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1.
Acta Neurochir Suppl ; 127: 179-183, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31407082

RESUMO

From 2013 to 2017, at the Burdenko Institute of Neurosurgery, intra-arterial verapamil for treatment of cerebral vasospasm following intracranial hemorrhage after aneurysm rupture was administered to 35 patients (total 75 procedures). The age is from 8 to 77 years. All ruptured aneurysms were treated: in 26 cases with open approach-clipping-and in 9 cases with endovascular occlusion. The procedure was carried out from 0 to 11 days after the operation. Severity of spasm was assessed by angiography and TCDU. Efficacy of the administration was assessed by TCDU 1 h after the procedure and by clinical evaluation of the patient's condition. The dose of verapamil was 15-50 mg (on average 40 mg) per procedure/per carotid pool and depended on the data of TCDU and clinical and radiological picture. The procedure was performed repeatedly (1-5 times) according to the indications and depending on the patient's condition, with an interval of 24 h. The procedure was effective as a preventive measure for care of patients in the initial stage of cerebral ischemia and was ineffective with a formed focus of ischemia. Endovascular administration of verapamil for treatment of cerebral vasospasm is a safe technique which positively affects the overall recovery of such patients.


Assuntos
Aneurisma Roto , Hemorragia Subaracnóidea , Vasodilatadores , Vasoespasmo Intracraniano , Verapamil , Adolescente , Adulto , Idoso , Criança , Humanos , Pessoa de Meia-Idade , Hemorragia Subaracnóidea/tratamento farmacológico , Hemorragia Subaracnóidea/prevenção & controle , Resultado do Tratamento , Vasodilatadores/uso terapêutico , Vasoespasmo Intracraniano/tratamento farmacológico , Verapamil/uso terapêutico , Adulto Jovem
3.
Undersea Hyperb Med ; 46(4): 483-494, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31509904

RESUMO

The aim of this study was to establish the effect of combined therapy with hyperbaric oxygen (HBO2) therapy and verapamil, amlodipine or nicorandil on functional recovery and oxidative stress markers after ischemia in the isolated rat heart. The study included 48 rats (Wistar albino, male gender, eight weeks old, body weight 200±50g). All animals were exposed to HBO2 treatment over 14 days. Isolated heart rats were perfused by the Langendorff retrograde method at a constant coronary pressure of 70 cm H2O. After stabilization period the hearts were divided into the following groups: HBO2 group (animals exposed to only HBO2 preconditioning); HBO2 + verapamil; HBO2 + amlodipine; andHBO2 + nicorandil (animals pretreated with HBO2 and appropriate pharmacological agent). Afterward, the hearts in all groups were subjected to 20-minute global ischemia and 30-minute reperfusion. Parameters of heart function were registered, including maximum and minimum rate of pressure development, systolic and diastolic left ventricular pressure, heart rate and coronary flow. Levels of pro-oxidants such as index of lipid peroxidation, measured as thiobarbituric acid-reactive substances, nitrites, levels of superoxide anion radicals and hydrogen peroxide were determined in coronary venous effluent. Changes in cardiac tissue were evaluated by hematoxylin and eosin staining. Obtained results clearly indicate that blockage of calcium channel or the activation of adenosine triphosphate-sensitive potassium (KATP) in combination with HBO2 prevented ischemia/reperfusion-induced cardiac deleterious effects, thus contributing to improvement of functional recovery of the heart. However, future studies are certainly necessary for better understanding the mechanisms through which combination of these two maneuvers of preconditioning triggers cardioprotection.


Assuntos
Bloqueadores dos Canais de Cálcio/uso terapêutico , Oxigenação Hiperbárica , Precondicionamento Isquêmico Miocárdico/métodos , Isquemia Miocárdica/terapia , Traumatismo por Reperfusão Miocárdica/prevenção & controle , Bloqueadores dos Canais de Potássio/uso terapêutico , Anlodipino/uso terapêutico , Animais , Pressão Sanguínea/efeitos dos fármacos , Terapia Combinada/métodos , Circulação Coronária , Coração , Frequência Cardíaca/efeitos dos fármacos , Precondicionamento Isquêmico Miocárdico/efeitos adversos , Peroxidação de Lipídeos , Masculino , Miocárdio/patologia , Nicorandil/uso terapêutico , Estresse Oxidativo , Ratos , Ratos Wistar , Recuperação de Função Fisiológica , Verapamil/uso terapêutico
4.
Med Arch ; 73(2): 72-75, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31391690

