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1.
Artigo em Russo | MEDLINE | ID: mdl-32207707

RESUMO

RATIONALE: Treatment of osteoarthritis (OA) is a relevant problem of rheumatology. Despite a significant number of medical approaches and the creation of new drugs, the effectiveness of treatment remains unsatisfactory, which necessitates the creation of complex treatment programs. Pulse low-frequency magnetotherapy is a modern method that makes it possible to potentiate the therapeutic effects of chondroprotectors for transdermal administration using magnetophoresis technology. AIM: To evaluate the efficacy and tolerability of combination therapy using chondroprotective magnetophoresis using 'running' pulsed magnetic field (RPMF) and application of chondroxide (transdermal gel form) in patients with knee OA. MATERIAL AND METHODS: A randomized, placebo-controlled clinical trial included 65 patients with grade II - III knee OA according to the Kellgren-Lwrence classification. The 1st group included 25 patients who received local therapy - chondroxide magnetophoresis using RPMF (20 mT, frequency 6.25 Hz, exposure time 20 min, No. 12); in the 2nd group - 20 patients who underwent placebo-magnetotherapy of chondroxide; in the 3rd group - 20 patients who used RPMF without local chondroprotective therapy. We used VAS, WOMAC scales, EQ-5D questionnaire, OMERACT-OARSI criterion in order to analyze the results. RESULTS: A pronounced analgesic effect of the treatment was registered (according to the VAS and WOMAC scales) in patients receiving magnetotherapy (p<0.01). A significant improvement in functional parameters (according to WOMAC) was noted, more pronounced in patients who used chondroxide magnetophoresis (p<0.001). During the course of treatment, a positive effect of magnetotherapy on the indicators of quality of life (according to EQ-5D) was registered. A high percentage of response (68.1%) to therapy using magnetophoresis of the transdermal form of chondroxide (according to OMERACT-OARSI) was demonstrated. No adverse reactions were registered during treatment. CONCLUSION: The use of the local therapy method in the form of magnetophoresis of the transdermal form of the chondroxide is an effective and safe treatment technology that improves the functional state and quality of life of patients with OA of the knee joint.


Assuntos
Antirreumáticos/administração & dosagem , Sulfatos de Condroitina/administração & dosagem , Terapia de Campo Magnético , Osteoartrite do Joelho/terapia , Administração Cutânea , Antirreumáticos/uso terapêutico , Sulfatos de Condroitina/uso terapêutico , Géis , Humanos , Osteoartrite do Joelho/tratamento farmacológico , Qualidade de Vida , Resultado do Tratamento
2.
BMC Gastroenterol ; 19(1): 217, 2019 Dec 16.
Artigo em Inglês | MEDLINE | ID: mdl-31842768

RESUMO

BACKGROUND: Portal vein thrombosis (PVT) is a common complication of cirrhosis. However, in patients with PVT and cirrhosis, there is no clear evidence supporting effective treatment modalities. In this study, we examined the effectiveness and safety of anticoagulation therapy using danaparoid sodium for PVT in patients with cirrhosis. METHODS: This retrospective study assessed 52 cirrhotic patients with PVT treated with danaparoid sodium for 2 weeks between November 2008 and September 2018. The primary outcome measure was the post-treatment status of PVT assessed by reduction in thrombus volume and safety of the therapeutic intervention. PVT status was evaluated with contrast-enhanced computed tomography (CECT). All patients received 1250 units of danaparoid sodium twice daily by intravenous injection for 14 days. Patients on antithrombin III (AT-III) combination therapy were additionally administered 1500 units of AT-III on days 1-5 and days 8-12. Effectiveness was evaluated by CECT from between days 13 and 18. The secondary outcome measure was the prognosis of PVT. RESULTS: All patients showed reduction in PVT volume without complications. Return of plasma AT-III level to > 70% during the treatment period contributes to ≥75% reduction of PVT volume. The prognosis in PVT patients depends on hepatic reserve capacity. When limited to Child-Pugh B and C liver cirrhosis patients, a ≥ 75% reduction of PVT volume improved the prognosis. CONCLUSIONS: Danaparoid sodium-based anticoagulation therapy was effective and safe for PVT in patients with cirrhosis. Return of plasma AT-III level to the normal range during the treatment period contributes to reduction of PVT volume. A reduction of ≥75% in PVT volume may improve the prognosis of Child-Pugh B and C decompensated cirrhosis patients with PVT.


