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1.
PLoS One ; 15(11): e0242184, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33175880

RESUMO

Ivermectin has recently shown efficacy against SARS-CoV-2 in-vitro. We retrospectively reviewed severe COVID-19 patients receiving standard doses of ivermectin and we compared clinical and microbiological outcomes with a similar group of patients not receiving ivermectin. No differences were found between groups. We recommend the evaluation of high-doses of ivermectin in randomized trials against SARS-CoV-2.


Assuntos
Infecções por Coronavirus/tratamento farmacológico , Imunossupressores/uso terapêutico , Ivermectina/uso terapêutico , Pneumonia Viral/tratamento farmacológico , Adulto , Anticorpos Monoclonais Humanizados/uso terapêutico , Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/virologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Nasofaringe/virologia , Pandemias , Pneumonia Viral/diagnóstico , Pneumonia Viral/virologia , Estudos Retrospectivos , Resultado do Tratamento
3.
Sci Rep ; 10(1): 17073, 2020 10 13.
Artigo em Inglês | MEDLINE | ID: mdl-33051517

RESUMO

Ivermectin is a widely used antiparasitic drug with known efficacy against several single-strain RNA viruses. Recent data shows significant reduction of SARS-CoV-2 replication in vitro by ivermectin concentrations not achievable with safe doses orally. Inhaled therapy has been used with success for other antiparasitics. An ethanol-based ivermectin formulation was administered once to 14 rats using a nebulizer capable of delivering particles with alveolar deposition. Rats were randomly assigned into three target dosing groups, lower dose (80-90 mg/kg), higher dose (110-140 mg/kg) or ethanol vehicle only. A toxicology profile including behavioral and weight monitoring, full blood count, biochemistry, necropsy and histological examination of the lungs was conducted. The pharmacokinetic profile of ivermectin in plasma and lungs was determined in all animals. There were no relevant changes in behavior or body weight. There was a delayed elevation in muscle enzymes compatible with rhabdomyolysis, that was also seen in the control group and has been attributed to the ethanol dose which was up to 11 g/kg in some animals. There were no histological anomalies in the lungs of any rat. Male animals received a higher ivermectin dose adjusted by adipose weight and reached higher plasma concentrations than females in the same dosing group (mean Cmax 86.2 ng/ml vs. 26.2 ng/ml in the lower dose group and 152 ng/ml vs. 51.8 ng/ml in the higher dose group). All subjects had detectable ivermectin concentrations in the lungs at seven days post intervention, up to 524.3 ng/g for high-dose male and 27.3 ng/g for low-dose females. nebulized ivermectin can reach pharmacodynamic concentrations in the lung tissue of rats, additional experiments are required to assess the safety of this formulation in larger animals.


Assuntos
Antiparasitários/uso terapêutico , Infecções por Coronavirus/tratamento farmacológico , Ivermectina/uso terapêutico , Pneumonia Viral/tratamento farmacológico , Administração por Inalação , Animais , Antiparasitários/farmacocinética , Antiparasitários/farmacologia , Comportamento Animal/efeitos dos fármacos , Infecções por Coronavirus/patologia , Relação Dose-Resposta a Droga , Feminino , Meia-Vida , Ivermectina/farmacocinética , Ivermectina/farmacologia , Pulmão/metabolismo , Pulmão/patologia , Masculino , Necrose , Pandemias , Pneumonia Viral/patologia , Estudo de Prova de Conceito , Ratos , Ratos Sprague-Dawley , Transtornos Respiratórios/tratamento farmacológico , Transtornos Respiratórios/patologia
4.
Washington; PAHO; Oct. 30, 2020. 121 p.
Não convencional em Inglês | LILACS, PIE | ID: biblio-1127985

RESUMO

As of 31 October 2020 This is the tenth edition of this summary of rapid systematic reviews, which includes the results of a rapid systematic review of currently available literature. More than 200 therapeutic options or their combinations are being investigated in more than 1,700 clinical trials. In this review, 46 therapeutic options are examined. The Pan American Health Organization (PAHO) is continually monitoring ongoing research on any possible therapeutic options. As evidence emerges, then PAHO will immediately assess and update its position, and particularly as it applies to any special sub-group populations such as children, expectant mothers, those with immune conditions, etc.


