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The current outbreak of COVID-19 is leading an unprecedented scientific effort focusing on targeting SARS-CoV-2 proteins critical for its viral replication. Herein, we performed high-throughput virtual screening of more than eleven thousand FDA-approved drugs using backpropagation-based artificial neural networks (q2LOO = 0.60, r2 = 0.80 and r2pred = 0.91), partial-least-square (PLS) regression (q2LOO = 0.83, r2 = 0.62 and r2pred = 0.70) and sequential minimal optimization (SMO) regression (q2LOO = 0.70, r2 = 0.80 and r2pred = 0.89). We simulated the stability of Acarbose-derived hexasaccharide, Naratriptan, Peramivir, Dihydrostreptomycin, Enviomycin, Rolitetracycline, Viomycin, Angiotensin II, Angiotensin 1-7, Angiotensinamide, Fenoterol, Zanamivir, Laninamivir and Laninamivir octanoate with 3CLpro by 100 ns and calculated binding free energy using molecular mechanics combined with Poisson-Boltzmann surface area (MM-PBSA). Our QSAR models and molecular dynamics data suggest that seven repurposed-drug candidates such as Acarbose-derived Hexasaccharide, Angiotensinamide, Dihydrostreptomycin, Enviomycin, Fenoterol, Naratriptan and Viomycin are potential SARS-CoV-2 main protease inhibitors. In addition, our QSAR models and molecular dynamics simulations revealed that His41, Asn142, Cys145, Glu166 and Gln189 are potential pharmacophoric centers for 3CLpro inhibitors. Glu166 is a potential pharmacophore for drug design and inhibitors that interact with this residue may be critical to avoid dimerization of 3CLpro. Our results will contribute to future investigations of novel chemical scaffolds and the discovery of novel hits in high-throughput screening as potential anti-SARS-CoV-2 properties.Communicated by Ramaswamy H. Sarma.

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ABSTRACT Objective: To assess the efficacy and safety of atosiban in pregnant women with risk of preterm delivery as compared to nifedipine, indomethacin, terbutaline, fenoterol and placebo. Materials and methods: A systematic literature review was carried out in eight electronic databases, including Medline, Central, and Embase, using free and standardized search terms. Outcomes assessment included time delay until delivery, neonatal mortality, ratio of adverse maternal events, and ratio of neonatal complications. The quality of the evidence was evaluated per study and for the body of evidence and, whenever feasible, the information was synthesized into a meta-analysis. Alternatively, a narrative summary was presented. Results: Eleven studies were included. Atosiban did not show any statistically significant differences in terms of delaying delivery versus other uterine contraction inhibitors. The neonatal mortality was lower compared to indomethacin (RR = 0.21; 95% CI: 0.05 to 0.92), and the percentage of total maternal adverse events was lower compared to fenoterol (RR = 0.16; 95% CI: 0.08 to 0.31), nifedipine (RR = 0.48; 95% CI: 0.3 to 0.78), and terbutaline (RR = 0.44; 95% CI: 0.28 to 0.71). Conclusions: Atosiban has similar efficacy for delivery delay in patients with risk of preterm delivery as compared to other agents (moderate certainty), showing some advantages regarding neonatal mortality (low certainty) versus indomethacin, and compared to fenoterol, nifedipine and terbutaline in terms of maternal adverse events (moderate certainty).

RESUMEN Objetivo: evaluar la eficacia y seguridad de atosiban en gestantes con amenaza de parto pretérmino comparado con nifedipino, indometacina, terbutalina, fenoterol y placebo. Materiales y métodos: se realizó una revisión sistemática de la literatura en ocho bases de datos electrónicas (Medline, Central, Embase, entre otras), mediante términos de búsqueda libres y estandarizados. Los desenlaces evaluados incluyeron tiempo de retardo del parto, mortalidad neonatal, proporción de eventos adversos maternos y proporción de complicaciones neonatales. Se evaluó la calidad de la evidencia por estudio y para el cuerpo de evidencia, y se sintetizó la información mediante metaanálisis, cuando fue posible; de lo contrario, se resumió de forma narrativa. Resultados: se incluyeron once estudios. Atosiban no mostró diferencias estadísticamente significativas en retardo del parto contra otros uteroinhibidores. Mostró menor mortalidad neonatal que la indometacina (RR = 0,21; IC 95 %: 0,05 a 0,92), y menor proporción de eventos adversos maternos totales que el fenoterol (RR = 0,16; IC 95 %: 0,08 a 0,31), el nifedipino (RR = 0,48; IC 95 %: 0,3 a 0,78) y la terbutalina (RR = 0,44; IC 95 %: 0,28 a 0,71). Conclusiones: atosiban tiene una eficacia similar para retardar el parto ante la amenaza de un parto pretérmino con otros comparadores (certeza moderada), con ventajas frente a indometacina en mortalidad neonatal (certeza baja) y frente a fenoterol, nifedipino y terbutalina en eventos adversos maternos (certeza moderada).

