124 research outputs found
Oral surgery in patients on oral anticoagulant therapy : a randomized comparison of different intensity targets
No full textObjective: To evaluate whether or not it is possible to perform oral surgery in patients on oral anticoagulant therapy (OAT) without stopping treatment. Study design: A prospective randomized open-label study was designed to evaluate the outcome of oral surgery in patients on OAT, operated upon in conditions of reduced international normalized ratio (INR), compared with patients maintained in their usual therapeutic ranges of the prothrombin time INR. The INR target in the group with reduced OAT was 1.8, and the INR target of the group without reduced OAT was 2.5 or more in carriers of artificial valves. Results: One hundred thirty-one patients on OAT were randomized to reduced anticoagulation or to full anticoagulation, and 511 teeth were extracted by the same surgeon. Mild bleeding, but excessive enough to warrant adoption of supplementary local hemostatic measures, was observed in 10 cases (15.1%) in the reduced dosage group and in 6 cases (9.2%) in the unmodified dosage group, which was a nonsignificant difference. There were no thrombotic complications in either group. Conclusions: This randomized study shows that, using simple measures for local hemostasis, it is not necessary to reduce OAT in patients undergoing routine dental extractionss
Caracterização sensorial de morangos cultivados na região de Pelotas.
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Previous issue date: 2017-06-1
Inhibitors of kynurenine hydroxylase and kynureninase increase cerebral formation of kynurenic acid and have sedative and anticonvulsant activities.
No full textShould we be concerned when COVID-19-positive patients take opioids to control their pain? Insights from a pharmacological point of view
No full textObjective: The purpose of this narrative review is to discuss the available information regarding the currently utilized COVID-19 therapies (and the evidence level supporting them) and opioids for chronic pain with a focus on warnings of potential interactions between these two therapeutic approaches. Materials and methods: Papers were retrieved from a PubMed search, using different combinations of keywords [e.g., pain treatment AND COVID-19 AND drug-drug interaction (DDI)], without limitations in terms of publication date and language. Results: Remdesivir is an inhibitor of CYP3A4 and may increase the plasma concentration of CYP3A4 substrates (e.g., fentanyl). Dexamethasone is an inducer of CYP3A4 and glycoprotein P, thus coadministration with drugs metabolized by this isoform will lead to their increased clearance. Dexamethasone may cause hypokalemia, thus potentiating the risk of ventricular arrhythmias if it is given with opioids able to prolong the QT interval, such as oxycodone and methadone. Finally, the existing differences among opioids with regard to their impact on immune responses should also be taken into account with only tapentadol and hydromorphone appearing neutral on both cytokine production and immune parameters. Conclusions: Clinicians should keep in mind the frequent DDIs with drugs extensively metabolized by the CYP450 system and prefer opioids undergoing a limited hepatic metabolism. Identification and management of DDIs and dissemination of the related knowledge should be a major goal in the delivery of chronic care to ensure optimized patient outcomes and facilitate updating recommendations for COVID-19 therapy in frail populations, namely comorbid, poly-medicated patients or individuals suffering from substance use disorder
Modulation of the Kynurenine Pathway in Search for New Neuroprotective Agents. Synthesis and Preliminary Evaluation of (m-Nitrobenzoyl)alanine, a Potent Inhibitor of Kynurenine-3-hydroxylase
No full textThe synthesis of (o-nitrobenzoyl)-, (m-nitrobenzoyl)-, and (p-nitrobenzoyl)alanine (o-, m-, and p-NBA), three new kynurenine analogues, and their evaluation as inhibitors of kynureninase and kynurenine-3-hydroxylase are reported. The most potent of these compounds, m-NBA, has an IC50 of 0.9 +/- 0.1 microM as an inhibitor of kynurenine-3-hydroxylase and of 100 +/- 12 microM as an inhibitor of kynureninase. When administered to rats, m-NBA significantly increases the concentration of kynurenine and kynurenic acid in the brain as well as in blood and in the liver. m-NBA has also been shown to increase the concentration of kynurenic acid in hippocampal extracellular fluid. This increase is associated with sedative and anticonvulsant activities, thus confirming the possibility of antagonizing L-glutamate-mediated effects by modulating the kynurenine pathway of L-tryptophan metabolism
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