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1.
Molecules ; 26(4)2021 Feb 19.
Artigo em Inglês | MEDLINE | ID: mdl-33669839

RESUMO

Despite Alzheimer's disease (AD) incidence being projected to increase worldwide, the drugs currently on the market can only mitigate symptoms. Considering the failures of the classical paradigm "one target-one drug-one disease" in delivering effective medications for AD, polypharmacology appears to be a most viable therapeutic strategy. Polypharmacology can involve combinations of multiple drugs and/or single chemical entities modulating multiple targets. Taking inspiration from an ongoing clinical trial, this work aims to convert a promising cromolyn-ibuprofen drug combination into single-molecule "codrugs." Such codrugs should be able to similarly modulate neuroinflammatory and amyloid pathways, while showing peculiar pros and cons. By exploiting a linking strategy, we designed and synthesized a small set of cromolyn-ibuprofen conjugates (4-6). Preliminary plasma stability and neurotoxicity assays allowed us to select diamide 5 and ethanolamide 6 as promising compounds for further studies. We investigated their immunomodulatory profile in immortalized microglia cells, in vitro anti-aggregating activity towards Aß42-amyloid self-aggregation, and their cellular neuroprotective effect against Aß42-induced neurotoxicity. The fact that 6 effectively reduced Aß-induced neuronal death, prompted its investigation into an in vivo model. Notably, 6 was demonstrated to significantly increase the longevity of Aß42-expressing Drosophila and to improve fly locomotor performance.


Assuntos
Doença de Alzheimer/tratamento farmacológico , Cromolina Sódica/uso terapêutico , Ibuprofeno/uso terapêutico , Polifarmacologia , Peptídeos beta-Amiloides/química , Peptídeos beta-Amiloides/toxicidade , Animais , Comportamento Animal/efeitos dos fármacos , Sobrevivência Celular/efeitos dos fármacos , Cromolina Sódica/síntese química , Cromolina Sódica/química , Cromolina Sódica/farmacologia , Drosophila/efeitos dos fármacos , Desenho de Fármacos , Endocitose/efeitos dos fármacos , Ibuprofeno/síntese química , Ibuprofeno/química , Ibuprofeno/farmacologia , Imunomodulação/efeitos dos fármacos , Camundongos , Microglia/efeitos dos fármacos , Microglia/metabolismo , Neurônios/efeitos dos fármacos , Neurônios/metabolismo , Fármacos Neuroprotetores/farmacologia , Neurotoxinas/toxicidade , Agregados Proteicos/efeitos dos fármacos , Ratos Wistar
3.
J Endod ; 47(5): 705-710, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33548329

RESUMO

INTRODUCTION: The success rate of inferior alveolar nerve block decreases exorbitantly in teeth with symptomatic irreversible pulpitis. The purpose of this prospective, double-blind, randomized clinical trial was to evaluate the combined effect of oral premedication with ibuprofen and dexamethasone on the success rate of inferior alveolar nerve block in mandibular molars with symptomatic irreversible pulpitis. METHODS: Ninety-four adult patients actively experiencing pain and diagnosed with symptomatic irreversible pulpitis willingly participated in this study. Preoperative pain was recorded on the Heft-Parker visual analog scale. Patients were randomly allocated to 4 different groups and received placebo, 0.5 mg dexamethasone, 800 mg ibuprofen, or a combination of 0.5 mg dexamethasone and 800 mg ibuprofen. One hour after oral premedication, all patients received standard inferior alveolar nerve block containing 2% lignocaine with 1:200,000 adrenaline. Access cavity preparation was initiated 15 minutes after the administration of anesthesia. Pain scores were recorded on VAS after anesthesia, at dentin penetration to pulp chamber opening, and on file placement. Success was defined as no or mild pain (0-54 mm) throughout the procedure. RESULTS: The chi-square test was used for qualitative data comparison. The 1-way analysis of variance test and post hoc Bonferroni test showed a statistically significant difference between the combination of 0.5 mg dexamethasone and 800 mg ibuprofen group and the other 3 groups (P < .001). CONCLUSIONS: Preoperative administration of a combination of dexamethasone and ibuprofen improved the success rate of inferior alveolar nerve block in mandibular molars with symptomatic irreversible pulpitis.