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Salbutamol is a ß2 adrenergic agonist widely prescribed in patients with obstructive and restrictive lung diseases. The main side effects associated with its use are tachycardia and tremor. Myoclonus is an involuntary, irregular, abrupt, brief and sudden muscular contraction, which can be generalized, focal or multifocal. We report the case of a 61-year-old patient presenting with myoclonus difficult to treat who showed improvement only after the definitive discontinuation of the ß2 adrenergic agonist. We describe the clinical findings, the interventions, and the outcomes related to the onset of myoclonus secondary to the use of salbutamol, as well as the possible genesis and importance of this adverse effect. We used the CARE guidelines to delineate the clinical case. Although myoclonus secondary to the use of different drugs has been described in the literature, as far as we know this is the fourth report of salbutamol-induced myoclonus to date.

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Resumen El salbutamol es un agonista adrenérgico β2 ampliamente empleado en pacientes con enfermedades pulmonares obstructivas y restrictivas. Sus principales efectos secundarios son la taquicardia y el temblor. Las mioclonías son contracciones musculares involuntarias, irregulares, bruscas, breves y repentinas, y pueden ser generalizadas, focales o multifocales. Se presenta el caso de un paciente de 61 años con mioclonías de difícil manejo que solo presentó mejoría tras la suspensión definitiva del agonista adrenérgico β2. Se describen los hallazgos clínicos, las intervenciones y el resultado en las mioclonías asociadas con el uso de salbutamol y se discuten la posible génesis y la importancia de este efecto adverso. Para documentar el caso, se siguieron las recomendaciones de las guías para el reporte de casos (CAse REport, CARE). Aunque en diversos estudios se han descrito mioclonías secundarias al uso de diferentes fármacos, hasta donde se sabe, este sería el cuarto reporte de un caso asociado específicamente con el uso del salbutamol.

Abstract Salbutamol is a β2 adrenergic agonist widely prescribed in patients with obstructive and restrictive lung diseases. The main side effects associated with its use are tachycardia and tremor. Myoclonus is an involuntary, irregular, abrupt, brief and sudden muscular contraction, which can be generalized, focal or multifocal. We report the case of a 61-year-old patient presenting with myoclonus difficult to treat who showed improvement only after the definitive discontinuation of the β2 adrenergic agonist. We describe the clinical findings, the interventions, and the outcomes related to the onset of myoclonus secondary to the use of salbutamol, as well as the possible genesis and importance of this adverse effect. We used the CARE guidelines to delineate the clinical case. Although myoclonus secondary to the use of different drugs has been described in the literature, as far as we know this is the fourth report of salbutamol-induced myoclonus to date.