RESUMO

Introduction: The most appropriate choice of pharmacological treatment of heart rhythm disorders occurring in patients with chronic obstructive pulmonary disease (COPD) and cardiovascular comorbidity is often a topic of debate between pulmonologists and cardiologists in clinical practice, although numerous studies and clinical trials have demonstrated evidence to support the use of selective beta-blockers (BBs) in these patients. Aim: To examine the difference in the number of exacerbations in patients treated with a combination of verapamil and digoxin or BB alone in patients with different COPD stages. Patients and methods: The study included 68 patients (n = 68) diagnosed with COPD who were followed-up during a 12-month period, and the number of exacerbations were analyzed. The patients were divided into two groups according to the stage of COPD: GOLD II (moderate), and GOLD III (severe), and in each group a subdivision was established in relation to the use of either a combination of verapamil and digoxin or the use of BBs alone in pharmacological treatment. The inclusion criteria for patients were defined as following: a) established diagnosis of COPD according to present or deteriorated relevant clinical symptoms and signs, b) the ejection fraction (EF) of a left ventricle (LV) >35%, and c) spirometric cut-points classified as GOLD II (FEV1 / FVC <0.7, FEV1 predicted 50-80%), or GOLD III (FEV1/FVC <0.7, FEV1 predicted 30-50%) stage of the COPD. The exclusion criteria were EF of LV <35% and a lethal outcome during a follow-up period (2 patients were encountered). Exacerbation was defined as functional deterioration of the COPD symptoms verified by spirometric functional testing, frequency of hospitalizations according to GOLD stage assignment or verified clinical symptoms deterioration. Results: Regardless the pharmacological treatment, there is a statistically significant increase in the number of COPD exacerbations, in a 12-month period follow-up, in the GOLD III group (severe) compared to the GOLD II group (moderate). In the group of patients taking verapamil and digoxin, a two-tailed t-test was used to analyze the results between the GOLD II and GOLD III stage groups, p = 0.01, and 2. In the group of patients taking BBs, a two-tailed t-test was also used to analyze the results between the GOLD II and GOLD III stage groups, p = 0.003). Within the COPD GOLD II stage group, there appears to be no statistically significant difference in the number of exacerbations between the patients taking verapamil and digoxin (n = 24) and the patients taking BBs alone (n = 15), although, in patients taking BBs alone, there appears to be a trend towards a decrease in the exacerbations compared to the number of exacerbations in patients taking verapamil and digoxin (p = 0.007). Within the COPD GOLD III stage group, there is no difference in the number of exacerbations between the patients taking verapamil and digoxin (n = 20), and the patients taking BBs alone (n = 9), as analyzed by a two-tailed t-test, p = 0.577. Conclusion: Use of selective BBs in the treatment of cardiovascular comorbidity in patients with COPD represents a far better choice of pharmacological approach in the treatment of patients diagnosed with COPD GOLD II (moderate) stage.


Assuntos
Antagonistas Adrenérgicos beta/uso terapêutico , Antiarrítmicos/uso terapêutico , Arritmias Cardíacas/tratamento farmacológico , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Arritmias Cardíacas/epidemiologia , Bisoprolol/uso terapêutico , Estudos de Casos e Controles , Digoxina/uso terapêutico , Progressão da Doença , Volume Expiratório Forçado , Humanos , Metoprolol/uso terapêutico , Nebivolol/uso terapêutico , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Índice de Gravidade de Doença , Verapamil/uso terapêutico , Capacidade Vital
5.
BMJ Case Rep ; 12(7)2019 Jul 10.
Artigo em Inglês | MEDLINE | ID: mdl-31296618

RESUMO

Native right coronary artery (RCA) spasm is a less frequent early complication of perioperative coronary artery bypass grafting. Late presentation at 6 days postoperation is scarce and its relationship with an anomalous coronary artery is unknown. The optimal management and prevention remains controversial. In the case presented, the patient's anomalous left coronary artery originating from the right coronary cusp underwent ligation at its proximal segment at the time of bypass grafting. This ligation was preformed to prevent competitive flow. Six days postoperation, a refractory spasm of dominant native RCA occurred. The spasm resulted in right ventricular failure. Administration of intracoronary verapamil had a longer sustained vasodilatory effect and resolution of coronary spasm when compared with intracoronary nitroglycerine injection. An intra-aortic balloon pump, inotropic agents and low-dose nitroglycerine were used to maintain adequate haemodynamic support. Right ventricular systolic function recovery was noted within 2 days postintervention.