Assuntos
Anestesia Dentária , Bloqueio Nervoso , Pulpite , Adulto , Anestésicos Locais/uso terapêutico , Anti-Inflamatórios não Esteroides/uso terapêutico , Dexametasona/uso terapêutico , Método Duplo-Cego , Humanos , Ibuprofeno/uso terapêutico , Lidocaína , Nervo Mandibular , Dente Molar/cirurgia , Pré-Medicação , Estudos Prospectivos , Pulpite/cirurgia
4.
Br J Oral Maxillofac Surg ; 59(2): 191-196, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33483157

RESUMO

We undertook this study to assess the analgesic and anti-inflammatory properties of ibuprofen when administered through two drug delivery systems after mandibular third molar surgery. The study was conducted on 100 patients who required the surgical removal of impacted mandibular third molars under local anaesthesia. The study subjects were divided into two groups of 50 patients each. Patients in the study group were given ibuprofen-incorporated chitosan-based microspheres, which were packed into the third molar sockets after removal of impacted teeth. Patients in the control group were prescribed with ibuprofen 400mg tablets that were to be administered orally after the removal of impacted mandibular third molars. All patients were assessed for pain, swelling, and trismus on the second, fourth, and seventh postoperative days, and wound healing was assessed on the seventh postoperative day. Patients in the study group had significantly less pain and comparatively better mouth opening on the second, fourth, and seventh postoperative days, which showed clinically and statistically significant results of p<0.05, respectively, while the assessment of swelling for the study group did not show statistically significant results on any of the three postoperative days. Among 50 patients in the study group, two had wound gaping, and among 50 patients in the control group, four presented with wound gaping and three patients developed dry socket. Ibuprofen-incorporated chitosan-based microspheres (study group) had comparatively better analgesic and anti-inflammatory properties with drastic reduction of pain, swelling, trismus, and also had a reliable wound healing property when compared with the orally-administered ibuprofen (control group) after mandibular third molar surgery.


Assuntos
Quitosana , Preparações Farmacêuticas , Dente Impactado , Anti-Inflamatórios/uso terapêutico , Quitosana/uso terapêutico , Sistemas de Liberação de Medicamentos , Edema/tratamento farmacológico , Edema/etiologia , Edema/prevenção & controle , Humanos , Ibuprofeno/uso terapêutico , Mandíbula/cirurgia , Microesferas , Dente Serotino/cirurgia , Dor Pós-Operatória/tratamento farmacológico , Dor Pós-Operatória/prevenção & controle , Extração Dentária , Dente Impactado/cirurgia , Trismo/etiologia , Trismo/prevenção & controle
5.
Am J Nurs ; 121(2): 69, 2021 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-33497134

RESUMO

According to this study: In children younger than age two, treatment with ibuprofen was associated with reduced fever and less pain within the first 24 hours compared with acetaminophen.The incidence of adverse events was low with both treatments.


Assuntos
Acetaminofen/normas , Febre/tratamento farmacológico , Ibuprofeno/normas , Pediatria/normas , Acetaminofen/uso terapêutico , Anti-Inflamatórios não Esteroides/normas , Anti-Inflamatórios não Esteroides/uso terapêutico , Febre/fisiopatologia , Humanos , Ibuprofeno/uso terapêutico , Incidência , Pediatria/métodos
6.
Orv Hetil ; 161(50): 2104-2106, 2020 12 13.
Artigo em Húngaro | MEDLINE | ID: mdl-33310923

RESUMO

Összefoglaló. A koronavírus-fertozés 2019 végén indult útjára, lassan a Föld teljes lakosságát eléro pandémiaként. Egy olyan kórokozóról van szó, amely ilyen nagy számú megbetegedést még nem okozott, ezért annak természetes lefolyásáról, a szövodmények kialakulásáról és a kezelési lehetoségekrol még keveset tudunk. Ennek következtében a kezdetben megjelent információk nagyon felületesek voltak, a következtetések nemritkán tévútra vezették mind az orvosokat, mind a betegeket. Az adatok gyarapodásával azonban egyre több kérdésre kapunk választ. Erre a folyamatra az egyik legreprezentánsabb példa az ibuprofén története, amely kezdetben tiltott, késobb turt terápiás szer volt, de ma már támogatott kezelési lehetoség a koronavírus-fertozésben. Orv Hetil. 2020; 161(50): 2104-2106. Summary. The coronavirus infection started in late 2019, as a pandemic slowly reaching the entire population of the earth. This pathogen has not yet caused such a large number of diseases, so little is known about its natural course, the development of complications, and treatment options. As a result, the information initially published was very superficial, and the conclusions often misled both physicians and patients. As the data grows, however, we get more and more questions answered. One of the most representative examples of this process is the history of ibuprofen, which was initially banned, thereafter tolerated, and is now a supported treatment option for coronavirus infection. Orv Hetil. 2020; 161(50): 2104-2106.