Assuntos
Humanos , Pneumonia Viral/tratamento farmacológico , Ensaios Clínicos como Assunto , Infecções por Coronavirus/tratamento farmacológico , Pandemias/prevenção & controle , Betacoronavirus/efeitos dos fármacos , Antivirais/uso terapêutico , Plasma/imunologia , Ivermectina/uso terapêutico , Dexametasona/uso terapêutico , Metilprednisolona/uso terapêutico , Lopinavir/uso terapêutico , Hidroxicloroquina/uso terapêutico , Fatores Imunológicos/uso terapêutico
5.
Washington; PAHO; Oct. 09, 2020. 103 p.
Não convencional em Inglês | LILACS, PIE | ID: biblio-1127989

RESUMO

As of 31 October 2020 This is the tenth edition of this summary of rapid systematic reviews, which includes the results of a rapid systematic review of currently available literature. More than 200 therapeutic options or their combinations are being investigated in more than 1,700 clinical trials. In this review, 46 therapeutic options are examined. The Pan American Health Organization (PAHO) is continually monitoring ongoing research on any possible therapeutic options. As evidence emerges, then PAHO will immediately assess and update its position, and particularly as it applies to any special sub-group populations such as children, expectant mothers, those with immune conditions, etc.


Assuntos
Humanos , Pneumonia Viral/tratamento farmacológico , Ensaios Clínicos como Assunto , Infecções por Coronavirus/tratamento farmacológico , Pandemias/prevenção & controle , Betacoronavirus/efeitos dos fármacos , Antivirais/uso terapêutico , Plasma/imunologia , Ivermectina/uso terapêutico , Dexametasona/uso terapêutico , Metilprednisolona/uso terapêutico , Lopinavir/uso terapêutico , Hidroxicloroquina/uso terapêutico , Fatores Imunológicos/uso terapêutico
8.
BMC Infect Dis ; 20(1): 726, 2020 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-33008333

RESUMO

BACKGROUND: Ivermectin is an excellent microfilaricide against Onchocerca volvulus. However, in some regions, long term use of ivermectin has resulted in sub-optimal responses to the treatment. More data to properly document the phenomenon in various contexts of ivermectin mass drug administration (IVM-MDA) is needed. Also, there is a need to accurately monitor a possible repopulation of skin by microfilariae following treatment. Skin snip microscopy is known to have a low sensitivity in individuals with light infections, which can be the case following treatment. This study was designed with two complementary objectives: (i) to assess the susceptibility of O. volvulus microfilariae to ivermectin in two areas undergoing IVM-MDA for different lengths of time, and (ii) to document the repopulation of skin by the O. volvulus microfilariae following treatment, using 3 independent diagnostic techniques. METHOD: Identified microfilaridermic individuals were treated with ivermectin and re-examined after 1, 3, and 6 months using microscopy, actin real-time PCR (actin-qPCR) and O-150 LAMP assays. Susceptibility to ivermectin and trends in detecting reappearance of skin microfilariae were determined using three techniques. Microscopy was used as an imperfect gold standard to determine the performance of actin-qPCR and LAMP. RESULTS: In Bafia with over 20 years of IVM-MDA, 11/51 (21.6%) direct observe treated microfilaridemic participants were still positive for skin microfilariae after 1 month. In Melong, with 10 years of IVM-MDA, 2/29 (6.9%) treated participants were still positive. The microfilarial density reduction per skin biopsy within one month following treatment was significantly lower in participants from Bafia. In both study sites, the molecular techniques detected higher proportions of infected individuals than microscopy at all monitoring time points. LAMP demonstrated the highest levels of sensitivity and real-time PCR was found to have the highest specificity. CONCLUSION: Patterns in skin mirofilariae clearance and repopulation were established. O. volvulus worms from Bafia with higher number of annual MDA displayed a lower clearance and higher repopulation rate after treatment with ivermectin. Molecular assays displayed higher sensitivity in monitoring O. volvulus microfilaridemia within six months following treatment.


