Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 3.123
Filtrar
1.
Medicine (Baltimore) ; 99(46): e22323, 2020 Nov 13.
Artigo em Inglês | MEDLINE | ID: mdl-33181636

RESUMO

RATIONALE: Patients reporting high PD-L1 expression have shown to respond well to immunotherapy; however, some patients develop hyperprogressive disease upon initiation of immune checkpoint inhibitors. We report a patient with lung cancer and 100% PD-L1 expression who developed hyperprogressive disease while treated with pembrolizumab and responded well to salvage chemotherapy with carboplatin and pemetrexed. PATIENT CONCERNS: A 66-year-old African American female with 25-pack year smoking history, diabetes mellitus type 2, essential thrombocytosis, and a history of papillary thyroid carcinoma developed relapsed lung adenocarcinoma after 13 months of no evidence of disease. DIAGNOSIS: Surveillance imagine showed subcarinal and hilar lymphadenopathy, which was confirmed as recurrent lung adenocarcinoma via bronchoscopy. In addition, a brain scan showed a 5 mm enhancing left insular lesion. PD-L1 was reported as 100% expression. Staging was reported as stage IVB TxN3M1c lung adenocarcinoma. INTERVENTIONS: One fraction of radiation with a total dose of 20 Gray was delivered to the left insular lesion. The patient initiated pembrolizumab (200 mg) every 3 weeks. She was then treated with salvage chemotherapy consisting of carboplatin (AUC 5) and pemetrexed (500 mg/m) every 3 weeks for 3 cycles. OUTCOMES: The brain lesion resolved after the radiation therapy. The patient developed hyperprogression with a large pericardial effusion and right pleural effusion after 2 treatments of pembrolizumab. Her PD-L1 expression decreased from 100% to 0% over a 10-week period. Salvage chemotherapy with carboplatin and pemetrexed resulted with 20 months of ongoing to evidence of disease. LESSONS: Immune checkpoint inhibitor-related hyperprogressive disease may respond to second-line salvage chemotherapy. Complete PD-L1 expression loss was observed after the patient's treatment and could be a marker of hyperprogressive disease or tumor immunoevasion.


Assuntos
Antígeno B7-H1/análise , Carcinoma Pulmonar de Células não Pequenas/genética , Proteínas Serina-Treonina Quinases/análise , Idoso , Anticorpos Monoclonais Humanizados/uso terapêutico , Antígeno B7-H1/genética , Carcinoma Pulmonar de Células não Pequenas/tratamento farmacológico , Tratamento Farmacológico/métodos , Tratamento Farmacológico/normas , Feminino , Expressão Gênica/genética , Humanos , Proteínas Serina-Treonina Quinases/genética
2.
Medicine (Baltimore) ; 99(44): e22799, 2020 Oct 30.
Artigo em Inglês | MEDLINE | ID: mdl-33126317

RESUMO

BACKGROUND: As far as we know, several systematic review and meta-analysis have assessed the safety and efficacy of erythropoiesis-stimulating agents (ESAs) in the patients with chemotherapy-induced anemia (CIA). But no study assesses the safety and efficacy of ESAs combined with traditional Chinese medicine (TCM). The aim of our study is to assess the efficacy and safety of ESAs combination with TCM for patients with CIA and will provide a higher level of evidence for clinical applications. METHODS: This protocol adheres to the preferred reporting items for systematic reviews and meta-analysis protocol statement. The source of literature will be a structured search of the following 7 electronic databases: PubMed, Embase, Cochrane Library, Web of Science, China National Knowledge Infrastructure, Chinese Biomedical Literature Database, and Wanfang Database. Records will be independently evaluated by 2 reviewers. Disagreements will be resolved through consensus or third-party adjudication. Review Manager 5.3 software (Cochrane Collaboration, Copenhagen Denmark) will be used to perform meta-analysis. For dichotomous variables, odds ratio with 95% confidence intervals will be obtained by the Mantel-Haenszel method. For continuous data, mean difference with 95% confidence intervals will be used. P < 0.05 will be considered to be statistically significant. RESULTS: This study will be performed to test the efficacy and safety of ESAs combined with TCM for CIA in patients with cancer. CONCLUSIONS: The result of this study will be promoted mainly in 2 ways: publish in peer-reviewed journals in the fastest way; and promotion in domestic and foreign conferences. INPLASY REGISTRATION NUMBER: INPLASY202080041.