Assuntos
Infecções por Coronavirus/tratamento farmacológico , Ibuprofeno/efeitos adversos , Pneumonia Viral/tratamento farmacológico , Humanos , Ibuprofeno/uso terapêutico
7.
BMJ Case Rep ; 13(12)2020 Dec 13.
Artigo em Inglês | MEDLINE | ID: mdl-33318275

RESUMO

Although calcific tendinopathy of the shoulder is a relatively common clinical diagnosis, calcific tendinopathy of the rectus femoris tendon near its origin at the anterior inferior iliac spine is rare. We present a case of a 53-year-old female avid runner with left hip pain. Clinical evaluation and X-ray imaging led to a diagnosis of calcific tendinopathy of the rectus femoris tendon. The patient was treated conservatively with non-steroidal anti-inflammatory drugs, physical therapy and rest. Calcific tendinopathy of the rectus femoris tendon can occur rarely in active patients and may be a cause of hip pain, responsive to conservative management, but with other treatment options possible if recalcitrant.


Assuntos
Calcinose/diagnóstico por imagem , Músculo Quadríceps/lesões , Corrida/lesões , Tendinopatia/diagnóstico por imagem , Artralgia/etiologia , Calcinose/terapia , Diagnóstico Diferencial , Terapia por Exercício , Feminino , Articulação do Quadril/diagnóstico por imagem , Humanos , Ibuprofeno/uso terapêutico , Pessoa de Meia-Idade , Força Muscular , Músculo Quadríceps/diagnóstico por imagem , Radiografia , Descanso , Tendinopatia/terapia
8.
Medicine (Baltimore) ; 99(46): e23233, 2020 Nov 13.
Artigo em Inglês | MEDLINE | ID: mdl-33181710

RESUMO

BACKGROUND: Acute mountain sickness (AMS) is the effect when people accessing high altitude in a short period of time. As a cyclooxygenase (COX) inhibitor, ibuprofen could alleviate the symptoms of AMS. However, whether it can prevent AMS or not is still controversial. It is necessary to perform a meta-analysis to evaluate the role of ibuprofen in AMS prophylaxis. METHODS: PubMed, EMBASE, Medline, ISI Web of Science, Cochrane Library, China National Knowledge Infrastructure (CNKI) will be searched for the relevant published studies that explored the value of ibuprofen in AMS prophylaxis from inception to October 2020. The data will be independently extracted by 2 researchers. Risk of bias will be evaluated based on Cochrane risk of bias assessment tool. Heterogeneity among the included studies will be evaluated by χ and I values. The meta-analysis was conducted by RevMan software version 5.3. RESULTS: This study will evaluate the role of ibuprofen in AMS prophylaxis. CONCLUSION: This study will summarize the current evidence of ibuprofen in AMS prophylaxis, which could further guide the recommendation in prevention of AMS.Open Science Framework (OSF) registration number: October 8, 2020. osf.io/n3mjt.


Assuntos
Doença da Altitude/prevenção & controle , Protocolos Clínicos , Ibuprofeno/uso terapêutico , Profilaxia Pré-Exposição/normas , Doença da Altitude/tratamento farmacológico , Humanos , Ibuprofeno/farmacologia , Metanálise como Assunto , Profilaxia Pré-Exposição/métodos , Revisões Sistemáticas como Assunto
9.
Neurologia ; 35(9): 628-632, 2020.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-32896463

RESUMO

INTRODUCTION: In recent months, doubts have arisen among patients, general practitioners, and neurologists as to whether some drugs commonly used in patients with headaches and neuralgia may favour or complicate the disease caused by SARS-CoV-2. MATERIAL AND METHODS: We collected information on the opinions of scientific societies and medicines agencies (American, European, and Spanish) to clarify doubts regarding the use of drugs such as lisinopril, candesartan, ibuprofen, corticosteroids, carbamazepine, and monoclonal antibodies targeting the calcitonin gene-related peptide in the context of the COVID-19 pandemic. RESULTS: We make recommendations about the use of standard headache treatments in the context of the COVID-19 pandemic, based on the current scientific evidence. CONCLUSIONS: At present, there is no robust scientific argument to formally contraindicate any of the standard treatments employed for headaches and neuralgias.