Assuntos
Anticoagulantes/uso terapêutico , Sulfatos de Condroitina/uso terapêutico , Dermatan Sulfato/uso terapêutico , Heparitina Sulfato/uso terapêutico , Cirrose Hepática/complicações , Veia Porta , Trombose Venosa/tratamento farmacológico , Idoso , Feminino , Humanos , Masculino , Prognóstico , Estudos Retrospectivos , Trombose Venosa/etiologia
3.
Artigo em Russo | MEDLINE | ID: mdl-31626227

RESUMO

Osteoarthritis is one of the leading causes of a chronic pain in elderly people. Old and very old age in itself is a risk factor of a comorbidity, which often limits the therapy specified in clinical recommendations. First of all, it concerns NSAID. In such situations, priority is given to chondroitin sulfate (CS) and glucosamine sulfate (GS) having the anti-inflammatory properties comparable with effects of NSAID. CS and GS also promote the delay in progression of degenerative processes and restoration of the structure of cartilaginous tissue. The drugs of CS and GS groups are Chondroguard and Sustaguard Artro having the considerable evidence-based efficacy and safety and also a polymodality of effects in patients with a combination of osteoarthritis and socially important diseases (atherosclerosis, diabetes mellitus type 2, oncological diseases) and also geriatric syndromes (sarcopenia) and aging in general.


Assuntos
Sulfatos de Condroitina , Glucosamina , Osteoartrite , Manejo da Dor , Idoso , Sulfatos de Condroitina/uso terapêutico , Medicina Baseada em Evidências , Glucosamina/uso terapêutico , Humanos , Osteoartrite/complicações , Osteoartrite/tratamento farmacológico , Dor/etiologia
4.
Nutrients ; 11(9)2019 Aug 29.
Artigo em Inglês | MEDLINE | ID: mdl-31470599

RESUMO

Osteoarthritis (OA) is the most common form of arthritis in the world and is characterized by pain, various disabilities and loss of quality of life. Chondroitin sulfate (CS) is recommended as first-line therapy. CS of non-animal origin is of great interest for safety and sustainability reasons. This study aims to investigate the anti-inflammatory effects, anti-pain and ability-enhancement of a short-term supplementation with non-animal CS in overweight subjects with OA. In a randomized, double-blind, placebo-controlled pilot study, 60 overweight adults with symptomatic OA were allocated to consume 600 mg of non-animal CS (n = 30) or a placebo (n = 30) daily for 12 consecutive weeks. The assessment of knee-pain, quality of life, related inflammation markers and body composition was performed at 0, 4 and 12 weeks. The Tegner Lysholm Knee Scoring (TLKS) scale of the experimental group showed a statistically significant increase (+10.64 points; confidence interval (95% confidence interval (CI) 5.57; 15.70; p < 0.01), while the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score decreased (-12.24 points; CI 95% -16.01; -8.38; p < 0.01). The results also showed a decrease in the C-reactive protein (CRP) level (-0.14 mg/dL, CI 95% -0.26; -0.04; p < 0.01) and erythrocyte sedimentation rate (ESR) level (-5.01 mm/h, CI 95% -9.18; -0.84, p < 0.01) as well as the visual analogue scale (VAS) score in both knees. In conclusion, this pilot study demonstrates the effectiveness of non-animal CS supplementation in overweight subjects with knee OA in improving knee function, pain and inflammation markers.


Assuntos
Anti-Inflamatórios/uso terapêutico , Sulfatos de Condroitina/uso terapêutico , Suplementos Nutricionais , Articulação do Joelho/efeitos dos fármacos , Osteoartrite do Joelho/tratamento farmacológico , Sobrepeso/complicações , Absorciometria de Fóton , Adiposidade , Idoso , Anti-Inflamatórios/efeitos adversos , Biomarcadores/sangue , Proteína C-Reativa/metabolismo , Sulfatos de Condroitina/efeitos adversos , Suplementos Nutricionais/efeitos adversos , Método Duplo-Cego , Feminino , Humanos , Mediadores da Inflamação/sangue , Itália , Articulação do Joelho/diagnóstico por imagem , Articulação do Joelho/fisiopatologia , Masculino , Pessoa de Meia-Idade , Osteoartrite do Joelho/complicações , Osteoartrite do Joelho/diagnóstico por imagem , Osteoartrite do Joelho/fisiopatologia , Sobrepeso/diagnóstico por imagem , Sobrepeso/fisiopatologia , Medição da Dor , Projetos Piloto , Qualidade de Vida , Recuperação de Função Fisiológica , Fatores de Tempo , Resultado do Tratamento
5.
Molecules ; 24(15)2019 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-31374852

RESUMO

Galactosaminoglycans (GalAGs) are sulfated glycans composed of alternating N-acetylgalactosamine and uronic acid units. Uronic acid epimerization, sulfation patterns and fucosylation are modifications observed on these molecules. GalAGs have been extensively studied and exploited because of their multiple biomedical functions. Chondroitin sulfates (CSs), the main representative family of GalAGs, have been used in alternative therapy of joint pain/inflammation and osteoarthritis. The relatively novel fucosylated chondroitin sulfate (FCS), commonly found in sea cucumbers, has been screened in multiple systems in addition to its widely studied anticoagulant action. Biomedical properties of GalAGs are directly dependent on the sugar composition, presence or lack of fucose branches, as well as sulfation patterns. Although research interest in GalAGs has increased considerably over the three last decades, perhaps motivated by the parallel progress of glycomics, serious questions concerning the effectiveness and potential side effects of GalAGs have recently been raised. Doubts have centered particularly on the beneficial functions of CS-based therapeutic supplements and the potential harmful effects of FCS as similarly observed for oversulfated chondroitin sulfate, as a contaminant of heparin. Unexpected components were also detected in CS-based pharmaceutical preparations. This review therefore aims to offer a discussion on (1) the current and potential therapeutic applications of GalAGs, including those of unique features extracted from marine sources, and (2) the potential drawbacks of this class of molecules when applied to medicine.