Assuntos
Anemia/tratamento farmacológico , Eritropoetina/uso terapêutico , Medicina Tradicional Chinesa/normas , Metanálise como Assunto , Anemia/etiologia , Protocolos Clínicos , Tratamento Farmacológico/métodos , Eritropoetina/normas , Humanos , Medicina Tradicional Chinesa/métodos , Revisões Sistemáticas como Assunto
3.
N Z Med J ; 133(1520): 15-26, 2020 08 21.
Artigo em Inglês | MEDLINE | ID: mdl-32994590

RESUMO

AIMS: To explore variations in the use of and timeliness of chemotherapy in patients diagnosed with colorectal cancer in New Zealand. METHODS: This study included patients diagnosed with colorectal cancer in New Zealand between 1 January 2006 and 31 December 2016. The first chemotherapy regime was identified from Pharmaceutical Collection dataset. Logistic regression model was used to estimate the adjusted odds ratio of having chemotherapy by subgroup after adjustment for other factors. RESULTS: 27.8% (6,737/24,217) of colon cancer patients and 43.8% (3,582/8,170) of rectal cancer patients received publicly funded chemotherapy. The uptake and timeliness of chemotherapy has been improving over time. Pacific people were the least likely to receive chemotherapy, followed by Maori and Asian. Younger patients, New Zealand European, patients with metastatic disease and patients in the Southern Cancer Network were more likely to have chemotherapy in less than 10 weeks post-diagnosis. Over half of the advanced colorectal cancer patients who did not receive chemotherapy were aged 80+ years or had a short life expectancy. CONCLUSIONS: Although the uptake and timeliness of chemotherapy for colorectal cancer has been improving, Maori, Pacific, Asian and older patients were less likely to receive chemotherapy and less likely to receive chemotherapy in a timely manner. There is a variation in use of chemotherapy by Region with patients in the Southern Cancer region appearing to be the most likely to receive chemotherapy and to receive it within a timely period.


Assuntos
Neoplasias Colorretais/tratamento farmacológico , Neoplasias Colorretais/patologia , Tratamento Farmacológico/métodos , Disparidades em Assistência à Saúde/etnologia , Idoso , Idoso de 80 Anos ou mais , Neoplasias Colorretais/mortalidade , Tratamento Farmacológico/economia , Grupos Étnicos , Feminino , Disparidades em Assistência à Saúde/estatística & dados numéricos , Humanos , Expectativa de Vida/etnologia , Expectativa de Vida/tendências , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias/métodos , Nova Zelândia/etnologia , Fatores de Tempo
4.
Nat Commun ; 11(1): 4446, 2020 09 07.
Artigo em Inglês | MEDLINE | ID: mdl-32895387

RESUMO

Owing to the poor penetration depth of light, phototherapy, including photothermal and photodynamic therapies, remains severely ineffective in treating deep tissue infections such as methicillin-resistant Staphylococcus aureus (MRSA)-infected osteomyelitis. Here, we report a microwave-excited antibacterial nanocapturer system for treating deep tissue infections that consists of microwave-responsive Fe3O4/CNT and the chemotherapy agent gentamicin (Gent). This system, Fe3O4/CNT/Gent, is proven to efficiently target and eradicate MRSA-infected rabbit tibia osteomyelitis. Its robust antibacterial effectiveness is attributed to the precise bacteria-capturing ability and magnetic targeting of the nanocapturer, as well as the subsequent synergistic effects of precise microwaveocaloric therapy from Fe3O4/CNT and chemotherapy from the effective release of antibiotics in infection sites. The advanced target-nanocapturer of microwave-excited microwaveocaloric-chemotherapy with effective targeting developed in this study makes a major step forward in microwave therapy for deep tissue infections.


Assuntos
Nanopartículas de Magnetita/uso terapêutico , Micro-Ondas/uso terapêutico , Osteomielite/tratamento farmacológico , Infecções Estafilocócicas/tratamento farmacológico , Animais , Antibacterianos/uso terapêutico , Sistemas de Liberação de Medicamentos/métodos , Tratamento Farmacológico/métodos , Óxido Ferroso-Férrico/uso terapêutico , Gentamicinas/uso terapêutico , Staphylococcus aureus Resistente à Meticilina/efeitos dos fármacos , Nanotubos de Carbono , Osteomielite/microbiologia , Coelhos
5.
Medicine (Baltimore) ; 99(31): e21445, 2020 Jul 31.
Artigo em Inglês | MEDLINE | ID: mdl-32756161