Assuntos
Analgésicos/efeitos adversos , Infecções por Coronavirus/complicações , Cefaleia/tratamento farmacológico , Neuralgia/tratamento farmacológico , Pneumonia Viral/complicações , Corticosteroides/efeitos adversos , Corticosteroides/uso terapêutico , Analgésicos/farmacologia , Analgésicos/uso terapêutico , Anticorpos Monoclonais/efeitos adversos , Anticorpos Monoclonais/uso terapêutico , Anticonvulsivantes/efeitos adversos , Anticonvulsivantes/uso terapêutico , Anti-Hipertensivos/efeitos adversos , Anti-Hipertensivos/uso terapêutico , Antivirais/farmacologia , Benzimidazóis/efeitos adversos , Benzimidazóis/uso terapêutico , Betacoronavirus , Antagonistas do Receptor do Peptídeo Relacionado ao Gene de Calcitonina/efeitos adversos , Antagonistas do Receptor do Peptídeo Relacionado ao Gene de Calcitonina/uso terapêutico , Carbamazepina/efeitos adversos , Carbamazepina/uso terapêutico , Infecções por Coronavirus/tratamento farmacológico , Suscetibilidade a Doenças/induzido quimicamente , Interações Medicamentosas , Indução Enzimática/efeitos dos fármacos , Cefaleia/complicações , Cefaleia/prevenção & controle , Humanos , Ibuprofeno/efeitos adversos , Ibuprofeno/farmacologia , Ibuprofeno/uso terapêutico , Lisinopril/efeitos adversos , Lisinopril/uso terapêutico , Neuralgia/complicações , Pandemias , Peptidil Dipeptidase A/biossíntese , Peptidil Dipeptidase A/genética , Receptores Virais/biossíntese , Receptores Virais/genética , Fatores de Risco , Tetrazóis/efeitos adversos , Tetrazóis/uso terapêutico
11.
Inflammopharmacology ; 28(5): 1141-1152, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32797326

RESUMO

The coronavirus disease 19 (COVID-19) pandemic is currently the most acute healthcare challenge in the world. Despite growing knowledge of the nature of Severe Acute Respiratory Syndrome coronavirus-2 (SARS-CoV-2), treatment options are still poorly defined. The safety of non-steroidal anti-inflammatory drugs (NSAIDs), specifically ibuprofen, has been openly questioned without any supporting evidence or clarity over dose, duration, or temporality of administration. This has been further conflicted by the initiation of studies to assess the efficacy of ibuprofen in improving outcomes in severe COVID-19 patients. To clarify the scientific reality, a literature search was conducted alongside considerations of the pharmacological properties of ibuprofen in order to construct this narrative review. The literature suggests that double-blind, placebo-controlled study results must be reported and carefully analysed for safety and efficacy in patients with COVID-19 before any recommendations can be made regarding the use of ibuprofen in such patients. Limited studies have suggested: (i) no direct interactions between ibuprofen and SARS-CoV-2 and (ii) there is no evidence to suggest ibuprofen affects the regulation of angiotensin-converting-enzyme 2 (ACE2), the receptor for COVID-19, in human studies. Furthermore, in vitro studies suggest ibuprofen may facilitate cleavage of ACE2 from the membrane, preventing membrane-dependent viral entry into the cell, the clinical significance of which is uncertain. Additionally, in vitro evidence suggests that inhibition of the transcription factor nuclear factor-κB (NF-kB) by ibuprofen may have a role in reducing excess inflammation or cytokine release in COVID-19 patients. Finally, there is no evidence that ibuprofen will aggravate or increase the chance of infection of COVID-19.


Assuntos
Anti-Inflamatórios não Esteroides/uso terapêutico , Infecções por Coronavirus/tratamento farmacológico , Ibuprofeno/uso terapêutico , Pneumonia Viral/tratamento farmacológico , Anti-Inflamatórios não Esteroides/efeitos adversos , Infecções por Coronavirus/complicações , Humanos , Ibuprofeno/efeitos adversos , Inflamação/etiologia , Inflamação/prevenção & controle , NF-kappa B/efeitos dos fármacos , Pandemias , Peptidil Dipeptidase A/efeitos dos fármacos , Pneumonia Viral/complicações
12.
Zhongguo Zhen Jiu ; 40(7): 717-20, 2020 Jul 12.
Artigo em Chinês | MEDLINE | ID: mdl-32648394

