RESUMO
OBJECTIVE: To evaluate the effectiveness and tolerability of secnidazole combined with high-dose mebendazole for treatment of 5-nitroimidazole-resistant giardiasis. METHOD: Adults with microscopically verified Giardia intestinalis monoinfection attending a secondary level hospital in Matanzas City, Cuba were prospectively included in a cohort. A recently introduced treatment ladder consisting of metronidazole as first-line treatment, followed by secnidazole, tinidazole, secnidazole plus mebendazole and quinacrine as second-to fifth-line treatments, respectively, was used. Adverse events and treatment success were determined by questioning and microscopy on concentrated stool samples, respectively on days 3, 5 and 7 after the end of treatment. If G. intestinalis was detected on day 3, 5 or 7, then the infection was classified as refractory and no further microscopy was performed. RESULTS: A total of 456 individuals were included. Metronidazole, 500 mg three times daily for 5 days, cured 248/456 (54%) patients. A single 2-g secnidazole dose as second-line treatment cured 50/208 (24%) patients. A single 2-g tinidazole dose as third-line treatment cured 43/158 (27%) patients. Three rounds of 5-nitroimidazole therapy therefore cured 341/456 (75%) patients. Secnidazole plus mebendazole (200 mg every 8 hours for 3 days) cured 100/115 (87%) of nitroimidazole refractory infections. Quinacrine cured the remaining 15 patients. All treatments were well tolerated. CONCLUSIONS: 5-Nitroimidazole refractory giardiasis was common, indicating that an alternative first-line treatment may be needed. Retreatment of metronidazole refractory giardiasis with an alternative 5-nitroimidazole was suboptimal, indicating cross-resistance. Mebendazole plus secnidazole were well tolerated and effective for the treatment of 5-nitroimidazole refractory G. intestinalis infection in this setting.
Assuntos
Antiprotozoários/administração & dosagem , Giardíase/tratamento farmacológico , Mebendazol/administração & dosagem , Metronidazol/análogos & derivados , Quinacrina/administração & dosagem , Adulto , Idoso , Antiprotozoários/farmacologia , Cuba , Esquema de Medicação , Resistência a Medicamentos/efeitos dos fármacos , Quimioterapia Combinada , Fezes/parasitologia , Feminino , Giardia lamblia/efeitos dos fármacos , Giardia lamblia/isolamento & purificação , Humanos , Masculino , Mebendazol/farmacologia , Metronidazol/administração & dosagem , Metronidazol/farmacologia , Pessoa de Meia-Idade , Nitroimidazóis/uso terapêutico , Estudos Prospectivos , Quinacrina/farmacologia , Resultado do Tratamento , Adulto JovemRESUMO
Agaricus sylvaticus mushroom has been widely studied because of its high nutritional value and medicinal properties. The objective of this study was to evaluate the antioxidant potential of both alcoholic and aqueous extracts of Agaricus sylvaticusand quantify their total polyphenol content. The antioxidant activity was performed by the 2, 2-diphenyl-1-picrylhydrazyl radical scavenging capacity and total polyphenol content was assessed by colorimetric method. Observation also noted the great antioxidant potential of aqueous, alcoholic and ethereal extracts (14.6%, 75.6% and 14.6%, respectively) of the Agaricus sylvaticus mushroom, highlighting the alcoholic extract, which demonstrates the extraordinary benefits of this mushroom in the diet, since antioxidants prevent premature ageing and various types of cancer.
RESUMO
BACKGROUND: Giardia duodenalis is among the commonest protozoan parasites in the intestinal tract of humans and may cause significant morbidity worldwide. Although there are several antigiardial agents, treatment failures have been commonly reported. OBJECTIVE: To compare the efficacy and safety of chloroquine (CQ) versus metronidazole (MTZ) in the treatment of children with confirmed G duodenalis mono-infection. METHODS: A randomized, controlled, open-label trial was carried out at the Cuban Institute of Gastroenterology. One hundred and twenty-two children were randomly assigned to receive either CQ (10 mg/Kg bodyweight twice a day for five days) or MTZ [15 mg/Kg bodyweight divided in three daily does for five days]. All children were asked to provide three faecal samples on days 3, 5 and 7 after treatment completion. Children were considered to be cured, if no Giardia trophozoites or cysts were found in any of the three post-treatment faecal specimens evaluated by direct wet mounts and/or after Ritchie concentration techniques. RESULTS: The frequency of cure was a little higher for CQ than for MTZ but the difference was not statistically significant. Headache was more common in patients treated with CQ as was bitter taste. Yellowish colouration of the urine was more frequent in the MTZ treated group. CONCLUSION: Chloroquine, for five days, is as efficacious as the recommended treatment with MTZ in children infected with G duodenalis.