RESUMO

BACKGROUND: As a common clinical mental disorder, the prevalence rate of anxiety disorder increased yearly, devastating both physical health and social-economic prospect. The most common treatment relied on the use of western medications which is yet to fulfill ideal performance. While acupuncture is adopted as a treatment for anxiety disorders, the combination treatment of acupuncture and western medicines becomes more acknowledged. Albeit a spike in related literatures, the curative effect and safety of the treatment are still in lack of evidence. Therefore, this systematic review and meta-analysis protocol is planned to evaluate the efficacy and safety of the combination treatment of acupuncture and western medications. METHODS: Six English databases (PubMed, Web of science, Medline, EBASE, Springer Cochrane Library and WHO International Clinical Trials Registry Platform) and four Chinese databases (Wan fang Database, Chinese Scientific Journal Database, China National Knowledge Infrastructure Database (CNKI) and Chinese Biomedical Literature Database) will be searched normatively according to the rule of each database from the inception to June 1, 2020. Two reviewers will independently conduct article selection, data collection, and risk of bias evaluation. Any disagreement will be resolved by discussion with the third reviewer. Either the fixed-effects or random-effects model will be used for data synthesis based on the heterogeneity test. The change in the scores on the Hamilton Anxiety Scale (HANA) and the self-rating anxiety scale (SAS) will be used as the main outcome measure, quality of life scale (SF-36), changes of symptoms in TCM, hormone levels and clinical global impression (CGI) as the secondary outcome. treatment emergent symptom scale (TESS), general physical examination(temperature, pulse, respiration, blood pressure), Routine examination of blood, urine and stool, Electrocardiogram, Liver and kidney function examination as the security indexes. RevMan 5.3.5 will be used for meta-analysis. RESULTS: This study will provide high-quality evidence to assess the effectiveness and safety of acupuncture combined with western medicine for anxiety. CONCLUSION: This systematic review will explore whether acupuncture combined with western medicine is an effective and safe intervention for anxiety. ETHICS AND DISSEMINATION: Ethical approval is not required for this study. The systematic review will be published in a peer-reviewed journal, presented at conferences, and will be shared on social media platforms. This review will be disseminated in a peer-reviewed journal or conference presentation. PROSPERO REGISTRATION NUMBER: PROSPERO CRD42020149746.


Assuntos
Terapia por Acupuntura/métodos , Ansiedade/terapia , Terapia Combinada/métodos , Tratamento Farmacológico/métodos , Ansiedade/psicologia , Transtornos de Ansiedade/epidemiologia , Feminino , Humanos , Masculino , Avaliação de Resultados em Cuidados de Saúde , Prevalência , Qualidade de Vida , Segurança , Resultado do Tratamento
6.
Medicine (Baltimore) ; 99(34): e21876, 2020 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-32846844

RESUMO

BACKGROUND: Cancer continues to be a severe global health problem and the leading cause of death worldwide. Chemotherapy as the main treatment has various side effects, of which marrow suppression is the most common one. Acupuncture had shown clinical effects for marrow suppression after chemotherapy in many studies. However, the efficacy and safety of acupuncture therapy for marrow suppression after chemotherapy remains unclear. OBJECTIVE: This protocol aims to evaluate the efficacy and safety of acupuncture for marrow suppression after chemotherapy according to the existing randomized controlled trials. METHODS AND ANALYSIS: The randomized controlled trials on acupuncture therapy for marrow suppression after chemotherapy will be searched in the database of Embase, PubMed and Cochrane Library, Allied and Complementary Medicine Database (AMED), Chinese Biomedical Literature Database (CBM), China Science and Technology Journal Database (VIP), China National Knowledge Infrastructure (CNKI), WanFang Database (WF), and related registration platforms (WHO ICTRP, Clinical Trials, and Chinese Clinical Trial Register [ChiCTR]), Grey Literature Database from inception to 1 August 2020. The primary outcomes will be assessed using white blood cell (WBC) count, platelet count, hemoglobin count and the number of neutrophils (N). Review Manager V.5.3 software will be applied for statistical analyses. We will measure the risk of bias of the included studies with Cochrane Collaboration Risk of Bias Tool. Finally, Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) will be used to grade the overall quality of evidence. And we will use the intra-group correlation coefficient to assess the consistency of reviewers. RESULT: This systematic review and meta-analysis will put a high-quality synthesis of the efficacy and safety of acupuncture treatment in marrow suppression after chemotherapy. CONCLUSION: The conclusion of this systematic review will provide evidence to assess acupuncture therapy is an efficacy and safe intervention to treat and control marrow suppression after chemotherapy. PROSPERO REGISTRATION NUMBER: PROSPERO CRD42020163336.