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Problema: "¿Cuáles son los cambios clínico-flujométricos observados en pacientes con exacerbaciones agudas de asma bronquial leve, moderado y severo, con nebulización convencional en el servicio de emergencia del Hospital Nacional Arzobispo Loayza?". Objetivo: determinar los cambios en la función pulmonar medida con PEF y cambios clínicos en exacerbaciones agudas leves, moderadas o severas del asma bronquial en adultos sometidos a nebulización convencional. Metodología: Es un estudio descriptivo, observacional, prospectivo, realizado en emergencia del Hospital Nacional Arzobispo Loayza; se evaluó 136 pacientes mayores de 18 años con exacerbación aguda leve, moderada y severa de asma bronquial, nebulizados con fenoterol, con un IC de 95 por ciento, z de 1.96, potencia de 80 por ciento (para una muestra de131 pacientes); se excluyeron enfermedades respiratorias y cardiacas crónicas y asma casi fatal, etc. Se midió la variación del PEF, la mejoría clínica, estancia en la sala de emergencia, requerimiento de hospitalización y recaídas. Se estimó las frecuencias absolutas y relativas de cada variable y en algunos casos se sometió a pruebas de significación estadística para determinar las diferencias. La información se presenta en cuadros y gráficos. Resultados: Se reclutó 136 pacientes asmáticos, 108 mujeres, y 28 varones, 56 casos leves (41.2 por ciento), 60 casos moderados (44.1 por ciento) y 20 severos (14.7 por ciento); la edad promedio de los casos fue de 36.3 años, siendo de 50.6 años en el grupo de mayor severidad. Todos usaban beta agonistas como broncodilatador, y más de la mitad (55.9 por ciento) usaba corticoides en cualquiera de sus formas, el 35 por ciento usaba corticoides vía oral en sus crisis. La mayoría (64.7 por ciento) esperaba más de 1 día de inicio de la crisis para atenderse, todos los grupos tuvieron variación de la frecuencia cardiaca tras la nebulización siendo el de mayor taquicardia en el grupo de severo. No se registraron casos de...

Problem: "What are the clinical-flowmetry changes observed in patients with acute exacerbations of mild, moderate and severe bronchial asthma, with conventional nebulization in the emergency service of the National Hospital Arzobispo Loayza?” Objective: To determine changes in pulmonary function measured by PEF and clinical changes in mild, moderate or severe acute exacerbations of asthma in adults undergoing conventional nebulization. Methodology: A descriptive, observational, prospective study, conducted in emergency at National Hospital Arzobispo Loayza; 136 patients over 18 with mild, moderate and severe acute exacerbation of bronchial asthma, nebulized with fenoterol, with 95 per cent Cl, z 1.96, power of 80 per cent (for a sample of 131 patients) was evaluated; chronic respiratory and heart diseases and near-fatal asthma were excluded, etc. PEF variation, clinical improvement, stay in the emergency room, hospitalization requirement and relapse was measured. Absolute and relative to each variable and in some cases subjected to tests to determine statistical significance of differences was estimated frequencies. The information is presented in tables and graphs. Results: 136 asthmatic patients, 108 women and 28 men, 56 mild cases (41.2 per cent), moderate 60 cases (44.1 per cent) and 20 severe (14.7 per cent) were enrolled; the average age of the cases was 36.3 years, with 50.6 years in the group of greater severity. All beta agonists used as a bronchodilator, and more than half (55.9 per cent) used steroids in any form, 35 per cent used oral corticosteroids in their crisis. Most (64.7 per cent) waited more than 1 day of onset of the crisis to be addressed, all groups had variation in heart rate after nebulization tachycardia being the most severe in the group. No cases of fatal or near-fatal asthma were recorded. The stand by time and stay for treatment was variable, being the most severe cases prolonged length of stay, and the members of the SIS. A...

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Objetivo: Evaluar la efectividad de la progesterona natural micronizada administrada vía oral y del fenoterol administrado vía endovenosa, en el tratamiento de las pacientes con diagnóstico de amenaza de parto pretérmino. Métodos: Estudio experimental tipo ensayo terapéutico en pacientes que acudieron al Hospital Universitario de Caracas. Resultados: 15 pacientes del grupo estudio con progesterona presentaron resultados satisfactorios (X² = 155,837, df = 18); del grupo control, 13 pacientes con resultados satisfactorios (X² = 133,093, df = 18). La efectividad absoluta en el grupo de estudio fue de 0,68 contra 0,59 del grupo control (X² = 0,393; df = 1; P < 0,531). Conclusiones: Los tratamientos con progesterona natural micronizada y fenoterol demostraron ser inhibitorios de la dinámica uterina, a partir de la segunda hora de iniciado el tratamiento, evitando su progreso hacia trabajo de parto en un 90 %. La progesterona natural micronizada es efectiva en el tratamiento de la amenaza de parto pretérmino y se debe considerar su uso como alternativa terapéutica.