Assuntos
Antiparasitários/uso terapêutico , Ivermectina/uso terapêutico , Onchocerca volvulus/fisiologia , Oncocercose/tratamento farmacológico , Pele/patologia , Adolescente , Animais , Biópsia , Camarões , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Administração Massiva de Medicamentos , Microscopia , Reação em Cadeia da Polimerase em Tempo Real , Adulto Jovem
9.
Curr Top Med Chem ; 20(26): 2362-2378, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32962613

RESUMO

The article highlights an up-to-date progress in studies on structural and the remedial aspects of novel coronavirus 2019-nCoV, renamed as SARS-CoV-2, leading to the disease COVID-19, a pandemic. In general, all CoVs including SARS-CoV-2 are spherical positive single-stranded RNA viruses containing spike (S) protein, envelope (E) protein, nucleocapsid (N) protein, and membrane (M) protein, where S protein has a Receptor-binding Domain (RBD) that mediates the binding to host cell receptor, Angiotensin Converting Enzyme 2 (ACE2). The article details the repurposing of some drugs to be tried for COVID-19 and presents the status of vaccine development so far. Besides drugs and vaccines, the role of Convalescent Plasma (CP) therapy to treat COVID-19 is also discussed.


Assuntos
Antivirais/uso terapêutico , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/terapia , Pandemias , Peptidil Dipeptidase A/química , Pneumonia Viral/epidemiologia , Pneumonia Viral/terapia , Glicoproteína da Espícula de Coronavírus/genética , Monofosfato de Adenosina/análogos & derivados , Monofosfato de Adenosina/uso terapêutico , Alanina/análogos & derivados , Alanina/uso terapêutico , Betacoronavirus/efeitos dos fármacos , Betacoronavirus/imunologia , Betacoronavirus/patogenicidade , Betacoronavirus/ultraestrutura , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/imunologia , Infecções por Coronavirus/prevenção & controle , Expressão Gênica , Interações Hospedeiro-Patógeno/efeitos dos fármacos , Interações Hospedeiro-Patógeno/genética , Interações Hospedeiro-Patógeno/imunologia , Humanos , Hidroxicloroquina/uso terapêutico , Imunização Passiva/métodos , Ivermectina/uso terapêutico , Modelos Moleculares , Niclosamida/uso terapêutico , Peptidil Dipeptidase A/genética , Peptidil Dipeptidase A/imunologia , Pneumonia Viral/diagnóstico , Pneumonia Viral/imunologia , Domínios e Motivos de Interação entre Proteínas/efeitos dos fármacos , Estrutura Secundária de Proteína , Vírus da SARS/efeitos dos fármacos , Vírus da SARS/imunologia , Vírus da SARS/patogenicidade , Vírus da SARS/ultraestrutura , Síndrome Respiratória Aguda Grave , Glicoproteína da Espícula de Coronavírus/antagonistas & inibidores , Glicoproteína da Espícula de Coronavírus/química , Glicoproteína da Espícula de Coronavírus/imunologia , Vacinas Virais/biossíntese
10.
In Vivo ; 34(5): 3023-3026, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32871846

RESUMO

BACKGROUND/AIM: Coronavirus disease 2019 (COVID-19) is an infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). One drug that has attracted interest is the antiparasitic compound ivermectin, a macrocyclic lactone derived from the bacterium Streptomyces avermitilis. We carried out a docking study to determine if ivermectin might be able to attach to the SARS-CoV-2 spike receptor-binding domain bound with ACE2. MATERIALS AND METHODS: We used the program AutoDock Vina Extended to perform the docking study. RESULTS: Ivermectin docked in the region of leucine 91 of the spike and histidine 378 of the ACE2 receptor. The binding energy of ivermectin to the spike-ACE2 complex was -18 kcal/mol and binding constant was 5.8 e-08. CONCLUSION: The ivermectin docking we identified may interfere with the attachment of the spike to the human cell membrane. Clinical trials now underway should determine whether ivermectin is an effective treatment for SARS-Cov2 infection.


Assuntos
Betacoronavirus/efeitos dos fármacos , Infecções por Coronavirus/tratamento farmacológico , Ivermectina/química , Peptidil Dipeptidase A/química , Pneumonia Viral/tratamento farmacológico , Betacoronavirus/química , Betacoronavirus/patogenicidade , Sítios de Ligação/efeitos dos fármacos , Membrana Celular/efeitos dos fármacos , Infecções por Coronavirus/virologia , Reposicionamento de Medicamentos , Histidina/química , Humanos , Ivermectina/uso terapêutico , Leucina/química , Simulação de Acoplamento Molecular , Pandemias , Peptidil Dipeptidase A/efeitos dos fármacos , Pneumonia Viral/virologia , Streptomyces/química
11.
Exp Parasitol ; 218: 107998, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32941889

RESUMO

The aims of this study were to evaluate the efficacy of two injectable formulations of doramectin (DRM) against Psoroptes ovis in sheep infested under controlled experimental conditions and to characterize the DRM plasma disposition kinetics in the infested animals. To this end, sheep were experimentally infested with a P. ovis strain from a farm with a history of treatment failure, and then treated either with DRM 1% (traditional preparation) on days 0 and 7 or with DRM 3.15% (long-acting formulation) on day 0. The efficacy of each treatment was calculated by counting live mites in skin scrapings. Plasma samples were obtained from each animal and DRM concentrations were measured by HPLC. After the two doses of DRM 1%, the maximum efficacy (98.8%) was reached on day 28, whereas after the single dose of DRM 3.15%, the maximum efficacy (100%) was reached on day 35 and ratified on day 42. The long-acting formulation allowed obtaining higher exposure and more sustained concentrations of DRM than the traditional preparation. Although both DRM formulations studied were effective according to international protocols, they did not reach 100% effectiveness in the time required for approved pharmaceutical products against sheep scab, according to Argentine regulations.


Assuntos
Inseticidas/uso terapêutico , Ivermectina/análogos & derivados , Infestações por Ácaros/veterinária , Psoroptidae/efeitos dos fármacos , Doenças dos Ovinos/tratamento farmacológico , Animais , Disponibilidade Biológica , Feminino , Meia-Vida , Injeções Subcutâneas/veterinária , Inseticidas/administração & dosagem , Inseticidas/sangue , Inseticidas/farmacologia , Ivermectina/administração & dosagem , Ivermectina/sangue , Ivermectina/farmacologia , Ivermectina/uso terapêutico , Masculino , Infestações por Ácaros/tratamento farmacológico , Psoroptidae/crescimento & desenvolvimento , Ovinos , Doenças dos Ovinos/parasitologia
12.
Washington; PAHO; Sept. 22, 2020. 81 p.
Não convencional em Inglês | LILACS, PIE | ID: biblio-1127987

RESUMO

As of 31 October 2020 This is the tenth edition of this summary of rapid systematic reviews, which includes the results of a rapid systematic review of currently available literature. More than 200 therapeutic options or their combinations are being investigated in more than 1,700 clinical trials. In this review, 46 therapeutic options are examined. The Pan American Health Organization (PAHO) is continually monitoring ongoing research on any possible therapeutic options. As evidence emerges, then PAHO will immediately assess and update its position, and particularly as it applies to any special sub-group populations such as children, expectant mothers, those with immune conditions, etc.