Assuntos
Terapia por Acupuntura/métodos , Antineoplásicos/efeitos adversos , Células da Medula Óssea/efeitos dos fármacos , Medula Óssea/efeitos dos fármacos , Medula Óssea/patologia , Tratamento Farmacológico/métodos , Feminino , Hemoglobinas/análise , Humanos , Contagem de Leucócitos/métodos , Masculino , Neoplasias/tratamento farmacológico , Neutrófilos/citologia , Contagem de Plaquetas/métodos , Ensaios Clínicos Controlados Aleatórios como Assunto , Segurança , Resultado do Tratamento
7.
Medicine (Baltimore) ; 99(29): e21087, 2020 Jul 17.
Artigo em Inglês | MEDLINE | ID: mdl-32702853

RESUMO

BACKGROUND: Side effects after surgical therapy and chemotherapy of gastric cancer substantially reduce patients' quality of life. This systematic review aims to investigate whether moxibustion, as a complementary treatment, is effective in alleviating side effects in patients with gastric cancer who underwent surgical therapy or chemotherapy. METHODS: We will systematically search nine English and Chinese electronic databases to find relevant randomized controlled trials (RCTs) that compare basic treatment with and without moxibustion for treating the side effects induced by surgical therapy or chemotherapy in patients with gastric cancer. The time frame of the search will be from inception to July 1, 2020, and the publication language will not be limited. The literature screening and data extraction will be completed independently by 2 reviewers. The Cochrane risk of bias tool will be used to assess the risk of bias. For the analyses of the side effects of both surgical therapy and chemotherapy, the primary outcomes are defined as the incidence of any side effect, response rate, and quality of life. For the analyses of the side effects of surgical therapy, the secondary outcomes include the incidence of each individual side effect, time to first flatus/defecation/bowel sounds, and length of in-hospital stay. For the analysis of the side effects of chemotherapy, the secondary outcomes include incidence of each individual side effect, white blood cell/red blood cell/platelets counts, and hemoglobin level. R v3.6.2 software will be used to perform the meta-analyses. The quality of evidence will be classified using the Grading of Recommendations Assessment, Development and Evaluation system. RESULTS: This study will provide the first systematic review evidence on the efficacy of moxibustion as adjuvant management for gastric cancer by rigorous quality assessment and appropriate data synthesis. The results will be submitted to a peer-reviewed journal for publication. CONCLUSION: The findings of this study will provide currently best evidence on moxibustion for patients with gastric cancer who underwent surgical therapy or chemotherapy and may impact clinical practice.PROSPERO registration number: CRD42020169511.


Assuntos
Protocolos Clínicos , Moxibustão/normas , Neoplasias Gástricas/cirurgia , Tratamento Farmacológico/métodos , Humanos , Metanálise como Assunto , Moxibustão/métodos , Ensaios Clínicos Controlados Aleatórios como Assunto , Neoplasias Gástricas/complicações , Revisões Sistemáticas como Assunto
8.
Life Sci ; 257: 118051, 2020 Sep 15.
Artigo em Inglês | MEDLINE | ID: mdl-32634426

RESUMO

AIMS: Chemotherapy is an effective therapeutic modality which is commonly used for battling various cancers. However, several side effects induced by chemotherapeutic drugs would limit their clinical use. The present systematic review aims to evaluate the role of curcumin/curcuminoids co-administration during gastric cancer chemotherapy. METHODS: This systematic review was done according to PRISMA guidelines and a full systematic search in the electronic databases up to May 2020 using search terms in the titles and abstracts for the identification of relevant literature. 279 articles were found in electronic databases and 175 articles screened by title and abstract. Finally, 13 articles were included in this systematic review according to our inclusion and exclusion criteria. KEY FINDINGS: The findings indicated that gastric cancer chemotherapy induces cytotoxicity effects in various ways including a decrease of cell viability, colony formation, metastasis, tumor growth, and weight, as well as elevation of apoptosis pathway, oxidative stress pathway compared to the control group. Co-administration of curcumin/curcuminoids with chemotherapy synergistically increased the effects of anti-cancer chemotherapy compared to the group solo treated with chemotherapeutic agents. Also, in chemoresistance gastric cancer cells, co-administration of curcumin reduced chemoresistance mainly through the reduction of NF-κB activation and elevation of apoptosis. SIGNIFICANCE: According to the findings, the use of curcumin/curcuminoids during gastric cancer chemotherapy has chemosensitizing effects, and also it can reduce chemoresistance in gastric cancer.


Assuntos
Curcumina/uso terapêutico , Diarileptanoides/uso terapêutico , Neoplasias Gástricas/tratamento farmacológico , Antineoplásicos/farmacologia , Apoptose/efeitos dos fármacos , Linhagem Celular Tumoral , Sobrevivência Celular/efeitos dos fármacos , Curcumina/metabolismo , Curcumina/farmacologia , Diarileptanoides/metabolismo , Diarileptanoides/farmacologia , Tratamento Farmacológico/métodos , Humanos
9.
Medicine (Baltimore) ; 99(26): e20896, 2020 Jun 26.
Artigo em Inglês | MEDLINE | ID: mdl-32590800