RESUMO

OBJECTIVE: To observe the clinical therapeutic effect of herb-separated moxibustion on dysmenorrhea in ovarian endometriosis. METHODS: A total of 54 patients with ovarian endometriosis dysmenorrhea were randomized into a herb-separated moxibustion group and a waiting-list group, 27 cases in each one (3 cases dropped off in the herb-separated moxibustion group, 4 cases dropped off in the waiting-list group). Herb-separated moxibustion was applied at hypogastrium and lumbosacral area for 30 min in the herb-separated moxibustion group, once a week for 3 months, and oral ibuprofen sustained-release capsule was given to relieve pain when necessary. Excepting giving ibuprofen sustained-release capsule when necessary, no more intervention was adopted in the waiting-list group. Before and after treatment and in 3 months follow-up, visual analogue scale (VAS) score, days of dysmenorrhea, total dose of oral painkiller were observed. RESULTS: Compared before treatment, the VAS scores after tratment and in follow-up were decreased in the herb-separated moxibustion group (P<0.05), and were less than those in the waiting-list group (P<0.05); the days of dysmenorrhea and the total doses of oral painkiller after tratment and in follow-up were decreased in the herb-separated moxibustion group (P<0.05), and were less than those in the waiting-list group (P<0.05). CONCLUSION: Herb-separated moxibustion can effectively improve dysmenorrhea symptom and shorten dysmenorrhea days in patients with ovarian endometriosis.


Assuntos
Dismenorreia/terapia , Endometriose/terapia , Moxibustão , Ovário/fisiopatologia , Pontos de Acupuntura , Feminino , Humanos , Ibuprofeno/uso terapêutico
13.
J Endod ; 46(9): 1210-1216, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32565333

RESUMO

INTRODUCTION: Preoperative administration of nonsteroidal anti-inflammatory drugs has been suggested as a method for increasing the efficacy of local anesthetics and decreasing postoperative pain in symptomatic irreversible pulpitis cases. However, the effects of ibuprofen at the molecular level are still unknown. Hence, the purpose of this study was to compare the levels of proinflammatory mediators in the dental pulp of teeth with irreversible pulpitis in patients who medicated with preoperative ibuprofen versus those who did not. METHODS: Thirty-four patients undergoing conventional endodontic therapy for teeth with irreversible pulpitis were selected and randomly assigned into either the ibuprofen or nonibuprofen group. Four patients undergoing endodontic therapy for prosthodontic reasons served as controls. Patients in the ibuprofen group were instructed to take 600 mg ibuprofen 1 hour before treatment, whereas patients in the nonibuprofen and control groups were asked to avoid analgesics before treatment. Blood samples obtained from the pulp upon access were tested for levels of prostaglandin E2, tumor necrosis efactor alpha, interleukin (IL)-6, IL-1ß, and interferon gamma using high-sensitivity enzyme-linked immunosorbent assay. Postoperative pain levels were recorded for the groups. Data for the cytokine levels and postoperative pain were analyzed using statistical analysis. RESULTS: There was a significant decrease in the levels of prostaglandin E2, tumor necrosis factor alpha, IL-6, and interferon gamma in the ibuprofen group compared with the nonibuprofen group. No significant differences were noted in the postoperative pain levels between these groups. CONCLUSIONS: The data showed that preoperative ibuprofen significantly decreased the levels of most proinflammatory cytokines in the dental pulp, which could possibly help with anesthesia in irreversible cases.


Assuntos
Anestesia Dentária , Anti-Inflamatórios não Esteroides , Ibuprofeno , Pulpite , Anestésicos Locais , Anti-Inflamatórios não Esteroides/uso terapêutico , Método Duplo-Cego , Humanos , Ibuprofeno/uso terapêutico , Estudos Prospectivos , Pulpite/tratamento farmacológico
15.
Medicine (Baltimore) ; 99(19): e19881, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32384431