Assuntos
Ponte de Artéria Coronária , Vasoespasmo Coronário/complicações , Vasoespasmo Coronário/diagnóstico por imagem , Anomalias dos Vasos Coronários/complicações , Complicações Pós-Operatórias/diagnóstico por imagem , Cardiotônicos/uso terapêutico , Angiografia por Tomografia Computadorizada , Angiografia Coronária , Ponte de Artéria Coronária sem Circulação Extracorpórea , Vasoespasmo Coronário/tratamento farmacológico , Vasos Coronários/diagnóstico por imagem , Feminino , Humanos , Pessoa de Meia-Idade , Nitroglicerina/uso terapêutico , Complicações Pós-Operatórias/tratamento farmacológico , Vasodilatadores/uso terapêutico , Verapamil/uso terapêutico
6.
Medicine (Baltimore) ; 98(23): e15892, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31169698

RESUMO

RATIONALE: Atrial fibrillation (AF) is a common arrhythmia disease that can cause thromboembolic disease and/or heart failure, resulting in increased mortality. Propafenone, amiodarone, and flecainide are recommended for converting AF to sinus rhythm. Beta blockers, verapamil, diltiazem, and digoxin are recommended for controlling AF with fast ventricular rate (VR). In this case report, we found that verapamil successfully converted AF into sinus rhythm. PATIENT CONCERNS: A 92-year-old woman presented with fast VR AF with a history of coronary heart disease, hypertension, and diabetes. DIAGNOSES: Verapamil can successfully convert AF into sinus rhythm. INTERVENTIONS AND OUTCOMES: The patient was treated with amiodarone or propafenone, yet still had AF. After stopping amiodarone and propafenone, the patient was given verapamil to control the VR, and following 9 days of treatment the patient switched to sinus rhythm. When verapamil treatment was stopped, the patient experienced AF recurrence. Upon receiving verapamil again, the AF again converted into sinus rhythm. LESSONS: For the treatment of AF, nondihydropyridine calcium antagonists can be tried in the absence of antiarrhythmic drugs.


Assuntos
Antiarrítmicos/uso terapêutico , Fibrilação Atrial/tratamento farmacológico , Verapamil/uso terapêutico , Idoso de 80 Anos ou mais , Amiodarona/uso terapêutico , Comorbidade , Feminino , Humanos , Propafenona/uso terapêutico
8.
S Afr Med J ; 109(3): 152-153, 2019 Feb 26.
Artigo em Inglês | MEDLINE | ID: mdl-30834869

RESUMO

In this case report we describe a child with alternating hemiplegia of childhood, a rare neurodevelopmental disorder, and the effectiveness of an unconventional drug, verapamil, in treating this condition.


Assuntos
Bloqueadores dos Canais de Cálcio/uso terapêutico , Hemiplegia/tratamento farmacológico , Verapamil/uso terapêutico , Pré-Escolar , Hemiplegia/diagnóstico , Humanos , Masculino , África do Sul
9.
World Neurosurg ; 127: e149-e154, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30862588

RESUMO

BACKGROUND: Wide-necked intracranial aneurysms present unique treatment challenges in the setting of subarachnoid hemorrhage. New generations of endoluminal devices (stents) have expanded our ability to treat complex aneurysms. The PulseRider Aneurysm Neck Reconstruction Device (PulseRider [Cerenovus, Irvine, California, USA]) is new to the U.S. market after receiving Food and Drug Administration approval in June 2017. Official recommendation for use of the PulseRider is with dual antiplatelet therapy (DAPT). Its design has been hypothesized to carry a lower risk of thromboembolic complications in the circumstance that DAPT needs to be discontinued. METHODS: Between March and June 2018, we treated 4 cases of ruptured wide-necked basilar tip aneurysms at the University of Colorado Hospital, Aurora, Colorado, with PulseRider-assisted coil embolization. Imaging and chart reviews were performed retrospectively on each of these patients. RESULTS: All 4 aneurysms were successfully treated with PulseRider-assisted coil embolization. There were no periprocedural hemorrhages and no postprocedural reruptures. Two patients developed nonocclusive thrombi in the posterior cerebral arteries at the time of coiling, which was resolved with intra-arterial glycoprotein IIb/IIIa receptor antagonists. Two patients developed external ventricular drain-associated hemorrhages, only one of which developed after the administration of DAPT. All patients were eventually discharged to home. CONCLUSIONS: The PulseRider device represents a novel design for stent-assisted coil embolization. We report a small but promising series of its successful use in the acute treatment of wide-necked, ruptured basilar artery aneurysms. Additional experience is needed to determine if this device has a place in our armamentarium for treatment of ruptured aneurysms.


Assuntos
Aneurisma Roto/terapia , Embolização Terapêutica/instrumentação , Aneurisma Intracraniano/terapia , Abciximab/uso terapêutico , Adulto , Idoso , Aneurisma Roto/complicações , Aneurisma Roto/diagnóstico por imagem , Bloqueadores dos Canais de Cálcio/uso terapêutico , Angiografia Cerebral , Terapia Combinada , Embolização Terapêutica/efeitos adversos , Embolização Terapêutica/métodos , Eptifibatida/uso terapêutico , Desenho de Equipamento , Feminino , Humanos , Aneurisma Intracraniano/complicações , Aneurisma Intracraniano/diagnóstico por imagem , Trombose Intracraniana/tratamento farmacológico , Trombose Intracraniana/etiologia , Masculino , Pessoa de Meia-Idade , Inibidores da Agregação de Plaquetas/uso terapêutico , Artéria Cerebral Posterior , Stents , Hemorragia Subaracnóidea/diagnóstico por imagem , Hemorragia Subaracnóidea/etiologia , Hemorragia Subaracnóidea/terapia , Vasoespasmo Intracraniano/tratamento farmacológico , Vasoespasmo Intracraniano/etiologia , Verapamil/uso terapêutico
10.
Oxid Med Cell Longev ; 2019: 1896041, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30733849

RESUMO

Diabetic neuropathy (DN) is a common and severe complication of diabetes mellitus. There is still a lack of an effective treatment to DN because of its complex pathogenesis. Thioredoxin-interacting protein (TXNIP), an endogenous inhibitor of thioredoxin, has been shown to be associated with diabetic retinopathy and nephropathy. Herein, we aim to investigate the role of TXNIP in prediabetic neuropathy and therapeutic potential of verapamil which has been shown to inhibit TXNIP expression. The effects of mediating TXNIP on prediabetic neuropathy and its exact mechanism were performed using high-fat diet- (HFD-) induced diabetic mice and palmitate-treated neurons. Our results showed that TXNIP upregulation is associated with prediabetic neuropathy in HFD-fed mice. TXNIP knockdown improved DN in HFD-induced prediabetic mice. Mechanistically, increased TXNIP in dorsal root ganglion is transferred into the cytoplasm and shuttled to the mitochondria. In cytoplasm, TXNIP binding to TRX1 results in the increased oxidative stress and inflammation. In mitochondria, TXNIP binding to TRX2 induced mitochondria dysfunction and apoptosis. TXNIP isolated from TRX2 then shuttles to the cytoplasm and binds to NLRP3, resulting in further increased TXNIP-NLRP3 complex, which induced the release of IL-1ß and the development of inflammation. Thus, apoptosis and inflammation of dorsal root ganglion neuron eventually cause neural dysfunction. In addition, we also showed that verapamil, a known inhibitor of calcium channels, improved prediabetic neuropathy in the HFD-fed mice by inhibiting the upregulation of TXNIP. Our finding suggests that TXNIP might be a potential target for the treatment of neuropathy in prediabetic patients with dyslipidemia.


Assuntos
Antiarrítmicos/uso terapêutico , Proteínas de Transporte/antagonistas & inibidores , Diabetes Mellitus Experimental/complicações , Estado Pré-Diabético/complicações , Tiorredoxinas/antagonistas & inibidores , Verapamil/uso terapêutico , Animais , Antiarrítmicos/farmacologia , Apoptose , Diabetes Mellitus Experimental/patologia , Dieta Hiperlipídica , Feminino , Humanos , Inflamação , Camundongos , Camundongos Endogâmicos C57BL , Estado Pré-Diabético/patologia , Verapamil/farmacologia
11.
Hum Exp Toxicol ; 38(4): 381-388, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30526075

RESUMO

Liver is a precious organ to maintain body life. Hepatotoxicity is a worldwide health problem that is still a challenge for research. Although countless pharmaceutical drugs and herbal compounds were screened for their hepatoprotective effects, the death from hepatotoxicity is increasing. Thus, there is continuous necessity of searching for the hepatoprotective effect of commonly used drugs. Accordingly, our aim was to examine a hepatoprotective potential for the antihypertensive drug, verapamil, and searching for new insights underlie its protective mechanism. Four groups of adult male rats were randomly arranged as controls, thioacetamide (TAA) hepatotoxic, and TAA + verapamil treated. Serum liver enzyme, hepatic antioxidant, lipid peroxidation, and inflammatory parameters were assessed. Gene relative expression for heme oxygenase-1 (HO-1), nuclear factor-erythroid 2-related factor 2 (Nrf2), phosphoinositide 3-kinase (PI3K), and serine/threonine-specific protein kinase (Akt) were quantified in hepatic tissue. TAA caused hepatic injury evident both histopathologically and biochemically by a decrease in all gene expressions. Verapamil alleviated the injury via its antioxidant and anti-inflammatory effects that were suggested to be via upregulation of the previous gene expressions. In conclusion, the calcium channel blocker, verapamil, that is used widely as antihypertensive exhibits a valuable hepatoprotective effect. The protection partially rests on activation of Nrf2/HO-1 and PI3K/Akt pathways.


Assuntos
Anti-Inflamatórios/farmacologia , Antioxidantes/farmacologia , Bloqueadores dos Canais de Cálcio/farmacologia , Doença Hepática Induzida por Substâncias e Drogas/genética , Heme Oxigenase (Desciclizante)/genética , Fator 2 Relacionado a NF-E2/genética , Fosfatidilinositol 3-Quinases/genética , Proteínas Proto-Oncogênicas c-akt/genética , Tioacetamida , Verapamil/farmacologia , Animais , Anti-Inflamatórios/uso terapêutico , Antioxidantes/uso terapêutico , Bloqueadores dos Canais de Cálcio/uso terapêutico , Doença Hepática Induzida por Substâncias e Drogas/tratamento farmacológico , Doença Hepática Induzida por Substâncias e Drogas/patologia , Fígado/efeitos dos fármacos , Fígado/metabolismo , Fígado/patologia , Masculino , Ratos , Transdução de Sinais , Verapamil/uso terapêutico
12.
Fundam Clin Pharmacol ; 33(1): 122-124, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30025186

RESUMO

An inappropriate immunologic response has been suggested to play a role in the pathogenesis of hidradenitis suppurativa (HS). Adalimumab was the first TNF-α inhibitor approved for moderate to severe HS. We report on a case of HS (Hurley stage 2) in a 39-year-old man, who had received fusidic acid and isotretinoin treatments without evident benefit during the last 8 years. The patient noticed a reduction in the number of lesions and quality of life (DLQI from 27 to 6) in the 2 months following verapamil initiation for cluster headache. When verapamil was stopped, the lesions recurred within 1.5 months. The patient resumed taking verapamil as before and a remission occurred. Verapamil has been shown to inhibit TNF-α and IL-1ß in vitro and in vivo. We hypothesize that verapamil inhibits the inflammatory process through the TNF-α/IL-1 pathway involved in the HS physiopathology. Compared to biologic agents as anti-TNF-α (adalimumab) and anti-IL1 (anakinra), verapamil is safer and cheaper. Given its possible role on TNF-α/IL-1, verapamil may represent an alternative therapeutic option in mild and moderate HS.


Assuntos
Hidradenite Supurativa/tratamento farmacológico , Qualidade de Vida , Verapamil/uso terapêutico , Adulto , Bloqueadores dos Canais de Cálcio/farmacologia , Bloqueadores dos Canais de Cálcio/uso terapêutico , Ácido Fusídico/administração & dosagem , Hidradenite Supurativa/imunologia , Hidradenite Supurativa/patologia , Humanos , Isotretinoína/administração & dosagem , Masculino , Resultado do Tratamento , Fator de Necrose Tumoral alfa/antagonistas & inibidores , Verapamil/farmacologia
13.
Carbohydr Polym ; 206: 121-131, 2019 Feb 15.
Artigo em Inglês | MEDLINE | ID: mdl-30553305

RESUMO

An amphiphilic carboxymethyl chitosan-rhein (CR) conjugate was prepared, characterized, and evaluated as a potential carrier material for oral delivery of paclitaxel (PTX). CR conjugate self-assembled in aqueous environment into CR polymeric micelles (CR PMs). The drug loading capacity and entrapment efficiency of PTX-loaded CR PMs were 35.24 ± 1.58% and 86.99 ± 12.26%, respectively. Pharmacokinetic results indicate that PTX-loaded CR PMs could significantly enhance the oral bioavailability of PTX. Confocal imaging of intestinal sections verified many of CR PMs were absorbed as whole through the intestinal membrane. The cytotoxicity assays in Caco-2 cells and in vivo antitumor efficacy showed that PTX-loaded CR PMs had a stronger antitumor efficacy. A synergistic antitumor effect between CR conjugate and PTX was proven in MCF-7 cells and antitumor efficacy studies. The investigation of CR conjugate developed in this study showed that CR PMs are promising for oral delivery of water-insoluble antitumor drugs.


Assuntos
Antraquinonas/uso terapêutico , Antineoplásicos Fitogênicos/uso terapêutico , Portadores de Fármacos/química , Micelas , Neoplasias/tratamento farmacológico , Paclitaxel/uso terapêutico , Administração Oral , Animais , Antraquinonas/administração & dosagem , Antraquinonas/síntese química , Antraquinonas/farmacocinética , Antineoplásicos Fitogênicos/administração & dosagem , Antineoplásicos Fitogênicos/química , Antineoplásicos Fitogênicos/farmacocinética , Linhagem Celular Tumoral , Quitosana/administração & dosagem , Quitosana/análogos & derivados , Quitosana/síntese química , Quitosana/química , Portadores de Fármacos/administração & dosagem , Portadores de Fármacos/síntese química , Liberação Controlada de Fármacos , Sinergismo Farmacológico , Humanos , Masculino , Camundongos Endogâmicos ICR , Paclitaxel/administração & dosagem , Paclitaxel/química , Paclitaxel/farmacocinética , Verapamil/uso terapêutico
14.
BMJ Case Rep ; 11(1)2018 Dec 14.
Artigo em Inglês | MEDLINE | ID: mdl-30567256

RESUMO

Hypokalaemia can be treated with potassium chloride mixture. Some mixtures contain liquorice extract (glycyrrhizin) as a supplement to improve taste. Glycyrrhizin can cause pseudohyperaldosteronism and thereby result in hypertension and hypokalaemia. We here present a case where treatment with potassium chloride mixture causes hypertension and hypokalaemia in a 50-year-old woman. After unravelling differential diagnosis, the potassium chloride mixture was stopped. After the discontinuation, the patient's blood pressure was well managed and the potassium levels normalised.


Assuntos
Glycyrrhiza/efeitos adversos , Ácido Glicirrízico/efeitos adversos , Hiperaldosteronismo/induzido quimicamente , Hipertensão/tratamento farmacológico , Hipopotassemia/induzido quimicamente , Cloreto de Potássio/efeitos adversos , Verapamil/uso terapêutico , Diagnóstico Diferencial , Feminino , Ácido Glicirrízico/uso terapêutico , Humanos , Hiperaldosteronismo/sangue , Hiperaldosteronismo/diagnóstico , Hipertensão/sangue , Hipertensão/diagnóstico , Hipopotassemia/sangue , Hipopotassemia/diagnóstico , Hipopotassemia/etiologia , Pessoa de Meia-Idade , Potássio/sangue , Cloreto de Potássio/farmacologia , Cloreto de Potássio/uso terapêutico , Resultado do Tratamento
15.
Expert Opin Emerg Drugs ; 23(4): 261-269, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30482063

RESUMO

Introduction: Dravet syndrome (DS) is an early-onset genetic developmental epileptic encephalopathy characterized by multiple seizure types which are refractory to antiseizure medication. There is an unmet need for effective and tolerable drugs to control different seizure types in DS types, with the aim of improving quality of life and preventing neurological impairment. Areas covered: Narrative review of efficacy and tolerability of fenfluramine, cannabidiol (CBD), verapamil, and modulators of serotonin signaling pathways (lorcaserin or trazodone) in the treatment of DS. Expert opinion/commentary: A recent large randomized controlled trial has shown that CBD is effective in the treatment of DS; preliminary data from the placebo-controlled trial on fenfluramine are also promising. Further studies are definitely required to evaluate the role of verapamil and modulators of serotonin signaling in DS. At present, drugs used to treat seizures in DS treat the symptoms of epilepsy rather than its cause(s). Future research should focus on elucidating the natural history of DS and whether appropriate treatment can have a beneficial impact on its disease course. A multidisciplinary, individualized approach to care of DS patients is required.


Assuntos
Epilepsias Mioclônicas/tratamento farmacológico , Animais , Canabidiol/uso terapêutico , Fenfluramina/uso terapêutico , Humanos , Serotoninérgicos/uso terapêutico , Verapamil/uso terapêutico
16.
Zhong Nan Da Xue Xue Bao Yi Xue Ban ; 43(8): 843-851, 2018 Aug 28.
Artigo em Chinês | MEDLINE | ID: mdl-30197311

RESUMO

OBJECTIVE: To evaluate the anti-cicatricial and anti-restenosis effect of verapamil on anterior urethral stricture.
 Methods: A total of 32 patients received anterior urethral stricture were enrolled in this study. They were divided into 4 blocks according to the duration of previous urethral operations and dilations. Every block was further randomly divided into an experimental group and a control group. Experimental groups received 2 mL injection of verapamil around the anastomosis site of urethra before and after the surgery (2, 4, 6, 8, and 10 weeks after the surgery), while the control groups only received the anastomosis surgery. After surgery, maximal urinary flow rate (Qmax) was examined for all patients once the catheter was removed. In addition, they were also conducted palpation of urethral scar range. The sum of long transverse diameters of urethral scar was measured, and the narrowest urethral inner diameter was examined. The Qmax was rechecked and the urethral scar range was assessed by penis color Doppler elastography after 12 weeks of surgery. The above 4 indexes were used to evaluate the inhibitory effect of verapamil on urethral scar.
 Results: The length of palpated urethral scar in the Block 1 to 4 of the experimental groups was (22.75±1.03), (21.25±0.25), (20.75±1.03), and (20.0±0.58) mm, respectively; and those in the control groups (26.00±0.82), (24.5±1.04), (25.75±1.65), and (28.25±1.75) mm, respectively. The Qmax rates in the Block 1 to 4 of the experimental groups were (11.85±0.77), (11.33±0.81), (10.23±0.26), and (10.35±0.17) mL/s, respectively; and those in the control groups were (10.85±0.39), (10.50±0.76), (10.53±1.00), (12.60±0.39) mL/s, respectively. The Qmax rates in the Block 1 to 4 of the experimental groups were (11.73±0.87), (10.65±0.25), (10.23±0.19), and (10.35±0.29) mL/s, respectively; and those in the control groups were (8.05±0.28), (7.73±0.68), (7.53±0.92), and (9.60±0.32) mL/s, respectively. The narrowest diameters of urethral in the Block 1 to 4 of the experimental groups were (9.00±0.58), (7.50±2.89), (7.00±0.10), and (7.00±0.41) mm, respectively; and those in the control groups were (5.50±0.29), (5.00±0.41), (4.75±0.48), and (6.75±0.48) mm, respectively. The ultrasound strain ratio in the Block 1 to 4 of the experimental groups were 6.10±0.22, 6.10±0.17, 5.10±0.16, and 6.90±0.19, respectively; and those in the control groups were 8.00±0.25, 10.60±0.29, 11.30±0.16, and 8.90±0.33, respectively. Compared with the control groups, the experimental groups displayed smaller urethral scar range, less severe scarring, improved Qmax rates and wider inner diameters (all P<0.05).
 Conclusion: Urethral regional injection of verapamil intraoperatively or postoperatively can prevent overgrowth of urethral scar tissues after the transperineal anastomosis surgery, and reduce the tendency of postoperative restenosis of anterior urethral stricture.


Assuntos
Cicatriz/prevenção & controle , Complicações Pós-Operatórias/prevenção & controle , Estreitamento Uretral/prevenção & controle , Estreitamento Uretral/cirurgia , Agentes Urológicos/uso terapêutico , Verapamil/uso terapêutico , Anastomose Cirúrgica/efeitos adversos , Cicatriz/diagnóstico por imagem , Cicatriz/tratamento farmacológico , Dilatação/efeitos adversos , Humanos , Masculino , Pênis/diagnóstico por imagem , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/tratamento farmacológico , Prevenção Secundária , Ultrassonografia , Uretra/diagnóstico por imagem , Uretra/cirurgia , Micção
17.
Br J Neurosurg ; 32(4): 431-435, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30207193

RESUMO

PURPOSE: Medically refractory reversible cerebral vasoconstriction syndrome (RCVS), a rare variant of RCVS, poses a significant therapeutic challenge. Herein we describe a case of medically refractory RCVS that required treatment with intra-arterial (IA) verapamil and subsequent nimodipine, resulting in both angiographic and clinical improvement after failing to respond to hemodynamic augmentation. We also supplement a description of our case with a review of other case studies and case series in which IA calcium channel blockers were used to treat RCVS. We propose that the case we outline below demonstrates that neurointerventional management with IA verapamil is appropriate and effective as an early intervention of medically refractory RCVS. METHODS AND MATERIALS: Using PubMed and Google Scholar, we performed a search of the English language literature with several combinations of the keywords "intra-arterial", "calcium channel blockers", "reversible cerebral vasoconstriction syndrome", "RCVS", "nimodipine", "verapamil", "milrinone", and "nicardipine" to identify studies in which RCVS was treated with IA calcium channel blockers. RESULTS: We identified eight case studies and case series that met our inclusion criteria. Eighteen patients are encompassed in these eight studies. CONCLUSIONS: IA administration of calcium channel blockers has been shown to return cerebral vessels to their normal caliber in patients with medically refractory RCVS. However, there are no randomized controlled trials of the treatment of RCVS, and further studies are needed to elucidate the optimal treatment protocol for medically refractory RCVS.