Assuntos
Humanos , Pneumonia Viral/tratamento farmacológico , Ensaios Clínicos como Assunto , Infecções por Coronavirus/tratamento farmacológico , Pandemias/prevenção & controle , Betacoronavirus/efeitos dos fármacos , Antivirais/uso terapêutico , Plasma/imunologia , Ivermectina/uso terapêutico , Dexametasona/uso terapêutico , Metilprednisolona/uso terapêutico , Lopinavir/uso terapêutico , Hidroxicloroquina/uso terapêutico , Fatores Imunológicos/uso terapêutico
13.
PLoS Negl Trop Dis ; 14(9): e0008642, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32976514

RESUMO

Mass Drug Administration (MDA) programs to eliminate Lymphatic Filariasis (LF) in western Africa use the anthelminthics ivermectin plus albendazole. These drugs have the potential to impact also Soil-Transmitted Helminth (STH) infections, since the drugs have a broad range of anthelminthic activity. Integration of preventive chemotherapy efforts for LF, onchocerciasis and STH is recommended by the World Health Organization (WHO) in order to avoid duplication of MDA and to reduce costs. The objective of the current study was to determine whether five semi-annual rounds of community-wide MDA to eliminate LF and onchocerciasis have a greater impact on STH than three annual rounds of MDA with similar compliance. The effects of MDA using ivermectin (IVM, 0.2 mg/kg) combined with albendazole (ALB, 400 mg) on the prevalence and intensity of hookworm infection were evaluated in the Abengourou (annual MDA) and Akoupé (semi-annual MDA) health Districts in eastern Côte d'Ivoire from 2014 to 2017. A cross-sectional approach was used together with mixed logistic regression, and mixed linear models. Subjects were tested for STH using the Kato-Katz technique before the first round of MDA and 12, 24, and 36 months after the first round of MDA. The mean self-reported MDA compliance assessed during the survey was 65%, and no difference was observed between treatment areas. These results were confirmed by an independent coverage survey as recommended by WHO. Hookworm was the most prevalent STH species in both areas (23.9% vs 12.4%) and the prevalence of other STH species was less than 1%. The crude prevalence of hookworm dropped significantly, from 23.9% to 5.5% (p <0.001, 77% reduction) in the annual MDA treatment area and from 12.4% to 1.9% (p <0.001, 85% reduction) in the semi-annual treatment area. The average intensity of hookworm infection decreased in the annual MDA area (406.2 epg to 118.3 epg), but not in the semi-annual MDA area (804.9 epg to 875.0 epg). Moderate and heavy infections (1% and 1.3% at baseline) were reduced to 0% and 0.4% in the annual and semi-annual treatment areas, respectively. Using a mixed logistic regression model, and after adjusting for baseline prevalence, only the year 2 re-examination showed a difference in prevalence between treatments (OR: 2.26 [95% CI: 1.03, 4.98], p = 0.043). Analysis of intensity of hookworm infection indicated also that treatment differences varied by follow-up visit. In conclusion twelve months after the last treatment cycle, three annual and five semi-annual rounds of community-wide MDA with the combination of IVM and ALB showed strong, but similar impact on hookworm prevalence and intensity in eastern Côte d'Ivoire. Therefore, an annual MDA regimen seems to be an efficient strategy to control hookworm infection in endemic areas with low and moderate infection prevalence. Trial registration: The study was registered at ClinicalTrial.gov under the number NTC02032043.


Assuntos
Filariose Linfática/tratamento farmacológico , Infecções por Uncinaria/tratamento farmacológico , Administração Massiva de Medicamentos/métodos , Oncocercose/tratamento farmacológico , Adolescente , Adulto , Albendazol/administração & dosagem , Albendazol/uso terapêutico , Ancylostomatoidea , Animais , Criança , Costa do Marfim/epidemiologia , Estudos Transversais , Combinação de Medicamentos , Filariose Linfática/epidemiologia , Feminino , Infecções por Uncinaria/epidemiologia , Humanos , Ivermectina/administração & dosagem , Ivermectina/uso terapêutico , Masculino , Pessoa de Meia-Idade , Oncocercose/epidemiologia , Prevalência , Adulto Jovem
14.
Brasília; s.n; 12 ago. 2020.
Não convencional em Português | LILACS, BRISA/RedTESA, PIE | ID: biblio-1117983

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, referentes 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 13 artigos e 10 protocolos.