Objective: To evaluate the effectiveness of micronized natural progesterone administered orally and intravenously administered fenoterol in the treatment of patients with a diagnosis of preterm labor. Method: The type of therapeutic trial in patients attended at the Hospital Universitario de Caracas. Results: 15 patients in the progesterone study showed satisfactory results (X² = 155.837 df = 18); the control group, 13 patients with satisfactory results (X² = 133.093 df = 18). The absolute effectiveness in the study group was 0.68 against 0.59 in the control group (X² = 0.393 df = 1, P < 0.531). Conclusions: Treatment with micronized natural progesterone and fenoterol proved inhibitory uterine dynamics from the second hour of starting treatment preventing its progress toward labor by 90 %. The micronized natural progesterone is effective in the treatment of preterm labor and should be considered as an alternative therapeutic use.

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Noonan syndrome (NS) is an autosomal dominant disorder consisting of short stature, short and/or webbed neck, distinctive facial features, cardiac abnormalities, cryptorchidism, and coagulation defects. NS exhibits genetic heterogeneity, associated with mutated genes that participate in RAS-mitogen-activated protein kinase signal transduction. Recently, a new gene (RIT1) was discovered as the causative gene in 17 of 180 Japanese individuals who were negative for the previously known genes for NS and were studied using exome sequencing (four patients), followed by Sanger sequencing (13 patients). The present study used the same technique in 70 Brazilian patients with NS and identified six with RIT1 missense mutations. Thus, we confirm that RIT1 is responsible for approximately 10% of the patients negative for mutations in the previously known genes. The phenotype includes a high frequency of high birth weight, relative macrocephaly, left ventricular hypertrophy, and ectodermal findings, such as curly hair, hyperpigmentation, and wrinkled palms and soles. Short stature and pectus deformity were less frequent. The majority of patients with a RIT1 mutation did not show apparent intellectual disability. Because of the relatively high frequency of mutations in RIT1 among patients with NS and its occurrence in different populations, we suggest that it should be added to the list of genes included in panels for the molecular diagnosis of NS through targeted next-generation sequencing.

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PURPOSE: To compare the efficacy of nifedipine and fenoterol in the management of threatened preterm labor (TPL). METHODS: A randomized and multicenter study assessing the tocolytic effect of nifedipine versus fenoterol in patients admitted to the participating maternity units with a diagnosis of TPL and a cost-savings study for economic assessment. For a power of 80% and an α error equal to 0.05, 132 consecutive patients were recruited during the study period; 66 patients were assigned to each group. A χ(2) analysis and a mean differences test were performed according to variable types and survival curves per intention-to-treat. RESULTS: Demographics were similar in both groups. The latency period was similar in both groups (26.7 vs. 25.6; p = 0.3). There were no differences in the results obtained. Nifedipine failed more frequently to obtain tocolysis when used as a first-line agent (80 vs. 90%, p = 0.0001). The group treated with fenoterol showed more drug adverse events (57.8 vs. 19.0%, p = 0.0001). The economic assessment did not evidence a significant difference in terms of cost savings between groups treated with either drug. CONCLUSION: The present study failed to demonstrate either clinical or economic superiority of any of the two drugs used in TPL management. The highest failure percentage of nifedipine when used as a first-line agent should encourage further research.

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Fenoterol hydrobromide is a B2-adrenergic agonist agent used for asthma and chronic obstructive pulmonary disease treatment. HPLC methodology was developed and validated for quantitative determination of fenoterol hydrobromide. The methodology was achieved by using a reversed-phase C18column, (150 mm ¡Á 3.9 mm i.d., 5 ¦Ìm) Thermo. The mobile phase was consisted of acetonitrile: water(30:70, v/v) with 0,1% triethylamine, pH adjusted to 5.0 with formic acid and flow rate of 1.0 mL.min-1with UV detection at 276 nm. The concentration range was from 0.025 to 0.15 mg.mL-1, and the correlation coefficient of analytical curve was >0.999. The detection limit and the quantifying limit (QL) were 0.003mg.mL-1 and 0.012 mg.mL-1, respectively. Intra- and interday relative standard deviations were ¡Ü2.0%. Themetho dology accuracy showed the percentage mean of 99.53%. The described technique was found to be simple, rapid, precise, accurate and sensitive; the advantages over the others current methodologies arethe low-cost and low-polluting conditions. Owing to its simplicity and reliable results, this methodology is suitable to be used in quality control of pharmaceutical drugs containing fenoterol hydrobromide as active componente. (AU)

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