Assuntos
Angioplastia/métodos , Vasoespasmo Intracraniano/tratamento farmacológico , Bloqueadores dos Canais de Cálcio/administração & dosagem , Bloqueadores dos Canais de Cálcio/uso terapêutico , Resistência a Medicamentos , Feminino , Humanos , Infusões Intra-Arteriais , Imagem por Ressonância Magnética , Pessoa de Meia-Idade , Nimodipina/administração & dosagem , Nimodipina/uso terapêutico , Síndrome , Resultado do Tratamento , Vasodilatadores/uso terapêutico , Vasoespasmo Intracraniano/diagnóstico por imagem , Verapamil/administração & dosagem , Verapamil/uso terapêutico
18.
J Electrocardiol ; 51(5): 874-878, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30177332

RESUMO

Verapamil-sensitive left fascicular monomorphic ventricular tachycardia (LF-VT) was first described ~4 decades ago. Our knowledge regarding this arrhythmia is evolving continuously. The current review aims to highlight up to date aspects of this arrhythmia focusing on its ECG recognition, new considerations of the reentrant circuit, ablation targets in inducible and non-inducible patients and the approach to LF-VT with multiform morphology.


Assuntos
Eletrocardiografia , Taquicardia Ventricular , Ablação por Cateter/métodos , Diagnóstico Diferencial , Sistema de Condução Cardíaco/anatomia & histologia , Humanos , Taquicardia Ventricular/diagnóstico , Taquicardia Ventricular/fisiopatologia , Taquicardia Ventricular/terapia , Verapamil/uso terapêutico
19.
J Electrocardiol ; 51(5): 895-897, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30177336

RESUMO

Hypertrophic cardiomyopathy (HCM) patients sometimes develop subendocardial ischemia without coronary artery stenosis. We report a case of non-obstructive HCM, in which electrocardiographic changes were observed with improvement of subendocardial ischemia. A 76-year-old man presented with chest pain on exertion. The electrocardiogram revealed left ventricular (LV) hypertrophy with repolarization abnormalities. No coronary stenosis was found on computed tomography angiography, but thallium-201 exercise scintigraphy revealed transient LV cavity dilation after exercise, consistent with subendocardial ischemia. His chest symptoms disappeared after starting verapamil. Transient LV cavity dilation improved without a reduction in exercise tolerance, as did electrocardiographic abnormalities without any changes on echocardiography.


Assuntos
Cardiomiopatia Hipertrófica/complicações , Dor no Peito/etiologia , Eletrocardiografia , Isquemia Miocárdica/diagnóstico , Idoso , Bloqueadores dos Canais de Cálcio/uso terapêutico , Complicações do Diabetes , Endocárdio , Humanos , Masculino , Isquemia Miocárdica/complicações , Isquemia Miocárdica/tratamento farmacológico , Verapamil/uso terapêutico
20.
Nat Commun ; 9(1): 3314, 2018 08 17.
Artigo em Inglês | MEDLINE | ID: mdl-30115924

RESUMO

The widely used antimalarial combination therapy dihydroartemisinin + piperaquine (DHA + PPQ) has failed in Cambodia. Here, we perform a genomic analysis that reveals a rapid increase in the prevalence of novel mutations in the Plasmodium falciparum chloroquine resistance transporter PfCRT following DHA + PPQ implementation. These mutations occur in parasites harboring the K13 C580Y artemisinin resistance marker. By introducing PfCRT mutations into sensitive Dd2 parasites or removing them from resistant Cambodian isolates, we show that the H97Y, F145I, M343L, or G353V mutations each confer resistance to PPQ, albeit with fitness costs for all but M343L. These mutations sensitize Dd2 parasites to chloroquine, amodiaquine, and quinine. In Dd2 parasites, multicopy plasmepsin 2, a candidate molecular marker, is not necessary for PPQ resistance. Distended digestive vacuoles were observed in pfcrt-edited Dd2 parasites but not in Cambodian isolates. Our findings provide compelling evidence that emerging mutations in PfCRT can serve as a molecular marker and mediator of PPQ resistance.


Assuntos
Antimaláricos/uso terapêutico , Resistência a Medicamentos/genética , Malária Falciparum/tratamento farmacológico , Malária Falciparum/parasitologia , Proteínas de Membrana Transportadoras/genética , Mutação/genética , Plasmodium falciparum/genética , Proteínas de Protozoários/genética , Quinolinas/uso terapêutico , Animais , Antimaláricos/farmacologia , Camboja , Forma Celular/efeitos dos fármacos , Cloroquina/farmacologia , Cloroquina/uso terapêutico , Resistência a Medicamentos/efeitos dos fármacos , Dosagem de Genes , Edição de Genes , Haplótipos/genética , Humanos , Parasitos/efeitos dos fármacos , Parasitos/genética , Parasitos/crescimento & desenvolvimento , Plasmodium falciparum/efeitos dos fármacos , Plasmodium falciparum/crescimento & desenvolvimento , Plasmodium falciparum/isolamento & purificação , Quinolinas/farmacologia , Verapamil/farmacologia , Verapamil/uso terapêutico
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