Assuntos
Acetilgalactosamina/uso terapêutico , Artralgia/tratamento farmacológico , Osteoartrite/tratamento farmacológico , Polissacarídeos/uso terapêutico , Acetilgalactosamina/química , Sulfatos de Condroitina/química , Sulfatos de Condroitina/uso terapêutico , Humanos , Polissacarídeos/química , Ácidos Urônicos/química , Ácidos Urônicos/uso terapêutico
6.
Carbohydr Polym ; 222: 115031, 2019 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-31320064

RESUMO

The detailed structure of a further Chondroitin Sulfate from Litopenaeus vannamei shrimp (sCS) is described. The backbone structure was established by 1H/13C NMR, which identified 3-O-sulfated GlcA, 4-O-sulfated GalNAc, 6-O-sulfated GalNAc, and 4,6-di-O-sulfated GalNAc residues. GlcA is linked to GalNAc 4,6 di S and GlcA 3S is linked to GalNAc 4S, GalNAc 4,6 di-S and GalNAc6S residues. The anticoagulant properties of this sCS were evaluated by activated partial thromboplastin time, anti-IIa, anti-Xa and anti-heparin cofactor II-mediated activities, and sCS failed to stabilise antithrombin in a fluoresence shift assay. The anti-inflammatory effect of sCS was explored using a model of acute peritonitis, followed by leukocyte count and measurement of the cytokines, IL-1ß, IL-6 and TNF-α. The compound showed low clotting effects, but high anti-IIa activity and HCII-mediated thrombin inhibition. Its anti-inflammatory effect was shown by leukocyte recruitment inhibition and a decrease in pro-inflammatory cytokine levels. Although the biological role of sCS remains unknown, its properties indicate that it is suitable for studies of multi-potent molecules obtained from natural sources.


Assuntos
Anti-Inflamatórios/uso terapêutico , Antitrombinas/uso terapêutico , Sulfatos de Condroitina/uso terapêutico , Inflamação/tratamento farmacológico , Penaeidae/química , Peritonite/tratamento farmacológico , Animais , Anti-Inflamatórios/química , Anti-Inflamatórios/isolamento & purificação , Antitrombinas/química , Antitrombinas/isolamento & purificação , Sulfatos de Condroitina/química , Sulfatos de Condroitina/isolamento & purificação , Citocinas/metabolismo , Lipopolissacarídeos , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Peso Molecular , Óxido Nítrico/metabolismo , Peritonite/induzido quimicamente , Células RAW 264.7 , Ratos Wistar
7.
Carbohydr Polym ; 222: 115025, 2019 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-31320079

RESUMO

Fucosylated chondroitin sulfate (FCS) oligosaccharides of specific molecular weight have shown potent anticoagulant activities with selectivity towards intrinsic factor Xase complex. However, the preparation of FCS oligosaccharides by traditional methods requires multiple purification steps consuming large amounts of time and significant resources. The current study focuses on developing a method for the rapid preparation of FCS oligomers from sea cucumber Pearsonothuria graeffei having 6-18 saccharide residues. The key steps controlling molecular weight (Mw) and purity of these FCS oligomers were evaluated. Structural analysis showed the resulting FCS oligomers were primarily l-Fuc3,4diS-α1,3-d-GlcA-ß1,3-(d-GalNAc4,6diS-ß1,4-[l-Fuc3,4diS-α1,3-]d-GlcA-ß1,3-)nd-anTal-ol4,6diS (n = 1˜5) accompanied by partial de-fucosylation and/or de-sulfation. In vitro and in vivo experiments demonstrate that these FCS oligomers selectively inhibit intrinsic factor Xase complex and exhibit remarkable antithrombotic activity without hemorrhagic and hypotension side effects. This method is suitable for large-scale preparation of FCS oligosaccharides as clinical anticoagulants.