RESUMO

INTRODUCTION: Metastatic neuroblastoma (NB) is an aggressive malignancy with a poor prognosis. Many patients present with relapsed high-risk NB after undergoing first-line treatment, and there is no standard therapy available in this setting. PATIENT CONCERNS: The present study aimed to present the cases of 2 patients with recurrent high-risk NB. DIAGNOSIS: Two children with International Neuroblastoma Stage System stage 4 high-risk NB chemotherapy. The disease recurrent after finishing the treatment. INTERVENTIONS: Both patients (34 months old and 41 months old) experienced recurrence, received second-line treatment, and then received maintenance treatment using apatinib plus retinoic acid. The apatinib (10 mg/kg per day) and retinoic acid (160 mg/m per day) were administered on alternating 2-week cycles, which was continued for 1 year. OUTCOMES: The 2 patients had achieved complete response by the 1-year follow-up after starting apatinib plus retinoic acid, and did not experience any adverse drug reactions. CONCLUSION: The outcomes from these cases suggest that apatinib plus isotretinoin might be an option for maintenance therapy in patients with recurrent high-risk NB.


Assuntos
Neuroblastoma/complicações , Neuroblastoma/tratamento farmacológico , Piridinas/uso terapêutico , Tretinoína/uso terapêutico , Dor Abdominal/etiologia , Antineoplásicos/uso terapêutico , Pré-Escolar , Tratamento Farmacológico/métodos , Tratamento Farmacológico/normas , Humanos , Masculino , Metástase Neoplásica/tratamento farmacológico , Metástase Neoplásica/fisiopatologia , Neuroblastoma/fisiopatologia , Recidiva
10.
Nat Biomed Eng ; 4(7): 732-742, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32572197

RESUMO

Drugs that induce thrombosis in the tumour vasculature have not resulted in long-term tumour eradication owing to tumour regrowth from tissue in the surviving rim of the tumour, where tumour cells can derive nutrients from adjacent non-tumoral blood vessels and tissues. Here, we report the performance of a combination of tumour-infarction therapy and chemotherapy, delivered via chitosan-based nanoparticles decorated with a tumour-homing peptide targeting fibrin-fibronectin complexes overexpressed on tumour-vessel walls and in tumour stroma, and encapsulating the coagulation-inducing protease thrombin and the chemotherapeutic doxorubicin. Systemic administration of the nanoparticles into mice and rabbits bearing subcutaneous or orthotopic tumours resulted in higher tumour growth suppression and decreased tumour recurrence than nanoparticles delivering only thrombin or doxorubicin, with histological and haematological analyses indicating an absence of detectable toxicity. The co-administration of a cytotoxic payload and a protease to elicit vascular infarction in tumours with biodegradable tumour-targeted nanoparticles represents a promising strategy for improving the therapeutic index of coagulation-based tumour therapy.


Assuntos
Antineoplásicos/administração & dosagem , Doxorrubicina/administração & dosagem , Sistemas de Liberação de Medicamentos/métodos , Tratamento Farmacológico/métodos , Infarto/tratamento farmacológico , Nanopartículas/química , Trombina/administração & dosagem , Animais , Antineoplásicos/química , Protocolos de Quimioterapia Combinada Antineoplásica , Neoplasias da Mama/tratamento farmacológico , Linhagem Celular Tumoral , Modelos Animais de Doenças , Doxorrubicina/química , Feminino , Neoplasias Hepáticas , Melanoma/tratamento farmacológico , Camundongos , Camundongos Endogâmicos BALB C , Camundongos Endogâmicos C57BL , Camundongos Nus , Coelhos , Ensaios Antitumorais Modelo de Xenoenxerto
12.
PLoS One ; 15(5): e0230950, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32365122

RESUMO

A pharmacogenomics-based pathway represents a series of reactions that occur between drugs and genes in the human body after drug administration. PG-path is a pharmacogenomics-based pathway that standardizes and visualizes the components (nodes) and actions (edges) involved in pharmacokinetic and pharmacodynamic processes. It provides an intuitive understanding of the drug response in the human body. A pharmacokinetic pathway visualizes the absorption, distribution, metabolism, and excretion (ADME) at the systemic level, and a pharmacodynamic pathway shows the action of the drug in the target cell at the cellular-molecular level. The genes in the pathway are displayed in locations similar to those inside the body. PG-path allows personalized pathways to be created by annotating each gene with the overall impact degree of deleterious variants in the gene. These personalized pathways play a role in assisting tailored individual prescriptions by predicting changes in the drug concentration in the plasma. PG-path also supports counseling for personalized drug therapy by providing visualization and documentation.