Assuntos
Humanos , Pneumonia Viral/tratamento farmacológico , Infecções por Coronavirus/tratamento farmacológico , Betacoronavirus/efeitos dos fármacos , Avaliação da Tecnologia Biomédica , Ivermectina/uso terapêutico , Imunoglobulinas/uso terapêutico , Vacina BCG/uso terapêutico , Colchicina/uso terapêutico , Estudos Transversais , Estudos de Coortes , Azitromicina/uso terapêutico , Ritonavir/uso terapêutico , Lopinavir/uso terapêutico , Inibidores de Janus Quinases/uso terapêutico , Telmisartan/uso terapêutico , Hidroxicloroquina/uso terapêutico
15.
Washington; PAHO; Aug. 11, 2020. 91 p.
Monografia em Inglês | LILACS, PIE | ID: biblio-1094870

RESUMO

More than 200 therapeutic options or their combinations are being investigated in more than 1,700 clinical trials. In this review we examined 30 therapeutic options. Findings from the RECOVERY Trial showed that low doses of dexamethasone (6 mg of oral or intravenous preparation once daily for 10 days) significantly reduced mortality by one-third in ventilated patients and by one fifth in patients receiving oxygen only. The anticipated RECOVERY. Trial findings and WHO's SOLIDARITY Trial findings both show no benefit via use of hydroxychloroquine and lopinavir/ritonavir in terms of reducing 28-day mortality or reduced time to clinical improvement or reduced adverse events. Currently, there is no evidence of benefit in critical outcomes (i.e. reduction in mortality) from any therapeutic option (though remdesivir is revealing promise as one option based on 2 randomized controlled trials) and that conclusively allows for safe and effective use to mitigate or eliminate the causative agent of COVID-19. Currently, as to ivermectin, we found 1 in vitro study and 4 observational studies that were largely confounded (nonrandomized), and lacked the methodological rigor to allow much confidence in the results. They were pre-print and non-peer reviewed and were judged to be of high risk of bias and very low quality of evidence. The researchers concluded in large part that the findings could be considered hypothesis testing and urged the conduct of large sample sized RCTs to assess any clinical benefit. Currently, as to favipiravir, we found 1 RCT and 2 observational studies. The results were inconclusive for benefits of favipiravir, and sample sizes were small and results came via largely preprints and non-peer reviewed publications. The 2 nonrandomized observational designs revealed sub-optimal methods with no optimal adjustments, masking, or stratification. A recent release by Glenmark announced promising results from a Phase 3 Clinical Trial of favipiravir in patients with mild to moderate COVID-19. A Phase 3 RCT demonstrates statistically significant faster time to clinical improvement with favipiravir treatment compared to control (n=150 patients).


Assuntos
Humanos , Antivirais/uso terapêutico , Plasma/imunologia , Pneumonia Viral/tratamento farmacológico , Ivermectina/uso terapêutico , Dexametasona/uso terapêutico , Metilprednisolona/uso terapêutico , Infecções por Coronavirus/tratamento farmacológico , Pandemias/prevenção & controle , Lopinavir/uso terapêutico , Betacoronavirus/efeitos dos fármacos , Hidroxicloroquina/uso terapêutico , Fatores Imunológicos/uso terapêutico , Ensaios Clínicos como Assunto
17.
Exp Parasitol ; 217: 107961, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32777223

RESUMO

Scabies is considered one of the commonest dermatological diseases that has a global health burden. Current treatment with ivermectin (IVM) is insufficient and potential drug resistance was noticed. Moxidectin (MOX), with a better pharmacological profile may be a promising alternative. The efficacy of moxidectin against Sarcoptes scabiei was assessed both in vitro and in vivo in comparison with ivermectin. For the in vitro assay, both drugs were used in two concentrations (50 µg/ml and 100 µg/ml). For the in vivo assay, twenty rabbits infected with Sarcoptes scabiei were divided into three groups: untreated, moxidectin-treated and ivermectin-treated with the same dose of 0.3 mg/kg once. Another four rabbits were used as a normal control non-infected group. Treatment efficacy was evaluated by clinical assessment, parasitological evaluation and histopathological examination of skin samples using Hematoxylin and eosin and toluidine blue for mast cell staining. Immune response was also assessed by immunohistochemical staining of CD3 T cells in skin samples. Our results showed that moxidectin had a high efficacy (100%) in killing mites when used in both concentrations (50 µg/ml, 100 µg/ml) in the in vitro assay. Concerning the in vivo assay, on day 14 post-treatment, all MOX-treated rabbits were mite-free with full clinical cure by the end of the study (D21) showing (100%) reduction of mites count. Also, marked improvement in the epidermis with absence of mites in skin samples were shown. Poor clinical and parasitological improvements were noted in the ivermectin-treated rabbits, when given as a single dose with a percentage reduction (60.67%) in the 2nd week and progressive increase in lesions and mites count in the 3rd week post-treatment. Regarding the immune response, MOX-treated group showed mild infiltration with both mast cells and CD3 T cells in comparison to severe infiltration with both types of cells in the untreated and IVM-treated group. On conclusion, our results demonstrated that a single dose of MOX was more effective than IVM, supporting MOX as a valuable therapeutic approach for scabies therapy.


Assuntos
Acaricidas/farmacologia , Macrolídeos/farmacologia , Sarcoptes scabiei/efeitos dos fármacos , Escabiose/tratamento farmacológico , Acaricidas/uso terapêutico , Animais , Biópsia por Agulha , Orelha Externa/efeitos dos fármacos , Orelha Externa/parasitologia , Orelha Externa/patologia , Imuno-Histoquímica , Ivermectina/farmacologia , Ivermectina/uso terapêutico , Macrolídeos/uso terapêutico , Masculino , Coelhos , Pele/parasitologia , Pele/patologia
18.
BMC Infect Dis ; 20(1): 613, 2020 Aug 18.
Artigo em Inglês | MEDLINE | ID: mdl-32811453

RESUMO

BACKGROUND: Strongyloidiasis is caused by the helminth Strongyloides stercoralis and is well-recognised amongst transplant recipients. Serious complications, including Strongyloides hyperinfection which is a syndrome of accelerated autoinfection, or disseminated disease, can occur post-transplantation, resulting in significant morbidity and mortality. Here we present the first published case we are aware of, describing post-transplant Strongyloides hyperinfection in an HIV-positive kidney transplant patient. We discuss the diagnostic challenges and the role of pre-transplant screening. CASE PRESENTATION: A 58-year-old African-American male, originally from the Caribbean, received a deceased donor kidney transplant for presumed focal segmental glomerulosclerosis. He was known to be HIV-positive, with a stable CD4 count, and an undetectable viral load. Five months post-transplant, he developed gastrointestinal symptoms and weight loss. He had a normal eosinophil count (0.1-0.2 × 109/L), negative serum cytomegalovirus DNA, and negative blood and stool cultures. His Strongyloides serology remained negative throughout. A diagnosis of Strongyloides hyperinfection was made by the histological examination of his duodenum and lung, which identified the parasites. He completed his course of treatment with Ivermectin but exhibited profound deconditioning and required a period of total parenteral nutrition. He was subsequently discharged after a prolonged hospital admission of 54 days. CONCLUSIONS: This case highlights the challenges in diagnosing Strongyloides infection and the need to maintain a high index of clinical suspicion. Non-invasive techniques for the diagnosis of Strongyloides may be insufficient. Routine pre-transplant serological strongyloidiasis screening is now performed at our centre.