Assuntos
Anticoagulantes/uso terapêutico , Sulfatos de Condroitina/uso terapêutico , Fator IXa/antagonistas & inibidores , Fator VIIIa/antagonistas & inibidores , Fibrinolíticos/uso terapêutico , Proteínas de Neoplasias/antagonistas & inibidores , Animais , Anticoagulantes/química , Anticoagulantes/farmacologia , Sequência de Carboidratos , Sulfatos de Condroitina/química , Sulfatos de Condroitina/farmacologia , Cisteína Endopeptidases , Fibrinolíticos/química , Fibrinolíticos/farmacologia , Masculino , Camundongos , Coelhos , Ratos Sprague-Dawley , Pepinos-do-Mar/química , Trombose Venosa/tratamento farmacológico
8.
Urologiia ; (1): 35-39, 2019 Apr.
Artigo em Russo | MEDLINE | ID: mdl-31184015

RESUMO

AIM: It is established that intravesical sodium hyaluronate and chondroitin sulfate has high efficacy in patients with bladder pain syndrome/interstitial cystitis (BPS/IC). Currently, an oral form of chondroitin sulfate is also available. The aim of study was to compare the efficacy of intravesical hyaluronic acid monotherapy and long-term oral chondroitin sulfate in combination with intravesical therapy in patients with BPS/IC. MATERIALS AND METHODS: A total of 59 patients with BPS/IC were randomized in two groups. In Group 1, 30 women (mean age 57.1 years) received viscoelastic solution of sodium hyaluronate 50 ml 1 time per week for 12 weeks as intravesical monotherapy. In Group 2 (n=29), patients were prescribed to complex therapy, which included the similar intravesical therapy combined with chondroitin sulfate in a dose 0.39 g, 2 capsules 3 times a day, also for 12 weeks. All patients completed visual analogue scale (VAS), interstitial cystitis symptom index (ISCI), interstitial cystitis problems index (ICPI) and voiding diary before and 1 week after the start of therapy. In all cases a cystoscopy and urodynamic study were performed in order to exclude other bladder pathologies. RESULTS: At baseline, a mean VAS score in both groups was 7 points, a mean ISCI score was 17 points in Group 1 and 18 points in Group 2 (p>0.1). The mean ICPI score in both groups was 15 points. A frequency of urination in Group 1 and 2 was 11.4 and 11.6 per day, respectively (p>0,1). A mean volume of urination was 138+/-24.6 and 131+/-18.6 , respectively. After 12 weeks of therapy there was significant improvement of VAS, ICSI and ICPI scores in both groups, as well as frequency and volume of urination, but in Group 2 an improvement in almost all parameters studied, except for the volume of urination, was more pronounced. CONCLUSION: The combined therapy of BPS/IC with intravesical hyaluronic acid and oral chondroitin sulfate provides significantly better results in comparison with intravesical hyaluronic acid as monotherapy.


Assuntos
Sulfatos de Condroitina , Cistite Intersticial , Ácido Hialurônico , Dor , Administração Intravesical , Sulfatos de Condroitina/uso terapêutico , Cistite Intersticial/complicações , Cistite Intersticial/tratamento farmacológico , Feminino , Humanos , Ácido Hialurônico/uso terapêutico , Pessoa de Meia-Idade , Dor/tratamento farmacológico , Medição da Dor
9.
J Cutan Med Surg ; 23(4): 413-420, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31179746

RESUMO

OBJECTIVES: It is uncertain whether dermal regeneration templates (DRTs) are helpful to reconstruct nasal defects. The aim of this study was to assess whether the aesthetic subunits determine the outcome. METHODS: In this unicentric, retrospective study, the surgical procedures and outcomes of patients who received DRTs to reconstruct nasal defects were assessed and compared with the involved aesthetic subunits. RESULTS: DRTs were used for reconstruction of 36 nasal defects in 35 patients with involvement of 76 aesthetic subunits: nasal sidewall (n = 21), nasal ala (n = 13), nasal tip/columella (n = 12, n = 1, respectively), nasal dorsum (n = 12), and extranasal aesthetic areas (n = 17). Fifty-eight nasal and 8 extranasal aesthetic subunits were reconstructed with DRTs, 10 subunits with a flap. Twenty-nine of 36 defects healed without any complications (80.5%). All reconstructed nasal tips/columella and the nasal dorsa healed without any complications. Region-specific complications were retraction of the ala rim (4/12; 33.3% of the patients with involvement of the nasal ala) and the formation of a fistula in the nasal sidewall (1/21; 4.8%). Region-specific complications of extranasal subunits were the development of an ectropium (2/3; 66.7% of the patients with involvement of the lower lid). CONCLUSIONS: DRTs can be helpful to reconstruct nasal defects. However, if the defect involves the aesthetic subunits nasal ala or the infraorbital region, different techniques should be preferred.