Assuntos
Biologia Computacional/métodos , Redes e Vias Metabólicas/genética , Preparações Farmacêuticas/metabolismo , Farmacogenética/métodos , Medicina de Precisão/métodos , Software , Bases de Dados Genéticas , Tratamento Farmacológico/métodos , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/genética , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/metabolismo , Absorção Gastrointestinal/genética , Estudos de Associação Genética , Humanos , Inativação Metabólica/efeitos dos fármacos , Inativação Metabólica/genética , Armazenamento e Recuperação da Informação/métodos , Redes e Vias Metabólicas/efeitos dos fármacos , Modelos Teóricos
13.
CJEM ; 22(5): 591-594, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32438948

RESUMO

A 53-year-old male presents with cough, fever, and myalgias for 7 days. Vitals include temperature, 38.0°C; heart rate, 110; blood pressure, 118/70 mm Hg; respiration rate, 28; and oxygen saturation 83% on room air. His only past medical history is hypertension. Your community is in the midst of the coronavirus disease 2019 (COVID-19) pandemic. The patient is hypoxic but responds to oxygen supplementation with nasal cannula and a face mask. His chest x-ray demonstrates multifocal infiltrates. Are there any therapeutic agents currently available for COVID-19?


Assuntos
Monofosfato de Adenosina/análogos & derivados , Alanina/análogos & derivados , Infecções por Coronavirus/tratamento farmacológico , Tratamento Farmacológico/métodos , Pneumonia Viral/tratamento farmacológico , Síndrome Respiratória Aguda Grave/tratamento farmacológico , Monofosfato de Adenosina/administração & dosagem , Alanina/administração & dosagem , Inibidores da Enzima Conversora de Angiotensina/administração & dosagem , Inibidores da Enzima Conversora de Angiotensina/farmacologia , Antibacterianos/administração & dosagem , Antibacterianos/farmacologia , Anti-Inflamatórios não Esteroides/administração & dosagem , Antimaláricos/administração & dosagem , Antimaláricos/farmacologia , Antivirais/administração & dosagem , Antivirais/farmacologia , Infecções por Coronavirus/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Determinação de Necessidades de Cuidados de Saúde , Pandemias , Segurança do Paciente , Pneumonia Viral/epidemiologia , Medição de Risco , Síndrome Respiratória Aguda Grave/diagnóstico , Índice de Gravidade de Doença , Esteroides/administração & dosagem , Esteroides/farmacologia , Resultado do Tratamento
14.
Rev. neurol. (Paris) ; 176(5): [1-28], May 2020.
Artigo em Inglês | BIGG - guias GRADE | ID: biblio-1117239

RESUMO

Neuropathic pain remains a significant unmet medical need. Several recommendations have recently been proposed concerning pharmacotherapy, neurostimulation techniques and interventional management, but no comprehensive guideline encompassing all these treatments has yet been issued. We performed a systematic review of pharmacotherapy, neurostimulation, surgery, psychotherapies and other types of therapy for peripheral or central neuropathic pain, based on studies published in peer-reviewed journals before January 2018. The main inclusion criteria were chronic neuropathic pain for at least three months, a randomized controlled methodology, at least three weeks of follow-up, at least 10 patients per group, and a double-blind design for drug therapy. Based on the GRADE system, we provide weak-to-strong recommendations for use and proposal as a first-line treatment for SNRIs (duloxetine and venlafaxine), gabapentin and tricyclic antidepressants and, for topical lidocaine and transcutaneous electrical nerve stimulation specifically for peripheral neuropathic pain; a weak recommendation for use and proposal as a second-line treatment for pregabalin, tramadol, combination therapy (antidepressant combined with gabapentinoids), and for high-concentration capsaicin patches and botulinum toxin A specifically for peripheral neuropathic pain; a weak recommendation for use and proposal as a third-line treatment for high-frequency rTMS of the motor cortex, spinal cord stimulation (failed back surgery syndrome and painful diabetic polyneuropathy) and strong opioids (in the absence of an alternative). Psychotherapy (cognitive behavioral therapy and mindfulness) is recommended as a second-line therapy, as an add-on to other therapies. An algorithm encompassing all the recommended treatments is proposed.


Assuntos
Psicoterapia/organização & administração , Tratamento Farmacológico/métodos , Manejo da Dor/métodos , Neuralgia/prevenção & controle , Neuralgia/terapia , França
15.
Aust J Gen Pract ; 49(4): 200-205, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32233346

RESUMO

BACKGROUND: Prostate cancer is a common tumour type in Australian men. OBJECTIVE: The aim of this article is to review important changes in prostate cancer diagnosis and management over the past five years, particularly as they pertain to general practice. DISCUSSION: The management of prostate cancer has changed significantly in recent years, particularly the use of imaging, with the introduction of prostate magnetic resonance imaging as routine in the diagnostic pathway, and the increasing use of prostate-specific membrane antigen positron emission tomography for early stratification in the salvage setting for failure of primary treatment in localised disease. In addition, upfront combinations of androgen deprivation therapy with other systemic treatments have yielded significant gains in overall survival for patients with metastatic disease. There has also been an increasing recognition of the association between germline DNA repair defects and progressive disease, and interest in the potential to identify patients for therapies that target these defects. There have been significant changes in how prostate cancer is diagnosed and managed in the past five years, with the introduction of new clinical pathways that were unprecedented just a decade previously.


