RESUMO
The question of whether SARS-CoV-2 (severe acute respiratory syndrome-related coronavirus-2 [SARS-CoV-2], leading to the COVID-19 infection) can be harboured in the testes and/or semen is currently unanswered. It is essential to understand the limitations of both antibody and real-time PCR tests in interpreting SARS-CoV-2 data in relation to analyses of semen and testicular tissue without appropriate controls. This article critically analyses the evidence so far on this, and the possible implications. The limitations of diagnostic tests in both sampling and testing methodologies, their validation and their relevance in interpreting data are also highlighted.
Assuntos
Betacoronavirus , Técnicas de Laboratório Clínico , Infecções por Coronavirus/transmissão , Infertilidade Masculina/terapia , Pneumonia Viral/transmissão , Testículo/virologia , Enzima de Conversão de Angiotensina 2 , COVID-19 , Teste para COVID-19 , Infecções por Coronavirus/diagnóstico , Humanos , Masculino , Pandemias , Peptidil Dipeptidase A/metabolismo , Pneumonia Viral/diagnóstico , RNA Viral/análise , Receptores de Superfície Celular/análise , Receptores de Superfície Celular/metabolismo , SARS-CoV-2 , Sêmen/virologia , Serina Endopeptidases/análise , Serina Endopeptidases/metabolismo , Espermatozoides/virologia , Glicoproteína da Espícula de Coronavírus/metabolismo , Doadores de TecidosRESUMO
BACKGROUND: Community-acquired bacterial pneumonia (CABP) is a leading cause of morbidity and mortality, and treatment recommendations, each with specific limitations, vary globally. We aimed to compare the efficacy and safety of solithromycin, a novel macrolide, with moxifloxacin for treatment of CABP. METHODS: We did this global, double-blind, double-dummy, randomised, active-controlled, non-inferiority trial at 114 centres in North America, Latin America, Europe, and South Africa. Patients (aged ≥18 years) with clinically and radiographically confirmed pneumonia of Pneumonia Outcomes Research Team (PORT) risk class II, III, or IV were randomly assigned (1:1), via an internet-based central block randomisation procedure (block size of four), to receive either oral solithromycin (800 mg on day 1, 400 mg on days 2-5, placebo on days 6-7) or oral moxifloxacin (400 mg on days 1-7). Randomisation was stratified by geographical region, PORT risk class (II vs III or IV), and medical history of asthma or chronic obstructive pulmonary disease. The study sponsor, investigators, staff, and patients were masked to group allocation. The primary outcome was early clinical response, defined as an improvement in at least two of four symptoms (cough, chest pain, sputum production, dyspnoea) with no worsening in any symptom at 72 h after the first dose of study drug, with a 10% non-inferiority margin. The primary analysis was by intention to treat. This trial is registered with ClinicalTrials.gov, number NCT-01756339. FINDINGS: Between Jan 3, 2013, and Sept 24, 2014, we randomly assigned 860 patients to receive solithromycin (n=426) or moxifloxacin (n=434). Patients were followed up to days 28-35 after first dose. Solithromycin was non-inferior to moxifloxacin in achievement of early clinical response: 333 (78·2%) patients had an early clinical response in the solithromycin group versus 338 (77·9%) patients in the moxifloxacin group (difference 0·29, 95% CI -5·5 to 6·1). Both drugs had a similar safety profile. 43 (10%) of 155 treatment-emergent adverse events in the solithromycin group and 54 (13%) of 154 such events in the moxifloxacin group were deemed to be related to study drug. The most common adverse events, mostly of mild severity, were gastrointestinal disorders, including diarrhoea (18 [4%] patients in the solithromycin group vs 28 [6%] patients in the moxifloxacin group), nausea (15 [4%] vs 17 [4%] patients) and vomiting (ten [2%] patients in each group); and nervous system disorders, including headache (19 [4%] vs 11 [3%] patients) and dizziness (nine [2%] vs seven [2%] patients). INTERPRETATION: Oral solithromycin was non-inferior to oral moxifloxacin for treatment of patients with CABP, showing the potential to restore macrolide monotherapy for this indication. FUNDING: Cempra.
Assuntos
Antibacterianos/uso terapêutico , Infecções Comunitárias Adquiridas/tratamento farmacológico , Fluoroquinolonas/uso terapêutico , Macrolídeos/uso terapêutico , Pneumonia Bacteriana/tratamento farmacológico , Triazóis/uso terapêutico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/efeitos adversos , Método Duplo-Cego , Europa (Continente) , Feminino , Fluoroquinolonas/efeitos adversos , Humanos , América Latina , Macrolídeos/efeitos adversos , Masculino , Pessoa de Meia-Idade , Moxifloxacina , América do Norte , África do Sul , Triazóis/efeitos adversos , Adulto JovemAssuntos
Infecções por Coronavirus , Transmissão Vertical de Doenças Infecciosas , Pandemias , Pneumonia Viral , Complicações Infecciosas na Gravidez , Resultado da Gravidez , Aborto Espontâneo , Betacoronavirus , COVID-19 , Comorbidade , Feminino , Retardo do Crescimento Fetal , Humanos , Gravidez , Nascimento Prematuro , Fatores de Risco , SARS-CoV-2RESUMO
En esta revisión se mencionan, en primer lugar, algunas alteraciones odontológicas y oro-cráneo-faciales que son observadas con cierta frecuencia en pacientes que concurren a la consulta odontológica. Luego se realiza una descripción del rol del odontólogo en la evaluación de pacientes que pudieran presentar trastornos respiratorios relacionados con el sueño (TRRS). A continuación, se describen brevemente dos de los más frecuentes TRRS: el ronquido y la apnea obstructiva del sueño. Finalmente, se mencionan algunos recursos terapéuticos de utilidad en los TRRS, particularmente los beneficios de la implementación de la aparatología oral (AO) en estos pacientes (AU)
In this review, we first mention some odontological and oro-cranial-facial alterations that are frequently observe in patients who attend the dental office. After that, a description of the role of the dentist in the evaluation of patients who could present RDRS will be made. Besides two of the most frequent RDRS are briefly describe: snoring and obstructive sleep apnea. Finally, some useful therapeutic resources for the RDRS treatment will be comment, particularly the benefits of the implementation of oral appliances (OA) -in these patients (AU)