Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 855
Filtrar
1.
Aging Clin Exp Res ; 33(5): 1149-1156, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33774784

RESUMO

BACKGROUND: Since 2014, the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO) algorithm for the management of knee osteoarthritis (OA) is available worldwide. AIM: Based on this document, a Southeast Asia Working Group (SEAWG) wished to see how the new ESCEO algorithm developed in 2019 was perceived by Southeast Asian experts and how it was integrated into their clinical practice. METHODS: A SEAWG was set up between members of the international ESCEO task force and a group of Southeast Asian experts. RESULTS: Non-pharmacological management should always be combined with pharmacological management. In step 1, symptomatic slow-acting drugs for osteoarthritis are the main background therapy, for which high-quality evidence is available only for the formulations of patented crystalline glucosamine sulfate and chondroitin sulfate. In step 2, oral NSAIDs are a useful option, considering the cardiovascular/renal/gastrointestinal profiles of the individual patient. Intra-articular hyaluronic acid and corticosteroids are a possible alternative to oral NSAIDs, but limited evidence is available. If steps 1 and 2 do not give adequate relief of symptoms, tramadol can be used, but its safety is debated. In general, the indications of the ESCEO algorithm are important in Southeast Asian countries, but the reimbursement criteria of local health systems are an important aspect for adherence to the ESCEO algorithm. CONCLUSION: This guidance provides evidence-based and easy-to-follow advice on how to establish a treatment algorithm in knee OA, for practical implementation in clinical practice in Southeast Asian countries.


Assuntos
Osteoartrite do Joelho , Algoritmos , Anti-Inflamatórios não Esteroides/uso terapêutico , Sulfatos de Condroitina/uso terapêutico , Glucosamina/uso terapêutico , Humanos , Osteoartrite do Joelho/tratamento farmacológico
2.
Artigo em Russo | MEDLINE | ID: mdl-33605133

RESUMO

The article presents the data of the latest domestic and foreign original studies, the results of a number of meta-analyses, conclusions of randomized clinical trials (RCTs), and other scientific studies that prove the effectiveness and necessity of mandatory inclusion in the treatment of chronic pain syndrome of the stage of non-invasive non-pharmacological therapy. One of the promising areas of pharmacotherapy for degenerative-dystrophic joint lesions is the use of chondroprotectors (CP), in particular chondroitin sulfate (CS). According to new Clinical Recommendations of Ministry Health (MH) of the Russian Federation (RF) «Chronic pain in patients of elderly and senile age¼ (2020), according to which the purpose of CS is recommended for patients older than 60 years with joint pain and contraindications to non-steroidal anti-inflammatory drugs (NSAIDs) or senile asthenia for the purpose of pain relief and the prevention of exacerbations of pain. A high level of reliability and persuasiveness of the recommendations was noted (1A) of CS use. Most of the CS is available in the form of forms for oral use, the bioavailability of which, according to clinical studies, is 13-38% due to the destruction of the CS molecules in the gastrointestinal tract. Intramuscular (i/m) administration of the drug can increase the bioavailability of CS, which can not only increase the effectiveness of therapy, but also lead to a more rapid development of the symptomatic effect. In Russia available parenteral forms of CS (Chondroguard) pharmaceutical quality, efficacy has been proven in randomized clinical trial (RCT) MH RF. To relieve pain in the joints, it is recommended to use parenteral forms of CS (Chondroguard) at a dose of 100-200 mg per day, every other day, the total duration of the course of treatment is 25-30 injections.


Assuntos
Dor Crônica , Osteoartrite , Idoso , Anti-Inflamatórios não Esteroides/uso terapêutico , Sulfatos de Condroitina/uso terapêutico , Dor Crônica/tratamento farmacológico , Humanos , Metanálise como Assunto , Pessoa de Meia-Idade , Osteoartrite/tratamento farmacológico , Ensaios Clínicos Controlados Aleatórios como Assunto , Federação Russa
3.
Am J Case Rep ; 22: e928021, 2021 Jan 21.
Artigo em Inglês | MEDLINE | ID: mdl-33473099

RESUMO

BACKGROUND Cameron lesions are linear erosions and ulcers on the crests of gastric mucosal folds in the neck of a hiatal hernia and can be difficult to diagnose and treat. This report is of a case of chronic iron deficiency in a 61-year-old woman with a late diagnosis of a Cameron lesion, who did not respond to a single treatment with the proton pump inhibitor (PPI) pantoprazole, but was then treated with oral poloxamer 407 with hyaluronic acid and chondroitin sulfate in addition to PPI. CASE REPORT We report the case of a 61-year-old women with recurrent iron-deficiency anemia, first diagnosed 40 years prior to her presentation at our Endoscopy Unit, and an ongoing melena. We discovered an intrahiatal gastric mucosal defect, which we at first treated with proton pump inhibitors and sucralfate. After a follow-up gastroscopy revealed the persistence of the lesion, we decided to incorporate into the treatment a gel-like substance containing, among others, hyaluronic acid and chondroitin sulfate, and observed that the lesion resolved completely. CONCLUSIONS This report highlights that Cameron lesions should be considered in patients with hiatal hernia who have iron-deficiency anemia and can be diagnosed on upper endoscopy. Further clinical studies are required to determine the role of combined poloxamer 407 with hyaluronic acid and chondroitin sulfate in the management of Cameron lesions.


Assuntos
Anemia Ferropriva/tratamento farmacológico , Úlcera Gástrica/complicações , Úlcera Gástrica/tratamento farmacológico , Adjuvantes Imunológicos/uso terapêutico , Sulfatos de Condroitina/uso terapêutico , Doença Crônica , Portadores de Fármacos , Feminino , Gastroscopia , Hérnia Hiatal/complicações , Hérnia Hiatal/diagnóstico , Humanos , Ácido Hialurônico/uso terapêutico , Pessoa de Meia-Idade , Pantoprazol/uso terapêutico , Poloxâmero/uso terapêutico , Inibidores da Bomba de Prótons/uso terapêutico , Úlcera Gástrica/diagnóstico
4.
ACS Appl Mater Interfaces ; 13(2): 2382-2398, 2021 Jan 20.
Artigo em Inglês | MEDLINE | ID: mdl-33406837

RESUMO

In this article, we describe a method of delivery of chondroitin sulfate to skin as nanoparticles and demonstrate its anti-inflammatory and antioxidant role using UV irradiation as a model condition. These nanoparticles, formed through electrostatic interactions of chondroitin sulfate with a skin-penetrating peptide, were found to be homogenous with positive surface charges and stable at physiological and acidic pH under certain conditions. They were able to enter into the human keratinocyte cell line (HaCaT), artificial skin membrane (mimicking the human skin), and mouse skin tissue unlike free chondroitin sulfate. The preapplication of nanoparticles also exhibited reduced levels of oxidative stress, cyclobutane pyrimidine dimer formation, TNF-α, and so on in UV-B-irradiated HaCaT cells. In an acute UV-B irradiation mouse model, their topical application resulted in reduced epidermal thickness and sunburn cells, unlike in the case of free chondroitin sulfate. Thus, a completely noninvasive method was used to deliver a bio-macromolecule into the skin without using injections or abrasive procedures.


Assuntos
Anti-Inflamatórios/administração & dosagem , Antioxidantes/administração & dosagem , Sulfatos de Condroitina/administração & dosagem , Portadores de Fármacos/química , Peptídeos/química , Queimadura Solar/prevenção & controle , Administração Tópica , Animais , Anti-Inflamatórios/farmacocinética , Anti-Inflamatórios/uso terapêutico , Antioxidantes/farmacocinética , Antioxidantes/uso terapêutico , Linhagem Celular , Sulfatos de Condroitina/farmacocinética , Sulfatos de Condroitina/uso terapêutico , Portadores de Fármacos/metabolismo , Feminino , Humanos , Queratinócitos/efeitos dos fármacos , Queratinócitos/metabolismo , Queratinócitos/patologia , Camundongos , Camundongos Endogâmicos BALB C , Nanopartículas/química , Nanopartículas/metabolismo , Estresse Oxidativo/efeitos dos fármacos , Peptídeos/metabolismo , Absorção Cutânea , Queimadura Solar/metabolismo , Queimadura Solar/patologia , Raios Ultravioleta/efeitos adversos
5.
Khirurgiia (Mosk) ; (7): 76-81, 2020.
Artigo em Russo | MEDLINE | ID: mdl-32736467

RESUMO

OBJECTIVE: To evaluate symptom-modifying effects of a two-month parenteral therapy with chondroitin sulfate («Mucosat¼) in patients with knee and/or hip osteoarthritis (OA) in various combinations of adjuvant therapy. MATERIAL AND METHODS: There were 70 patients with primary and/or post-traumatic unilateral/bilateral knee and/or hip osteoarthritis (Kellgren-Lawrence grade I-II). Pain syndrome severity was assessed as ≥ 50 mm (100-mm VAS), total Leken's index - ≥ 5 points. The main group comprised 40 patients who received Mucosat for 60 days. NSAIDs were additionally prescribed in 9 (22.5%) of these patients. The control group included 30 patients with intra-articular injection of hyaluronic acid. All patients underwent clinical and functional examination (rating scales VAS, Leken's total index, WOMAC index, EQ-5D health questionnaire), laboratory diagnosis (IL-1, IL-6, TNF-α), X-ray examination, assessment of adverse events at 5 visits. RESULTS AND CONCLUSION: Administration of chondroitin sulfate is associated with reduced local pain syndrome and functional normalization of musculoskeletal system. Prolonged pain-free period with high safety profile due to reduced need for NSAIDs is an advantage of Mucosat therapy. Thus, this drug may be recommended for initial therapy. A combination of chondroitin sulfate with intra-articular injection of hyaluronic acid may be perspective for optimization of therapy and secondary prevention of exacerbations of OA. Further research is required.


Assuntos
Sulfatos de Condroitina/uso terapêutico , Ácido Hialurônico/uso terapêutico , Osteoartrite do Quadril/tratamento farmacológico , Osteoartrite do Joelho/tratamento farmacológico , Substâncias Protetoras/uso terapêutico , Artralgia/tratamento farmacológico , Artralgia/etiologia , Sulfatos de Condroitina/administração & dosagem , Humanos , Ácido Hialurônico/administração & dosagem , Injeções Intra-Articulares , Osteoartrite do Quadril/complicações , Osteoartrite do Joelho/complicações , Substâncias Protetoras/administração & dosagem , Resultado do Tratamento
6.
Artigo em Russo | MEDLINE | ID: mdl-32490621

RESUMO

OBJECTIVE: To evaluate the antiresorptive-cytokine effects of chondroitin sulfate on non-specific lower back pain in patients with knee osteoarthritis (OA). MATERIALS AND METHODS: Using the envelope method, 231 patients were randomized into two groups: group 1 (n=116, main) received nonsteroidal anti-inflammatory drugs (NSAIDs) and chondrogard, group 2 (n=115, comparison) received only NSAIDs. The 2-month study included 3 visits (V): V1 - at the beginning of the study, V2 - after 10 days, V3 - after 60 days with the assessment of blood parameters: transforming growth factor ß1 (TFR ß1), interleukin (IL)-1ß and IL-6, beta-Crosslaps, bone matrix formation indicator P1NP (n-terminal propeptide procollagen type 1), and determination of the level of deoxypyridinoline (DPID) in the urine. RESULTS AND CONCLUSION: At the end of the study, there is a significant decrease in all studied cytokines in patients of group 1 compared to group 2, as well as indicators of beta-Crosslaps (p<0,001) and DPID (p<0,001), which may indicate the presence of its own antiresorptive-cytokine effect in chondroitin sulfate.


Assuntos
Dor Lombar/tratamento farmacológico , Osteoartrite do Joelho/tratamento farmacológico , Anti-Inflamatórios não Esteroides/uso terapêutico , Sulfatos de Condroitina/uso terapêutico , Citocinas , Humanos
7.
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
8.
Plast Reconstr Surg ; 145(3): 608e-616e, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32097331

RESUMO

BACKGROUND: Various surgical techniques exist for lower extremity reconstruction, but limited high-quality data exist to inform treatment strategies. Using multi-institutional data and rigorous matching, the authors evaluated the effectiveness and cost of three common surgical reconstructive modalities. METHODS: All adult subjects with lower extremity wounds who received bilayer wound matrix, local tissue rearrangement, or free flap reconstruction were retrospectively reviewed (from 2010 to 2017). Cohorts' comorbidities and wound characteristics were balanced. Graft success at 180 days was the primary outcome; readmissions, reoperations, and costs were secondary outcomes. RESULTS: Five hundred one subjects (166 matrix, 190 rearrangement, and 145 free flap patients) were evaluated. Matched subjects (n = 312; 104/group) were analyzed. Reconstruction success at 180 days for matrix, local tissue rearrangement, and free flaps was 69.2 percent, 91.3 percent, and 93.3 percent (p < 0.001), and total costs per subject were $34,877, $35,220, and $53,492 (p < 0.001), respectively. Median length of stay was at least 2 days longer for free flaps (p < 0.0001). Readmissions and reoperations were greater for free flaps. Local tissue rearrangement, if achievable, provided success at low cost. Free flaps were effective with large, traumatic wounds but at higher costs and longer length of stay. Matrices successfully treated older, obese patients without exposed bone. CONCLUSIONS: Lower extremity reconstruction can be performed effectively using multiple modalities with varying degrees of success and costs. Local tissue rearrangement and free flaps demonstrate success rates greater than 90 percent. Bilayer wound matrix-based reconstruction effectively treats a distinct patient population. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.


Assuntos
Retalhos de Tecido Biológico/transplante , Traumatismos da Perna/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Transplante de Pele/métodos , Pele Artificial , Adulto , Idoso , Amputação/economia , Amputação/estatística & dados numéricos , Sulfatos de Condroitina/uso terapêutico , Colágeno/uso terapêutico , Feminino , Retalhos de Tecido Biológico/efeitos adversos , Retalhos de Tecido Biológico/economia , Sobrevivência de Enxerto , Custos de Cuidados de Saúde/estatística & dados numéricos , Humanos , Traumatismos da Perna/diagnóstico , Traumatismos da Perna/economia , Tempo de Internação/economia , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Readmissão do Paciente/economia , Readmissão do Paciente/estatística & dados numéricos , Procedimentos Cirúrgicos Reconstrutivos/efeitos adversos , Procedimentos Cirúrgicos Reconstrutivos/economia , Procedimentos Cirúrgicos Reconstrutivos/instrumentação , Reoperação/economia , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Índice de Gravidade de Doença , Transplante de Pele/efeitos adversos , Transplante de Pele/economia , Transplante de Pele/instrumentação , Resultado do Tratamento
9.
Carbohydr Polym ; 230: 115650, 2020 Feb 15.
Artigo em Inglês | MEDLINE | ID: mdl-31887904

RESUMO

Chondroitin sulfate (CS) is a naturally derived bioactive macromolecule and the major component of extracellular matrix (ECM), which widely distributed in various organisms and has attracted much attention due to their significant bioactivities. It is regarded as a favorable biomaterial that has been applied extensively in field of drug delivery and tissue engineering due to its property of non-poisonous, biodegradation, biocompatible and as a major component of ECM. The present article reviews the structure and bioactivities of CS, from the preparation to structure analysis, and emphatically focuses on the biomaterial exertion in delivery system and tissue engineering. At the same time, the present application status and prospect of CS are analyzed and the biomaterial exertion of CS in delivery system and various tissue engineering are also comparatively discussed in view of biomaterial development.


Assuntos
Sulfatos de Condroitina , Sistemas de Liberação de Medicamentos/métodos , Hidrogéis/uso terapêutico , Nanopartículas/uso terapêutico , Engenharia Tecidual/métodos , Animais , Materiais Biocompatíveis/uso terapêutico , Células Cultivadas , Sulfatos de Condroitina/síntese química , Sulfatos de Condroitina/uso terapêutico , Humanos , Camundongos , Ratos , Tecidos Suporte
10.
Mod Rheumatol ; 30(2): 332-337, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30924705

RESUMO

Objectives: The objective is to evaluate whether danaparoid is effective in improving the live birth rate in patients with obstetric antiphospholipid syndrome (oAPS).Methods: This prospective study included 91 pregnancies of 60 patients with oAPS diagnosed according to criteria of the International Congress on APS. Live birth rates, adverse pregnancies and perinatal outcomes were compared among patients treated with danaparoid and low dose aspirin (danaparoid group, LDA), unfractionated heparin (UFH) and LDA (UFH group) and LDA and/or prednisolone (LDA group).Results: After excluding 11 miscarriages with abnormal embryonic chromosomes, one chemical pregnancy and one ectopic pregnancy, live birth rates were 87.5% (14/16) for the danaparoid group, 90.0% (36/40) for the UFH group and 63.6% (14/22) for the LDA group, respectively. The live birth rates of patients treated with danaparoid and UFH were similar and tended to be higher than that of patients treated with LDA, respectively (OR 4.0, 95% confidence interval 0.72-22.22 and 5.15, 1.33-20.00). No patient given danaparoid and one patient with UFH developed heparin-induced thrombocytopenia which resulted in a stillbirth. Another patient with UFH suffered a lumbar compression fracture.Conclusion: Danaparoid is effective for improving the live birth rate and is safe for patients with oAPS.


Assuntos
Síndrome Antifosfolipídica/tratamento farmacológico , Sulfatos de Condroitina/uso terapêutico , Dermatan Sulfato/uso terapêutico , Fibrinolíticos/uso terapêutico , Heparitina Sulfato/uso terapêutico , Complicações na Gravidez/tratamento farmacológico , Adulto , Sulfatos de Condroitina/administração & dosagem , Sulfatos de Condroitina/efeitos adversos , Dermatan Sulfato/administração & dosagem , Dermatan Sulfato/efeitos adversos , Feminino , Fibrinolíticos/administração & dosagem , Fibrinolíticos/efeitos adversos , Heparitina Sulfato/administração & dosagem , Heparitina Sulfato/efeitos adversos , Humanos , Gravidez , Resultado da Gravidez
11.
Biol Trace Elem Res ; 194(1): 96-104, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31175635