Assuntos
Neoplasias da Próstata/terapia , Austrália/epidemiologia , Gerenciamento Clínico , Tratamento Farmacológico/métodos , Tratamento Farmacológico/tendências , Humanos , Imagem por Ressonância Magnética/métodos , Masculino , Vigilância da População/métodos , Próstata/anormalidades , Próstata/diagnóstico por imagem , Próstata/cirurgia , Prostatectomia/métodos , Prostatectomia/tendências , Neoplasias da Próstata/epidemiologia , Recidiva , Inibidores da Síntese de Esteroides/uso terapêutico
16.
Eur J Med Chem ; 197: 112311, 2020 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-32339855

RESUMO

Nonalcoholic Fatty Liver Disease (NAFLD) is the most common chronic liver disease in the world, which is characterized by liver fat accumulation unrelated to excessive drinking. Indeed, it attracts growing attention and becomes a global health problem. Due to the complexity of the NAFLD pathogenic mechanism, no related drugs were approved by Food and Drug Administration (FDA) till now. However, it is encouraging that a series of candidate drugs have entered the clinical trial stage with expectation to treat NAFLD. In this review, we summarized the main pathways and pathogenic mechanisms of NAFLD, as well as introduced the main potential therapeutic targets and the corresponding compounds involved in metabolism, inflammation and fibrosis. Furthermore, we also discuss the progress of these compounds, such as drug design and optimization, the choice of pharmacological properties and druglikeness, and the analysis of structure-activity relationship. This review offers a medium on future drug design and development, to be beneficial to relevant studies.


Assuntos
Tratamento Farmacológico/métodos , Hepatopatia Gordurosa não Alcoólica/tratamento farmacológico , Preparações Farmacêuticas/química , Animais , Desenho de Fármacos , Humanos , Estrutura Molecular , Hepatopatia Gordurosa não Alcoólica/etiologia , Relação Estrutura-Atividade
17.
Medicine (Baltimore) ; 99(17): e19931, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32332673

RESUMO

The aim of this study was to evaluate the outcomes of patients with advanced or recurrent ovarian cancer treated with cisplatin combined with topotecan as second- or higher-line palliative chemotherapy.We retrospectively reviewed the medical records of patients with advanced or recurrent ovarian cancer, who were treated with cisplatin (50 mg/m on day 1) and topotecan (0.75 mg/m on days 1-3). Treatment response, progression-free survival (PFS) and overall survival (OS) were analyzed, and laboratory data were reviewed to evaluate toxicities.Thirty one patients were treated with cisplatin and topotecan. The objective response rate (ORR) was 22.6%, and the disease control rate (DCR) was 61.3%. The median PFS was 3.7 months (95% confidence interval [CI], 2.3-5.2 months) and the median OS was 44.5 months (95% CI, 35.5-53.5 months). The ORR (33.3% vs. 0%; P = .012) was significantly better in the platinum-sensitive group compared to the platinum-resistant group. The median PFS was significantly longer in the platinum-sensitive group compared to the platinum-resistant group (7.7 vs 2.5 months; P < .001), and the median OS was also significantly longer in the platinum-sensitive group (46.6 vs 19.3 months; P < .001). Almost all of the patients reported some degree of hematological toxicity. A high rate of grade 3-4 neutropenia (87.1%) was observed. Grade 3-4 thrombocytopenia (41.9%) and febrile neutropenia (19.4%) were also seen.The results showed that cisplatin combined with topotecan, as second- or higher-line palliative chemotherapy for patients with advanced or recurrent ovarian cancer, might be effective, especially in the platinum-sensitive group. However, attention should be paid to the high hematological toxicity associated with this drug combination.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/normas , Tratamento Farmacológico/métodos , Neoplasias Ovarianas/tratamento farmacológico , Adulto , Idoso , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Cisplatino/normas , Cisplatino/uso terapêutico , Feminino , Humanos , Pessoa de Meia-Idade , Cuidados Paliativos/métodos , Recidiva , Estudos Retrospectivos , Topotecan/normas , Topotecan/uso terapêutico , Resultado do Tratamento
18.
Am J Emerg Med ; 38(6): 1253-1256, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32173235