RESUMO

BACKGROUND: Primary dysmenorrhea is common and troublesome. The comparative efficacy of over-the-counter analgesics (OTCAs) for dysmenorrhea is unclear. This study was aimed at conducting a network meta-analysis to assess the efficacy and safety of 5 OTCAs - naproxen, ibuprofen,diclofenac, aspirin, and ketoprofen - in patients with primary dysmenorrhea. METHODS: The study was registered with PROSPERO (number: CRD42019133556). The search strategy involved a review of PubMed, Embase, Cochrane Library, Web of Science, and CINAHL for relative randomized controlled trials of the 5 analgesics from the date of database establishment to July 2019. The outputs are presented as odds ratios (ORs), their corresponding 95% confidence intervals (CIs), and the surface under the cumulative ranking area (SUCRA) probabilities. RESULTS: Thirty-five trials with 4383 participants were included in our study. As for efficacy outcomes, all the included analgesics except aspirin were more effective than placebo in treating dysmenorrhea [naproxen (OR 3.99, 95% CI 2.18-7.30), ibuprofen (OR 10.08, 95% CI 3.29-30.85), diclofenac (OR 11.82, 95% CI 2.66-52.48), and ketoprofen (OR 5.12, 95% CI 1.57-16.69). The OTCAs were superior to the placebo in terms of pain relief in primary dysmenorrhea. Aspirin was less effective than ibuprofen (OR 0.17, 95% CI 0.04-0.73) and diclofenac (OR 1.17, 95% CI 0.02-0.85). The SUCRA curves showed that diclofenac and ibuprofen were the most and second most effective (85.1% and 83.8%, respectively), followed by ketoprofen, naproxen, and aspirin. Regarding safety, there was no significant difference between the 5 OTCAs included and the placebo. Diclofenac versus ibuprofen (OR 4.31, 95% CI 1.18-15.67), ketoprofen versus diclofenac (OR 0.18, 95% CI 0.04-0.78), and ketoprofen versus aspirin (OR 0.41, 95% CI 0.18-0.97) presented statistically significant differences. Ketoprofen and ibuprofen were ranked the best (SUCRA 90.6% and 79.6%), followed by naproxen, aspirin, and diclofenac. CONCLUSION: Considering the efficacy and safety, ibuprofen is recommended as the optimal OTCA for primary dysmenorrhea. Further well-designed studies that directly compare these analgesics are needed to support our conclusion.


Assuntos
Analgésicos/uso terapêutico , Anti-Inflamatórios não Esteroides/uso terapêutico , Dismenorreia/tratamento farmacológico , Medicamentos sem Prescrição/uso terapêutico , Adolescente , Adulto , Aspirina/uso terapêutico , Diclofenaco/uso terapêutico , Feminino , Humanos , Ibuprofeno/uso terapêutico , Cetoprofeno/uso terapêutico , Pessoa de Meia-Idade , Naproxeno/uso terapêutico , Metanálise em Rede , Resultado do Tratamento , Adulto Jovem
16.
F1000Res ; 9: 52, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32419926

RESUMO

A novel coronavirus recently identified in Wuhan, China (2019-nCoV) has expanded the number of highly pathogenic coronaviruses affecting humans. The 2019-nCoV represents a potential epidemic or pandemic threat, which requires a quick response for preparedness against this infection. The present report uses the informational spectrum methodology to identify the possible origin and natural host of the new virus, as well as putative therapeutic and vaccine targets. The performed in silico analysis indicates that the newly emerging 2019-nCoV is closely related to severe acute respiratory syndrome (SARS)-CoV and, to a lesser degree, Middle East respiratory syndrome (MERS)-CoV. Moreover, the well-known SARS-CoV receptor (ACE2) might be a putative receptor for the novel virus as well. Additional results indicated that civets and poultry are potential candidates for the natural reservoir of the 2019-nCoV, and that domain 288-330 of S1 protein from the 2019-nCoV represents promising therapeutic and/or vaccine target.


Assuntos
Betacoronavirus/química , Glicoproteína da Espícula de Coronavírus/química , Tropismo Viral , Actinas/química , Simulação por Computador , Infecções por Coronavirus/tratamento farmacológico , Humanos , Ibuprofeno/uso terapêutico , Coronavírus da Síndrome Respiratória do Oriente Médio , Pandemias , Peptidil Dipeptidase A/química , Pneumonia Viral/tratamento farmacológico , Receptores Virais/química , Vírus da SARS
17.
Am J Obstet Gynecol ; 223(2): 262.e1-262.e8, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32413429

RESUMO

BACKGROUND: Postoperative opioid prescription patterns play a key role in driving the opioid epidemic. A comprehensive system toward pain management in surgical patients is necessary to minimize overall opioid consumption. OBJECTIVE: This study aimed to evaluate the efficacy of a pain management model in patients undergoing pelvic reconstructive surgery by measuring postdischarge narcotic use in morphine milligram equivalents. STUDY DESIGN: This is a prospective clinical practice study that included women undergoing inpatient pelvic reconstructive surgery from December 2018 to June 2019 with overnight stay after surgery. As a routine protocol, all the patients followed an enhanced recovery after surgery protocol that included a preoperative multimodal pain regimen. Brief Pain Inventory surveys were collected preoperatively and on postoperative day 1. Brief pain inventory and activities assessment scale scores were collected at postoperative week 1 and postoperative weeks 4-6 after surgery. Patients were discharged with 15 tablets of an oral narcotic using an electronic prescription for controlled substances software platform, which is mandated in the state of Connecticut for all controlled substances, prescriptions, and refills. Patients were called at postoperative week 1 and postoperative weeks 4-6 to answer questions regarding their pain, the number of remaining narcotic tablets, and patient satisfaction regarding pain management. Patient electronic medical records and the Connecticut Prescription Monitoring and Reporting System were reviewed to determine whether patients received narcotic refills. Primary outcome was postdischarge narcotic use measured in morphine milligram equivalents. Secondary outcomes evaluated refill rate, brief pain inventory and activities assessment scale scores, and patient satisfaction with pain management. Descriptive statistics were described as mean and standard deviation and median and interquartile range. Bivariate comparisons used Spearman's rho (ρ) with α=0.05. RESULTS: A total 113 patients were enrolled; the median (interquartile range) morphine milligram equivalent prescribed (including refills) was 112.5 (112.5-112.5). The median postdischarge narcotic use was 24.0 (0-82.5) morphine milligram equivalent, which is equivalent to fewer than 4 oxycodone (5 mg) tablets. About 75% of our participants required fewer than 11 oxycodone tablets. The median unused morphine milligram equivalent was 90.0 (45-112.5). 81.4% (92/113), and 83.2% (94/113) of patients at postoperative week 1 and postoperative weeks 4-6, respectively, reported being satisfied or extremely satisfied with their postdischarge pain control. About 88.5% (100/113) of patients felt that the number of opioids they were discharged with was sufficient for their pain needs at the postoperative 1 and postoperative weeks 4-6 time points. At postoperative weeks 4-6, 19.5% of patients said that they filled the narcotic prescription but did not use any of the pills. The overall refill rate was 10.6% (12/113). All patients who needed a refill described the refill process as easy. In-hospital narcotic use was not predictive of postdischarge narcotic use (ρ0.065, P=.495). Patients reported median brief pain inventory scores for "average pain" of 0 (no pain) at postoperative week 1 and postoperative weeks 4-6; however, the scores did not clinically correlate with postdischarge narcotic use. Activities assessment scale scores were not correlated with postdischarge narcotic use. CONCLUSION: Most patients after pelvic reconstructive surgery used fewer than 11 oxycodone (5 mg) tablets, averaging less than 4 tablets, with a third of patients not requiring any opioids. Pain and activities scores did not correlate with narcotic use. A minimal number of opioids can be prescribed because the secure electronic prescribing system allows for convenient electronic refill if required. Our practical and comprehensive pre- and postoperative protocol for pain management minimizes opioid consumption in addition to maximizing patient satisfaction.


Assuntos
Analgésicos não Entorpecentes/uso terapêutico , Analgésicos Opioides/uso terapêutico , Anti-Inflamatórios não Esteroides/uso terapêutico , Procedimentos Cirúrgicos em Ginecologia , Dor Pós-Operatória/tratamento farmacológico , Prolapso de Órgão Pélvico/cirurgia , Procedimentos Cirúrgicos Reconstrutivos , Acetaminofen/uso terapêutico , Idoso , Celecoxib/uso terapêutico , Recuperação Pós-Cirúrgica Melhorada , Feminino , Gabapentina/uso terapêutico , Humanos , Ibuprofeno/uso terapêutico , Pessoa de Meia-Idade , Oxicodona/uso terapêutico , Manejo da Dor/métodos , Assistência Perioperatória , Estudos Prospectivos
18.
Obstet Gynecol ; 135(6): 1289-1295, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32459420

RESUMO

OBJECTIVE: To evaluate whether prophylactic dronabinol, a synthetic tetrahydrocannabinol, reduces pain during medical abortion. METHODS: We conducted a randomized, double-blind, placebo-controlled trial of women undergoing medical abortion with mifepristone and misoprostol up through 70 days of gestation. All participants received 800 mg of ibuprofen and were randomized to either 5 mg of oral dronabinol or a placebo 30 minutes before misoprostol administration. Participants used a text messaging service to report pain on a numeric rating scale from 0 to 10 (0=no pain, 10=worst pain). The primary outcome was maximum pain experienced during the 24 hours after misoprostol administration. Secondary outcomes were pain scores at 0, 6, and 24 hours after misoprostol administration; maximum anxiety and nausea scores; use of additional pain medication; reported side effects; and satisfaction (yes or no). We needed 68 participants (34 per group) to have 80% power to detect a 2-point difference in maximum pain on a numeric rating scale. RESULTS: From November 2018 to May 2019, we randomized 70 women (dronabinol=35, placebo=35). Participants in the study arms had comparable baseline characteristics. We found no difference between groups in the median maximum pain score reported (dronabinol 7 [interquartile range 6-8], placebo 7 [interquartile range 5-8], P=.82) or median pain scores at any timepoint. Groups were also no different in mean maximum anxiety (dronabinol 3.33 [SD 3.06], placebo 3.23 [SD 2.53], P=.88) or nausea scores (dronabinol 2.21 [SD 2.32], placebo 2.72 [SD 2.64], P=.41). Most women were satisfied with their pain management (76% dronabinol, 82% placebo, P=.51). CONCLUSION: Dronabinol does not reduce the maximum level of pain experienced by women undergoing medical abortion. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, NCT03604341.