RESUMO

To investigate selenium (Se) concentrations in serum of patients with rheumatoid arthritis (RA), osteoarthritis (OA), and Kashin-Beck disease (KBD), together with the effect of Se supplement (chondroitin sulfate [CS] nano-Se [SeCS]) on CS structure-modifying sulfotransferases in KBD chondrocyte. Fifty serum samples from each group with aged-matched (40-60 years), normal control (N), RA, OA, and KBD (25 males and females, respectively) were collected to determine Se concentrations. Furthermore, the KBD chondrocytes were divided into two groups following the intervention for 24 h: (a) non-treated KBD group and (b) SeCS-treated KBD group (100 ng/mL SeCS). The ultrastructural changes in chondrocytes were observed by transmission electron microscopy (TEM). Live/dead staining was used to observe cell viability. The expression of CS-modifying sulfotransferases including carbohydrate sulfotransferase 12, 13, and 15 (CHST-12, CHST-13, and CHST-15, respectively), and uronyl 2-O-sulfotransferase (UST) were examined by quantitative real-time polymerase chain reaction and western blotting analysis after SeCS intervention. The Se concentrations in serum of KBD, OA, and RA patients were lower than those in control. In OA, RA, and control, Se concentrations were higher in male than in female, while it is opposite in KBD. In the cell experiment, cell survival rate and mitochondrial density were increased in SeCS-treated KBD groups. Expressions of CHST-15, or CHST-12, and CHST-15 on the mRNA or protein level were significantly increased. Expression of UST slightly increased on the mRNA level, but no change was visible on the protein level. Se deficiency in serum of RA, OA, and KBD was observed. SeCS supplemented in KBD chondrocytes improved their survival rate, ameliorated their ultrastructure, and increased the expression of CS structure-modifying sulfotransferases.


Assuntos
Condrócitos/efeitos dos fármacos , Doença de Kashin-Bek/sangue , Selênio/sangue , Selênio/deficiência , Selênio/farmacologia , Adulto , Artrite Reumatoide/sangue , Artrite Reumatoide/tratamento farmacológico , Artrite Reumatoide/metabolismo , Sulfatos de Condroitina/sangue , Sulfatos de Condroitina/uso terapêutico , Feminino , Humanos , Doença de Kashin-Bek/tratamento farmacológico , Doença de Kashin-Bek/metabolismo , Masculino , Pessoa de Meia-Idade , Osteoartrite/sangue , Osteoartrite/tratamento farmacológico , Osteoartrite/metabolismo , Selênio/uso terapêutico
12.
Acta Haematol ; 143(3): 250-259, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31461700

RESUMO

BACKGROUND: Danaparoid sodium and synthetic protease inhibitors (SPIs) have been approved for the treatment of disseminated intravascular coagulation (DIC) in Japan. OBJECTIVES: To compare the clinical results of the treatment of DIC with danaparoid or SPIs. METHODS: We retrospectively examined 188 patients with hematological malignancy-related DIC. RESULTS: DIC resolution rate in the danaparoid group was higher than that in the SPIs group (61.5 vs. 42.6%; p = 0.031) on day 7. Multivariate analysis identified the response to chemotherapy as independent predictive factor for DIC resolution on day 7 (odds ratio, OR, 2.28; 95% confidence interval, CI, 1.21-4.31; p = 0.011). While there was no significant difference in the DIC resolution rate on day 14 (75.0 vs. 62.4%; p = 0.117), in a subgroup analysis of patients who did not show an improvement in the underlying disease, the danaparoid group showed a significantly better DIC resolution rate (OR 3.89; 95% CI 1.15-13.2; p = 0.030). There was no difference in the rate of cumulative mortality from bleeding within 28 days between the 2 groups (6.6 vs. 3.3%; p = 0.278). CONCLUSIONS: Danaparoid may be associated with more frequent resolution of DIC in patients with refractory underlying disease.


Assuntos
Sulfatos de Condroitina/uso terapêutico , Dermatan Sulfato/uso terapêutico , Neoplasias Hematológicas/sangue , Heparitina Sulfato/uso terapêutico , Inibidores de Proteases/uso terapêutico , Adulto , Idoso , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Transfusão de Componentes Sanguíneos , Sulfatos de Condroitina/efeitos adversos , Dermatan Sulfato/efeitos adversos , Coagulação Intravascular Disseminada/tratamento farmacológico , Coagulação Intravascular Disseminada/terapia , Feminino , Produtos de Degradação da Fibrina e do Fibrinogênio/análise , Fibrinogênio/análise , Neoplasias Hematológicas/tratamento farmacológico , Hemorragia/etiologia , Hemorragia/mortalidade , Heparitina Sulfato/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , Plasma , Inibidores de Proteases/efeitos adversos , Tempo de Protrombina , Estudos Retrospectivos , Resultado do Tratamento
13.
Pharm. care Esp ; 22(3): 131-147, 2020. tab
Artigo em Espanhol | IBECS | ID: ibc-196966

RESUMO

OBJETIVO: Revisar la evidencia reciente disponible sobre la eficacia del empleo de los SYSADOA (Symptomatic Slow Acting Drugsfor Osteoarthritis) en artrosis, como estrategia terapéutica que pudiera adaptarse mejor a la etiología de la enfermedad como al paciente por su elevada seguridad y tolerabilidad. Metodología: Se ha realizado una búsqueda bibliográfica de la literatura publicada hasta 30 de agosto de 2019 en PubMed, las palabras clave empleadas en la búsqueda fueron:"evidence", "clinical trials", "osteoarthritis", "management", "chondroitin" y "glucosamine". Se revisaron guías médicas internacionales, estudios epidemiológicos y fichas técnicas de medicamentos de la Agencia Española del Medicamento y Productos Sanitarios. RESULTADO: Se identificaron un total de154 artículos con los algoritmos de búsqueda empleados orientados a valorar la evidencia de este grupo terapéutico como el impacto económico y sanitario generado por la artrosis. Tras la lectura de títulos y resúmenes se procedió al descarte de 82 artículos por no adaptarse al objetivo del presente trabajo. Se realizó una segunda selección valorando la calidad metodológica y contenido. Finalmente se escogieron 8 artículos. También se consultaron las fichas técnicas de los fármacos involucrados como guías médicas y estudios epidemiológicos como el EPISER. Los últimos estudios muestran una tendencia favorable a los SYSADOA como alternativa al consumo continuado de AINE (Antiinflamatorios No Esteroideos), mostrándose una eficacia comparable al celecoxib, tanto en combinación en el estudio MOVES, como por separado en el estudio CONCEPT, ambos en 2017. CONCLUSIÓN: La elevada prevalencia de la artrosis y los inconvenientes derivados de su manejo tradicional hacen necesario el empleo de alternativas terapéuticas. Los SYSADOA se postulan como una herramienta que pudiera adaptarse mejor a la enfermedad por su carácter crónico, y al tipo de paciente al que frecuentemente van dirigidas estas terapias. Sin embargo, la disparidad obtenida en los ensayos clínicos dificulta alcanzar un consenso y ponen de manifiesto la necesidad de aclarar la confianza depositada en ellos


OBJECTIVE: To review the available recent evidence about the effectiveness of the usage of SYSADOA (Symptomatic Acting Drugsfor Osteoarthritis) in osteoarthritis, as a therapeutic strategy that could evolve with the etiology of the disease and the patient thanks toits high security and tolerability. METHODS: It was carried out a bibliographical research of the published literature until 30th August 2019 in PubMed. The key words employed in the search were: "evidence", "clinical trials", "osteoarthritis", "management", "chondroitin" and "glucosamide". International medical guides, epidemiologic studies and data sheets of drugs from The Spanish Agency for Medication and Healthcare Products (AEMPS) were examined. RESULTS: A total of 154 articles were identified with the search algorithms used, orientated to evaluate the evidence of this therapeutic group as well as the economic and health impact generated by the osteoarthritis. After having read titles and abstracts, 82 articles were dismissed because they did not fit in the objective of the present work. A second selection was done taking into account the methodological quality and the content. In the end, 8 articles were chosen. The data sheets of the involved drugs together with the medical guides, the epidemiology studies and the EPISER were checked. The last studies show a favorable tendency to the SYSADOA as an alternative to the continued consume of non-steroidal anti-inflammatories. It was shown effectiveness comparable to celecoxib in combination with the study MOVES but also separately in the study CONCEPT, both in 2017. CONCLUSION: The high prevalence of osteoarthritis and the disadvantages derived from its traditional management make the usage of therapeutic alternatives necessary. The SYSADOA postulate as a key that could adapt better to the disease because of its chronic character and the kind of patient to whom are commonly targeted these therapies. Nevertheless, the disparity obtained in the clinical trials makes difficult to reach a consensus and reveals the necessity of clarifying the confidence placed in them


Assuntos
Humanos , Artropatias/tratamento farmacológico , Glucosamina/uso terapêutico , Sulfatos de Condroitina/uso terapêutico , Antraquinonas/uso terapêutico , Gerenciamento Clínico , Resultado do Tratamento , Reprodutibilidade dos Testes
14.
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
16.
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
17.
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
18.
Adv Ther ; 36(11): 3221-3237, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31494830

RESUMO

INTRODUCTION: Oral supplementation of chondroitin sulfate (CS) and glucosamine (GlcN), symptomatic slow-acting molecules, is recommended by European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis and Musculoskeletal Diseases (ESCEO) and other European Union (EU) guidelines for the restoration of the articular cartilage surface in patients affected by osteoarthritis (OA). They are commercialized as pharmaceutical grade products and as food supplements in combination with plant extracts hyaluronic acid, methylsulfonylmethane, and other components. Food supplements do not need to undergo the strict regulatory controls of pharmaceutical grade products; thus, composition and contaminants that could be present may not be evidenced before commercialization and these uncertainties may give rise to concerns about the bioactivity of these formulations. METHODS: In this paper 10 different food supplements (FS) from diverse European countries were analyzed in comparison with two pharmaceutical grade products (Ph) using updated analytical approaches and biochemical cell-based assays. The purity, the titer, and the origin of CS in Ph and FS samples were initially assessed in order to successively compare the biological function. Both food supplements and pharmaceutical formulations were tested in vitro, using the same final CS concentration, on primary chondrocytes and synoviocytes in terms of (i) cell viability, (ii) activation of the NF-κB-mediated inflammation pathway, (iii) cartilage oligomeric matrix protein (COMP-2), IL-6, and IL-8 production. RESULTS: All the FS presented a certain insoluble fraction; the CS and the GlcN contents were lower than the declared ones in 9/10 and 8/10 samples, respectively. All FS contained keratan sulfate (KS) at up to 50% of the total glycosaminoglycan amount declared on the label. Primary cells treated with the samples diluted to present the same CS concentration in the medium showed cytotoxicity in 7/10 FS while Ph preserved viability and reduced NF-κB, COMP-2, and secreted inflammatory cytokines. CONCLUSION: Among all samples tested, the pharmaceutical grade products demonstrated effective modulation of biomarkers counteracting the inflammation status and improving viability and the physiological condition of OA human primary chondrocyte and synoviocyte cells. In contrast to that, most FS were cytotoxic at the tested concentrations, and only 3/10 of them showed similarities to Ph sample behavior in vitro. FUNDING: This work was partially supported by PON01_1226 NUTRAFAST, MIUR Ministero dell'Università e della Ricerca Scientifica. Bioteknet financed two short-term grants for graduate technicians. The journal's Rapid Service and Open Access fees were funded by IBSA CH.


Assuntos
Sulfatos de Condroitina/farmacocinética , Sulfatos de Condroitina/uso terapêutico , Suplementos Nutricionais , Glucosamina/farmacocinética , Glucosamina/uso terapêutico , Osteoartrite/tratamento farmacológico , Osteoporose/tratamento farmacológico , Administração Oral , Adulto , Idoso , Idoso de 80 Anos ou mais , Sulfatos de Condroitina/administração & dosagem , Europa (Continente) , Feminino , Glucosamina/administração & dosagem , Humanos , Masculino , Pessoa de Meia-Idade
19.
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
20.
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
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...