RESUMO

INTRODUCTION: Sex-based medicine, which can be defined as the process of understanding the inherent differences in disease pathophysiology and response to medications that exist between the sexes, seems like a necessary step in the movement towards personalized medicine. While there are strict guidelines for weight-based dosage of pediatric medications, similar guidelines do not exist for the treatment of adults, despite prominent biologic differences between the sexes. The lack of individualization is of particular importance in the treatment of adult patients in the emergency department (ED), because it can determine the trajectory of a patient's stay at the hospital. OBJECTIVES: This review was conducted to better understand the need for and possible benefits of altering drug dosing guidelines for different categories of medications in the ED. PubMed, SCOPUS, and Google Scholar were queried using a combination of the keywords "gender differences," "sex differences," "treatment," and "emergency". Abstracts, unpublished data, and duplicate articles were excluded. DISCUSSION: In considering some of the most common causes of ED visits, the majority of diseases demonstrate differences in morbidity and mortality between female and male patients, despite similar treatment regimens. These differences can be attributed to variations in drug pharmacodynamics and pharmacokinetics, which may be affected by sex-based biologic variations in body mass index and body composition, and physiologic variations such as hormonal changes, menstruation, pregnancy, and lactation. Regardless of the mechanism of these differences, there is overwhelming evidence that universal drug dosing results in suboptimal outcomes for both male and female patients. CONCLUSIONS: Female sex is a risk factor for clinically significant adverse drug reactions, which range from cutaneous reactions to major bleeding, and can have long-standing implications on patient outcomes. However, future studies are needed to understand the exact pathophysiology of these sex differences, after controlling for potential confounding factors such as demographic differences and provider bias in treatment.


Assuntos
Tratamento Farmacológico/métodos , Fatores Sexuais , Adulto , Asma/tratamento farmacológico , Fibrilação Atrial/tratamento farmacológico , Cálculos da Dosagem de Medicamento , Tratamento Farmacológico/normas , Tratamento Farmacológico/tendências , Serviço Hospitalar de Emergência/organização & administração , Insuficiência Cardíaca/tratamento farmacológico , Humanos , Infarto do Miocárdio/tratamento farmacológico , Embolia Pulmonar/tratamento farmacológico , Fatores de Risco
20.
BMC Cancer ; 20(1): 185, 2020 Mar 04.
Artigo em Inglês | MEDLINE | ID: mdl-32131779

RESUMO

BACKGROUND: To analyze the effects of BRCA1/2 mutations on chemotherapy response scores (CRS) and survival in a cohort of patients with advanced-stage ovarian cancer who were treated with neoadjuvant chemotherapy (NAC) followed by interval debulking surgery (IDS). METHODS: We retrospectively reviewed the medical records of 169 high-grade serous ovarian cancer patients who underwent a germline BRCA1/2 test and received three cycles of NAC at the Yonsei Cancer Center from 2006 to 2018. Chemotherapy response scores were compared in patients with and without BRCA1/2 mutations. The effects of BRCA1/2 mutations and CRS on survival were evaluated. RESULTS: BRCA1/2 mutations were detected in 47 (28.1%) of the 169 patients. Overall, 16 (34.0%) patients with BRCA1/2 mutations had a CRS 3 to chemotherapy compared to scores of 43 in patients (35.2%) without a mutation. Response scores of 3 in patients with BRCA1/2 mutations were not significantly associated with either improved progression-free survival (PFS) (P = 0.949) or overall survival (OS) (P = 0.168). However, CRS 3 in patients without BRCA mutations was significantly associated with both improved PFS (P = 0.030) and OS (P = 0.039). In patients with CRS1/2, carriers of BRCA1/2 mutations had better PFS (P = 0.0344) and OS (P = 0.043) than wild-type BRCA genotype patients. CONCLUSION: In ovarian cancer patients treated with NAC, CRS did not predict survival for BRCA 1/2 mutation carriers but did for BRCA wild-type patients.


Assuntos
Proteína BRCA1/genética , Proteína BRCA2/genética , Cistadenocarcinoma Seroso/terapia , Tratamento Farmacológico/métodos , Mutação em Linhagem Germinativa , Procedimentos Cirúrgicos em Ginecologia/métodos , Neoplasias Ovarianas/terapia , Adulto , Idoso , Cistadenocarcinoma Seroso/genética , Cistadenocarcinoma Seroso/patologia , Procedimentos Cirúrgicos de Citorredução , Feminino , Humanos , Pessoa de Meia-Idade , Terapia Neoadjuvante , Estadiamento de Neoplasias , Neoplasias Ovarianas/genética , Neoplasias Ovarianas/patologia , Estudos Retrospectivos , Análise de Sobrevida , Resultado do Tratamento
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA