolevulínico/efeitos adversos , Pressão Sanguínea , Feminino , Cabeça/patologia , Frequência Cardíaca , Humanos , Masculino , Fotoquimioterapia/efeitos adversos , Fotoquimioterapia/instrumentação , Fármacos Fotossensibilizantes/efeitos adversos , Estudos Prospectivos , Índice de Gravidade de Doença , Luz Solar
20.
Phytomedicine ; 61: 152894, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31054439

RESUMO

BACKGROUND: Cutaneous leishmaniasis (CL) is a vector-borne disease caused by obligate protist parasites from the genus Leishmania. The potential toxicity as well as the increased resistance of standard treatments has encouraged the development of new therapeutical strategies. Photodynamic inactivation (PDI) combines the use of a photosensitizer and light to generate reactive oxygen species and kill cells, including microorganisms. Vegetal kingdom constitutes an important source of bioactive compounds that deserve to be investigated in the search of naturally occurring drugs with leishmanicidal activity. PURPOSE: The purpose of this study was to test the antiparasitic activity of PDI (ApPDI) of five natural anthraquinones (AQs) obtained from Heterophyllaea lycioides (Rusby) Sandwith (Rubiacae). To support our results, effect of AQ mediated-PDI on parasite´s morphology and AQ uptake were studied. Cytotoxicity on fibroblasts was also evaluated. STUDY DESIGN/METHODS: Two monomers, soranjidiol (Sor) and 5-chlorosoranjidiol (5-ClSor) plus three bi-anthraquinones (bi-AQs), bisoranjidiol (Bisor), 7-chlorobisoranjidiol (7-ClBisor) and Lycionine (Lyc) were selected for this study. Recombinant L. amazonensis promastigote strain expressing luciferase was subjected to AQs and LED treatment. Following irradiation with variable light parameters, cell viability was quantified by bioluminescence. Alteration on parasite's morphology was analyzed by scanning electron microscopy (SEM). In addition, we verified the AQ uptake in Leishmania cells by fluorescence and their toxicity on fibroblasts by using MTT assay. RESULTS: Bisor, Sor and 5-ClSor exhibited photodynamic effect on L. amazonensis. SEM showed that promastigotes treated with Bisor-mediated PDI exhibited a significant alteration in shape and size. Sor and 5-ClSor presented higher uptake levels than bi-AQs (Bisor, Lyc and 7-ClBisor). Finally, Sor and Bisor presented the lowest toxic activity against fibroblasts. CONCLUSION: Taking together, our results indicate that Sor presents the highest specificity towards Leishmania cells with no toxicity on fibroblasts.


Assuntos
Antraquinonas/farmacologia , Antiparasitários/farmacologia , Leishmania/efeitos dos fármacos , Fotoquimioterapia/métodos , Fármacos Fotossensibilizantes/farmacologia , Antraquinonas/efeitos adversos , Antiparasitários/efeitos adversos , Apoptose/efeitos dos fármacos , Células Cultivadas , Avaliação Pré-Clínica de Medicamentos , Fibroblastos/efeitos dos fármacos , Humanos , Leishmania/ultraestrutura , Leishmaniose Cutânea/tratamento farmacológico , Microscopia Eletrônica de Varredura , Fármacos Fotossensibilizantes/efeitos adversos , Espécies Reativas de Oxigênio , Rubiaceae/química
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