Assuntos
Deformidades Adquiridas Nasais/cirurgia , Neoplasias Nasais/cirurgia , Rinoplastia/métodos , Neoplasias Cutâneas/cirurgia , Pele Artificial , Ferida Cirúrgica/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Sulfatos de Condroitina/uso terapêutico , Colágeno/uso terapêutico , Elastina/uso terapêutico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Transplante de Pele , Retalhos Cirúrgicos , Resultado do Tratamento
10.
Thromb Res ; 180: 70-73, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31229923

RESUMO

WHAT IS KNOWN AND OBJECTIVE: Heparin is widely used to prevent clotting of the extracorporeal circuit during haemodialysis (HD). Heparin-induced thrombocytopenia (HIT) is a potentially devastating immune mediated adverse drug reaction caused by the emergence of antibodies that activate platelets in the presence of heparin, leading to a pro-thrombotic state. Danaparoid is an alternative anticoagulant used in patients on HD with HIT but its dosing recommendations in obese patients on HD are relatively scarce. CASE SUMMARY: We report a case of a 48-year-old morbidly obese patient who received weight-based dosing of danaparoid for HD with monitoring of anti-Xa activity. However, despite the patient's anti-Xa level being within the therapeutic range at various time points, the circuit lines kept clotting during HD. WHAT IS NEW AND CONCLUSION: The report provides evidence that the manufacturer's recommendations on dosing danaparoid based on body weight may lead to sub-optimal therapeutic benefit and highlight the need for higher than recommended weight-based dosing in obese individuals on dialysis.


Assuntos
Anticoagulantes/uso terapêutico , Sulfatos de Condroitina/uso terapêutico , Dermatan Sulfato/uso terapêutico , Heparina/efeitos adversos , Heparitina Sulfato/uso terapêutico , Obesidade Mórbida/complicações , Diálise Renal , Trombocitopenia/induzido quimicamente , Anticoagulantes/administração & dosagem , Anticoagulantes/efeitos adversos , Sulfatos de Condroitina/administração & dosagem , Dermatan Sulfato/administração & dosagem , Relação Dose-Resposta a Droga , Feminino , Heparina/administração & dosagem , Heparina/uso terapêutico , Heparitina Sulfato/administração & dosagem , Humanos , Diálise Renal/efeitos adversos , Diálise Renal/métodos , Trombocitopenia/complicações , Trombose/complicações , Trombose/prevenção & controle
11.
PLoS One ; 14(6): e0218475, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31237905

RESUMO

Interstitial cystitis and/or bladder pain syndrome (IC/BPS) are characterized by discomfort, abdominal pain, and pelvic pain, and they are often associated with chronic diseases. Pathological conditions related to IC/BPS can occur due to a defect in the integrity of the bladder lining. This defect has been ascribed to damage to the glycosaminoglycan (GAG) layer of the urinary epithelium. In addition, the incipient cascade of inflammation events might prompt extracellular matrix degradation. Several medical devices based on GAG instillation were proposed to re-establish epithelial integrity by GAGs binding to proteoglycans or interacting with structural urothelium. However, to date, only in vitro studies have investigated the GAG, hyaluronic acid (HA). In the present study, TNFα treatment was used to mimic IC/BPS-induced damage in bladder cells in an in vitro model. Highly purified fermentative HA and pharmaceutical grade bovine chondroitin sulfate (CSb), alone or in combination, were evaluated for the ability to counteract bladder cell damage. We evaluated NF-κB with western blots, and we analyzed interleukin 6 and 8 expression at the transcriptional and protein levels with quantitative RT-PCR, western blotting, and ELISA. We also evaluated the expression of an antibacterial peptide, human ß-defensin-2. We confirmed our results in a 3D bladder epithelium model. Our results demonstrated that inflammatory status was reduced in the presence of HA, CSb, and the combination of both (HA/CSb 1.6%/2% w/v). This result suggested that these GAGs might be suitable for treating IC/BPS. All the assayed biomarkers showed that HA/CSb treatment modulated cells towards a more physiological status. Finally, we compared two commercial products suggested for the IC/BPS treatments and found that the product with more Ca++, showed enhanced anti-inflammatory activity and provided superior mucoadhesivity.


Assuntos
Sulfatos de Condroitina/uso terapêutico , Ácido Hialurônico/uso terapêutico , Inflamação/tratamento farmacológico , Bexiga Urinária/patologia , Animais , Bovinos , Linhagem Celular , Regulação da Expressão Gênica , Glicosaminoglicanos/metabolismo , Humanos , Hidrodinâmica , Interleucina-6/genética , Interleucina-6/metabolismo , Interleucina-8/genética , Interleucina-8/metabolismo , Modelos Biológicos , NF-kappa B/metabolismo , Transdução de Sinais , Fator de Necrose Tumoral alfa/metabolismo , Proteína da Zônula de Oclusão-1/metabolismo
12.
Aging Clin Exp Res ; 31(8): 1163-1167, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31243744

RESUMO

Osteoarthritis (OA) is the most prevalent musculoskeletal disease and a major cause of negative relevant outcomes, associated with an ever-increasing societal burden. Pharmaceutical-grade chondroitin sulfate (CS) was repeatedly reported to reduce pain and improve function in patients with knee OA. This treatment was also shown to be cost-effective, compared to placebo, up to 24 months. However, controversies still persist regarding the usefulness of CS for patients with knee OA, mainly due to inconsistent reports from various clinical trials. In this literature review, we aimed to summarize the main most recent findings on the efficacy and safety of CS in OA. Based on the results of studies presenting a low risk of bias, the most recent meta-analysis shows that only the pharmaceutical-grade CS may be considered as an appropriate background treatment for the management of knee OA. Evidence from another recent meta-analysis, using data from full safety reports, confirms the good safety profile of CS in OA. This new evidence on efficacy and safety suggests that recommendations for the use of CS in patients with knee OA cannot be extrapolated to other low-grade preparations as generics, nutraceutical-grade or over-the-counter preparations.


Assuntos
Sulfatos de Condroitina/uso terapêutico , Osteoartrite do Joelho/tratamento farmacológico , Humanos , Dor/tratamento farmacológico , Resultado do Tratamento
13.
Eur J Phys Rehabil Med ; 55(5): 658-664, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31106560

RESUMO

BACKGROUND: Osteoarthritis (OA) is a theme currently representing an emerging topic for its increasing incidence. It is well known that it is a chronic disease that could lead to important long-lasting disability; this generates increasing costs for the health care system. OA treatment options vary: localization, etiology, grading and symptomatology should be considered before choosing the most adequate therapy. Currently, a modern approach to managing OA involves SYmptomatic Slow-Acting Drug for OsteoArthritis (SYSADOAs). However, while all preparations may claim to deliver a therapeutic level of glucosamine or chondroitin, not all of them are supported by clinical evidence. Recently the European Society for Clinical and Economic aspects of Osteoporosis, Osteoarthritis and musculoskeletal diseases (ESCEO), produced an evidenced based document providing practitioners with the latest clinical and economic information, thereby allowing them to optimize the management of knee OA. According to this report, only crystalline glucosamine sulphate and the pharmaceutical-grade chondroitin sulphate are considered as effective in the first line approach to treating knee OA as an alternative drug to acetaminophen. However, some OA guidelines do not agree are not concordant in recommending the use of SYSADOA, perhaps because they are generally considered as a class and distinctions among formulations are not made. AIM: Aim of this study was to identify the main aspects involved in patient selection, the choice of therapeutic agents and the safety profile in using SYSADOA. DESIGN: Delphi method Consenus Statement. POPULATION: Italian Physicians having expertise in Osteoarthritis management. METHODS: A committee of 11 experts from Italian universities, public hospitals, territorial services, research institutes and patient associations was set up. Sixty-three clinicians from a large number of Italian medical centers specialized in osteoarthritis management took part in a Delphi process which was aimed at obtaining consensus statements among the participants. RESULTS: Large consensus was obtained for statements grouped under the following main themes: treatment indications; drug/medical devices choice; treatment efficacy. CONCLUSIONS: Results from the Italian consensus on appropriateness of OA therapies in osteoarthritis seems to be in line with the stepwise approach proposed by the ESCEO algorithm, where crystalline glucosamine sulphate shows greater clinical efficacy than other glucosamine-based formulations, according to several independent meta-analyses. CLINICAL REHABILITATION IMPACT: This study may be used as a practical reference tool to help Italian physicians treat osteoarthritis patients using SYSADOA.


Assuntos
Sulfatos de Condroitina/uso terapêutico , Glucosamina/uso terapêutico , Osteoartrite do Joelho/tratamento farmacológico , Consenso , Técnica Delfos , Quimioterapia Combinada , Medicina Baseada em Evidências , Humanos , Itália , Inquéritos e Questionários
14.
Int J Nanomedicine ; 14: 2573-2589, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31040673

RESUMO

Background: In the past few years, significant progress has been made in inhibiting neovascularization at the tumor site, cutting off the nutrient supply of the tumor, and inhibiting tumor growth and metastasis. However, many proteins/peptides have the disadvantage of poor stability, short half-life, and uncertain targeting ability. Chemical modification can be used to overcome these disadvantages; many polyethylene glycol-modified proteins/peptides have been approved by US FDA. The purpose of this study was to obtain a novel anti-angiogenic chondroitin sulfate (CS)-peptide nanoparticle conjugate with efficient anti-neovascularization and tumor targeting ability and an acceptable half-life. Materials and methods: The CS-ES2-AF nanoparticle conjugate was synthesized and characterized using 1H-nuclear magnetic resonance spectroscopy, transmission electron microscopy, and particle size and zeta potential analyzer. The anti-angiogenic ability was studied using MTT, migration, tube formation, and chick chorioallantoic membrane assays. The targeting ability of CS-ES2-AF was studied by ELISA, surface plasmon resonance, and bioimaging. The pharmacokinetics was also studied. Results: The CS-ES2-AF could self-assemble into stable nanoparticles in aqueous solution, which significantly enhances its anti-neovascularization activity, tumor targeting more explicit, and prolongs its half-life. Conclusion: CS is an effective protein/peptide modifier, and CS-ES2-AF displayed good potential in tumor targeting therapy.


Assuntos
Inibidores da Angiogênese/farmacologia , Sulfatos de Condroitina/farmacologia , Nanopartículas/química , Inibidores da Angiogênese/farmacocinética , Inibidores da Angiogênese/uso terapêutico , Animais , Movimento Celular , Sulfatos de Condroitina/química , Sulfatos de Condroitina/farmacocinética , Sulfatos de Condroitina/uso terapêutico , Membrana Corioalantoide/efeitos dos fármacos , Humanos , Receptores de Hialuronatos/metabolismo , Camundongos Endogâmicos BALB C , Camundongos Nus , Nanopartículas/ultraestrutura , Neoplasias/irrigação sanguínea , Neoplasias/patologia , Neovascularização Patológica/tratamento farmacológico , Tamanho da Partícula , Peptídeos/uso terapêutico , Espectroscopia de Prótons por Ressonância Magnética , Fatores de Tempo , Ensaios Antitumorais Modelo de Xenoenxerto
15.
Artigo em Russo | MEDLINE | ID: mdl-31089089

RESUMO

AIM: To study the efficacy and safety of chondroitin sulfate (mucosat) in the treatment of chronic lower back pain. MATERIAL AND METHODS: The medical documentation of 46 outpatients with chronic lumbosacral dorsalgia, who received 25 intramuscular injections of 2 ml mucosat, was studied. The assessment of patients' condition and efficacy and safety of the treatment was conducted based on the data of four visits (1-st, 10-th and 25-th day and 3 months after the end of treatment). Results of the clinical-neurological examination, pain intensity at rest and at movement according to the Visual Analogue Scale (VAS) and the severity of Lasegue and Wasserman signs and limitation of movements in the lumbar spine were taken into account. RESULTS: The use of mucosat at a dose of 2 ml intramuscularly 1 time in 2 days led to a significant decrease in the severity of pain syndrome and increased mobility in the lumbar spine (before treatment, the level of pain at rest according to the VAS was 4.22±1.28 scores, on the 25-th day 2.13±0.24, 3 month after treatment 2.37±0.31; the level of pain at movement: 5.78±1.15; 4.56±0.47; 4.78±0.22, respectively (p<0.01). There were a reduction of the dose of previously used non-steroidal anti-inflammatory drugs in the end of treatment and maintenance of the results of therapy for 3 months after the end of treatment. Good tolerability of the drug and the absence of significant side-effects were shown as well. CONCLUSION: This study showed the efficacy and safety of chondroitin sulfate (mucosat) in the treatment of outpatients with chronic lower back pain.


Assuntos
Anti-Inflamatórios não Esteroides , Sulfatos de Condroitina , Dor Lombar , Anti-Inflamatórios não Esteroides/uso terapêutico , Dor nas Costas , Sulfatos de Condroitina/uso terapêutico , Humanos , Dor Lombar/tratamento farmacológico , Vértebras Lombares , Resultado do Tratamento
16.
Clinics (Sao Paulo) ; 74: e722, 2019 05 13.
Artigo em Inglês | MEDLINE | ID: mdl-31090795

RESUMO

OBJECTIVES: This study aimed to provide evidence for understanding how to treat osteoarthritis (OA) in our country. Therefore, it was necessary to match information and investigations related to the treatment of the disease from the three main types of specialists involved: physiatrists, orthopedists and rheumatologists. METHODS: The authors acted as a scientific advisory committee. From the initial discussions, a structured questionnaire was developed for use with a group of specialists on OA using the Delphi technique. The questionnaire was sent to 21 experts appointed by the authors, and the results obtained were critically analyzed and validated. RESULTS: The prevalence of OA was 33% in Brazil, corresponding to one-third of the individuals in the reference population, which included individuals over 25 years of age. Another significant finding was that most patients did not receive any form of treatment in the early stages of OA. CONCLUSION: The committee pointed to the need for early intervention and that the available medicinal resources can fulfil this important role, as is the case with SYSADOA treatments. Glucosamine-based medicinal products with or without chondroitin could also fulfill this need for early treatment. The other generated evidence and included investigations were then grouped together and are the subject of this publication.


Assuntos
Competência Clínica/normas , Técnica Delfos , Medicina Baseada em Evidências/normas , Osteoartrite/terapia , Adulto , Anti-Inflamatórios não Esteroides/administração & dosagem , Brasil , Sulfatos de Condroitina/uso terapêutico , Consenso , Quimioterapia Combinada , Feminino , Glucosamina/uso terapêutico , Humanos , Masculino , Pessoa de Meia-Idade , Ortopedia/normas , Osteoartrite/tratamento farmacológico , Osteoartrite do Joelho/terapia , Medicina Física e Reabilitação/normas , Guias de Prática Clínica como Assunto , Reumatologia/normas , Índice de Gravidade de Doença , Resultado do Tratamento
18.
Rev Assoc Med Bras (1992) ; 65(4): 535-540, 2019 May 02.
Artigo em Inglês | MEDLINE | ID: mdl-31066806

RESUMO

The Guidelines Project, an initiative of the Brazilian Medical Association, aims to combine information from the medical field in order to standardize producers to assist the reasoning and decision-making of doctors. The information provided through this project must be assessed and criticized by the physician responsible for the conduct that will be adopted, depending on the conditions and the clinical status of each patient.