Assuntos
Soropositividade para HIV/fisiopatologia , HIV/imunologia , Transplante de Rim/efeitos adversos , Strongyloides stercoralis/isolamento & purificação , Estrongiloidíase/diagnóstico , Estrongiloidíase/etiologia , Transplantados , Afro-Americanos , Animais , Antiparasitários/uso terapêutico , Soropositividade para HIV/virologia , Humanos , Ivermectina/uso terapêutico , Masculino , Pessoa de Meia-Idade , Estrongiloidíase/tratamento farmacológico , Estrongiloidíase/parasitologia , Doadores de Tecidos , Resultado do Tratamento
19.
BMC Public Health ; 20(1): 1233, 2020 Aug 12.
Artigo em Inglês | MEDLINE | ID: mdl-32787813

RESUMO

BACKGROUND: Control and elimination of onchocerciasis requires regular follow-up and evaluation of community directed treatment with ivermectin (CDTi) program implementation. This research was aimed to assess the epidemiological status of onchocerciasis in disease endemic communities of Asosa and Yeki districts of Ethiopia after 5 and 15 years of successive CDTi respectively, and to evaluate the decline in infection and morbidity burden. METHODS: A community-based cross-sectional study was conducted from August 2017 to January 2018 (i.e. within 2-7 months since the last treatment) using interview, physical and parasitological examinations. Pre-CDTi epidemiological data were obtained from studies conducted prior to the launch of CDTi. RESULTS: A total of 3002 individuals (1567 from Asosa and 1435 from Yeki) were included. No infection was detected from Yeki. In Asosa, the prevalence of infection was 1.6%. The geometric mean intensity of infection was 0.02 mf/mg of skin snip. The prevalence rates of dermatitis, depigmentation, nodule, and atrophy in Yeki were 33(2.3%), 57(4%), 37(2.6%) and 11(0.7%), respectively. The prevalence rates of papular dermatitis, depigmentation, palpable nodule, atrophy, and blindness in Asosa were 94(6%), 38(2.4%), 30(1.9%), 28(1.8%) and 2(0.1%), respectively. Five years of CDTi had significantly reduced prevalence and intensity of infection by 91.8% (p < 0.001) and 99.7% (p < 0.001), respectively. Moreover, CDTi reduced prevalence of papular dermatitis by 95.9% (p < 0.001), palpable nodule by 90.5% (p < 0.001), and atrophy by 30% (p = 0.6) in Yeki. Similarly, CDTi reduced prevalence of papular dermatitis by 88.6% (p < 0.001), depigmentation by 90.3% (p < 0.001), atrophy by 89.5% (p < 0.001), and blindness by 90% (p < 0.001) in Asosa. CONCLUSIONS: Fifteen years of successive CDTi had brought the infection from high to zero in Yeki. However, thorough entomological and serological data need to be generated to ascertain whether complete interruption of parasite transmission has been attained, and for considerations of an evidence-based CDTi cessation. Five years of CDTi in Asosa has significantly reduced the infection and morbidity of onchocerciasis to very low level. We, hereby, recommend biannual CDTi to continue in Asosa and its surroundings until the infection transmission is fully interrupted.


Assuntos
Doenças Endêmicas/prevenção & controle , Ivermectina/uso terapêutico , Administração Massiva de Medicamentos , Oncocercose/tratamento farmacológico , Oncocercose/epidemiologia , Adolescente , Adulto , Estudos Transversais , Etiópia/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Morbidade , Prevalência , Avaliação de Programas e Projetos de Saúde , Adulto Jovem
20.
Indian J Tuberc ; 67(3): 448-451, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32825892

RESUMO

A group of senior doctors with vast clinical experience met on 19th July'20 under the aegis of Academy of Advanced Medical Education. The panel looked at Ivermectin, one of the old molecule and evaluated it's use in COVID 19 (Novel Coronavirus Disease 2019) management. After critical panel discussion, all the attending doctors came to a conclusion that Ivermectin can be a potential molecule for prophylaxis and treatment of people infected with Coronavirus, owing to its anti-viral properties coupled with effective cost, availability and good tolerability and safety.


Assuntos
Betacoronavirus , Infecções por Coronavirus/tratamento farmacológico , Ivermectina/uso terapêutico , Pneumonia Viral/tratamento farmacológico , Antiparasitários/uso terapêutico , Humanos , Pandemias , Fatores de Risco , Resultado do Tratamento
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