Assuntos
Aborto Induzido/efeitos adversos , Analgésicos não Entorpecentes/uso terapêutico , Dronabinol/uso terapêutico , Ibuprofeno/uso terapêutico , Dor/prevenção & controle , Adulto , Analgésicos não Entorpecentes/administração & dosagem , Método Duplo-Cego , Dronabinol/administração & dosagem , Feminino , Humanos , Ibuprofeno/administração & dosagem , Dor/etiologia , Manejo da Dor , Gravidez , Adulto Jovem
19.
Am J Ther ; 27(4): e400-e402, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32366740

RESUMO

Ibuprofen is an over-the-counter medication that is used widely for the treatment of pain and fever during COVID-19 pandemic. A concern was raised regarding the safety of ibuprofen use because of its role in increasing ACE2 levels within the Renin-Angiotensin-Aldosterone system. ACE2 is the coreceptor for the entry of SARS-CoV-2 into cells, and so, a potential increased risk of contracting COVID-19 disease and/or worsening of COVID-19 infection was feared with ibuprofen use. However, available data from limited studies show administration of recombinant ACE2 improves lung damage caused by respiratory viruses, suggesting ibuprofen use may be beneficial in COVID-19 disease. At this time, there is no supporting evidence to discourage the use of ibuprofen.


Assuntos
Anti-Inflamatórios não Esteroides/efeitos adversos , Infecções por Coronavirus/complicações , Ibuprofeno/efeitos adversos , Pneumonia Viral/complicações , Inibidores da Enzima Conversora de Angiotensina/uso terapêutico , Animais , Anti-Inflamatórios não Esteroides/uso terapêutico , Betacoronavirus , Infecções por Coronavirus/tratamento farmacológico , Medicina Baseada em Evidências , Humanos , Ibuprofeno/uso terapêutico , Pulmão/efeitos dos fármacos , Pandemias , Peptidil Dipeptidase A/biossíntese , Pneumonia Viral/tratamento farmacológico , Receptores Virais/efeitos dos fármacos , Sistema Renina-Angiotensina/efeitos dos fármacos
20.
Brasília; s.n; 15 maio 2020.
Não convencional em Português | LILACS, BRISA/RedTESA, PIE | ID: biblio-1097391

RESUMO

O Informe Diário de Evidências é uma produção do Ministério da Saúde que tem como objetivo acompanhar diariamente as publicações científicas sobre tratamento farmacológico e vacinas para a COVID-19. Dessa forma, são realizadas buscas estruturadas em bases de dados biomédicas, referente ao dia anterior desse informe. Não são incluídos estudos pré-clínicos (in vitro, in vivo, in silico). A frequência dos estudos é demonstrada de acordo com a sua classificação metodológica (revisões sistemáticas, ensaios clínicos randomizados, coortes, entre outros). Para cada estudo é apresentado um resumo com avaliação da qualidade metodológica. Essa avaliação tem por finalidade identificar o grau de certeza/confiança ou o risco de viés de cada estudo. Para tal, são utilizadas ferramentas já validadas e consagradas na literatura científica, na área de saúde baseada em evidências. Cabe ressaltar que o documento tem caráter informativo e não representa uma recomendação oficial do Ministério da Saúde sobre a temática. Foram encontrados 21 artigos e 24 protocolos.


Assuntos
Humanos , Pneumonia Viral/tratamento farmacológico , Infecções por Coronavirus/tratamento farmacológico , Betacoronavirus/efeitos dos fármacos , Sistema Renina-Angiotensina , Avaliação da Tecnologia Biomédica , Ibuprofeno/uso terapêutico , Azitromicina/uso terapêutico , Ritonavir/uso terapêutico , Combinação de Medicamentos , Oseltamivir/uso terapêutico , Proteína Antagonista do Receptor de Interleucina 1/uso terapêutico , Lopinavir/uso terapêutico , Sulfato de Atazanavir/uso terapêutico , Interferon alfa-2/uso terapêutico , Hidroxicloroquina/uso terapêutico
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