Assuntos
Cistite Intersticial/tratamento farmacológico , Administração Intravesical , Toxinas Botulínicas Tipo A/uso terapêutico , Brasil , Sulfatos de Condroitina/uso terapêutico , Tomada de Decisão Clínica , Dimetil Sulfóxido/uso terapêutico , Diterpenos/uso terapêutico , Humanos , Ácido Hialurônico/uso terapêutico , Lidocaína/uso terapêutico , Mycobacterium bovis , Poliéster Sulfúrico de Pentosana/uso terapêutico , Resultado do Tratamento
19.
J Craniofac Surg ; 30(3): 888-890, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31048615

RESUMO

Extensive full-thickness burn injury of the scalp involving the skull is a challenge to reconstruct. Here, the authors report a case of a 6-year old girl who suffered extensive flame burn injury involving a scalp defect of 1,5% total body surface area. After necrosectomy, full table damage of the skull was observed with a partially exposed dura mater. Neurosurgical consultation was necessary to accomplish a vital wound bed. Subsequently, in the absence of enough adequate tissue available for flap surgery reconstruction, reconstruction was performed by using a bilayer Integra Dermal Regeneration Template (IDRT) resulting in a lasting and stable coverage of the defect. This is the first case-report describing application of IDRT on a full-thickness scalp and skull defect with exposed dura mater in a child. Our results are encouraging and demonstrate that Integra can be used in a child to successfully cover exposed dura when no viable skull remains.


Assuntos
Queimaduras/cirurgia , Sulfatos de Condroitina/uso terapêutico , Colágeno/uso terapêutico , Procedimentos Cirúrgicos Reconstrutivos , Couro Cabeludo , Crânio , Criança , Feminino , Humanos , Procedimentos Cirúrgicos Reconstrutivos/instrumentação , Procedimentos Cirúrgicos Reconstrutivos/métodos , Couro Cabeludo/lesões , Couro Cabeludo/cirurgia , Crânio/lesões , Crânio/cirurgia
20.
Minerva Med ; 110(5): 419-424, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30938133

RESUMO

BACKGROUND: Osteoarthritis (OA) is a common worldwide disease induced by a wide range of biochemical processes, mainly inflammation and degradation of collagen. The aim of this study, was to describe the effect of a multistrain probiotic (PB) and chondroitin sulfate (CS), administered separately or in combination, on the expression of Ptgs2, Tgfb1 and Col2a1 during monoiodoacetate-induced OA in male rats. METHODS: OA was induced in male rats by injecting monoiodoacetate in right hind knee. Therapeutic groups received 3 mg/kg of CS for 28 days and/or 1.4 g/kg of multistrain PB for 14 days. Knee cartilage were taken 30 days after monoiodoacetate injection. RNA was extracted and the expression of Ptgs2, Tgfb1 and Col2a1 were analyzed using SYBR Green 1-step real-time quantitative polymerase chain reaction. RESULTS: Induction of OA caused an upregulation in Ptgs2, Tgfb1 expression, and downregulation of Col2a1. Separate administration of PB and CS reduced Ptgs2 and Tgfb1 expressions. Their combined administration significantly decreased the expression of these pro-inflammatory cytokines, comparable to controls. Expression of Col2a1 showed similar behavior, with upregulation in therapeutic group with separate administration and the cumulative effects in case of co-administration. CONCLUSIONS: The multistrain PB diet may offer a perspective to improve the standard treatment of OA and, necessitates further investigation with clinical trials.


Assuntos
Sulfatos de Condroitina/uso terapêutico , Colágeno Tipo II/biossíntese , Ciclo-Oxigenase 2/biossíntese , Osteoartrite do Joelho/dietoterapia , Osteoartrite do Joelho/tratamento farmacológico , Probióticos/uso terapêutico , Fator de Crescimento Transformador beta1/biossíntese , Animais , Cartilagem Articular/efeitos dos fármacos , Cartilagem Articular/metabolismo , Sulfatos de Condroitina/administração & dosagem , Colágeno Tipo II/genética , Ciclo-Oxigenase 2/genética , Avaliação Pré-Clínica de Medicamentos , Interações Alimento-Droga , Regulação da Expressão Gênica/efeitos dos fármacos , Ácido Iodoacético/toxicidade , Masculino , Microbiota , Osteoartrite do Joelho/induzido quimicamente , Osteoartrite do Joelho/metabolismo , RNA Mensageiro/biossíntese , Ratos , Fator de Crescimento Transformador beta1/genética
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