ANTECEDENTES: La giardia lamblia (giardia duodenalis) se halla entre los parásitos protozoos más comunes del tracto intestinal de los seres humanos, y puede causar una morbilidad significativa a nivel mundial. Aunque existen varios agentes antigiardiales, se han reportado fracasos en el tratamiento OBJETIVO: Comparar la eficacia y seguridad de la cloroquina (CQ) con el metronidazol (MTZ) en el tratamiento de los niños con mono-infección de G duodenalis. MÉTODOS: En el Instituto Cubano de Gastroenterología, se llevó a cabo un estudio de etiqueta abierta, randomizado y controlado. Ciento veintidós niños fueron aleatoriamente designados para recibir bien CQ (10 mg/Kg peso corporal dos veces por día durante cinco días) o MTZ (15 mg/Kg peso corporal dividido en tres dosis diarias por un período de cinco días). A todos los niños se les tomaron tres pruebas fecales los días 3, 5 y 7 después de terminado el tratamiento. Los niños se daban por curados, si no había presencia de tropozoítos o quistes de giardia en ninguno de los tres especimenes fecales post-tratamiento, evaluados directamente con portaobjetos húmedos y/o después de técnicas de concentración de Ritchie. RESULTADO: La frecuencia de la cura fue un poco más alta para CQ que para MTZ, pero la diferencia no fue estadísticamente significativa. El dolor de cabeza fue más común en pacientes tratados con CQ que el sabor amargo. La coloración amarillenta de la orina fue más frecuente en el grupo tratado con MTZ. CONCLUSIÓN: La cloroquina, administrada durante cinco días, es tan eficaz como el tratamiento recomendado con MTZ en niños infectados con giardias lamblias.
Assuntos
Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Amebicidas/uso terapêutico , Cloroquina/uso terapêutico , Giardíase/tratamento farmacológico , Cuba , Fezes/parasitologia , Resultado do TratamentoRESUMO
BACKGROUND: Giardia duodenalis is among the commonest protozoan parasites in the intestinal tract of humans and may cause significant morbidity worldwide. Although there are several antigiardial agents, treatment failures have been commonly reported. OBJECTIVE: To compare the efficacy and safety of chloroquine (CQ) versus metronidazole (MTZ) in the treatment of children with confirmed G duodenalis mono-infection. METHODS: A randomized, controlled, open-label trial was carried out at the Cuban Institute of Gastroenterology. One hundred and twenty-two children were randomly assigned to receive either CQ (10 mg/Kg bodyweight twice a day for five days) or MTZ [15 mg/Kg bodyweight divided in three daily does for five days]. All children were asked to provide three faecal samples on days 3, 5 and 7 after treatment completion. Children were considered to be cured, if no Giardia trophozoites or cysts were found in any of the three post-treatment faecal specimens evaluated by direct wet mounts and/or after Ritchie concentration techniques. RESULTS: The frequency of cure was a little higher for CQ than for MTZ but the difference was not statistically significant. Headache was more common in patients treated with CQ as was bitter taste. Yellowish colouration of the urine was more frequent in the MTZ treated group. CONCLUSION: Chloroquine, for five days, is as efficacious as the recommended treatment with MTZ in children infected with G duodenalis.
Assuntos
Amebicidas/uso terapêutico , Cloroquina/uso terapêutico , Giardíase/tratamento farmacológico , Adolescente , Criança , Pré-Escolar , Cuba , Fezes/parasitologia , Feminino , Humanos , Masculino , Resultado do TratamentoRESUMO
Mebendazole, a benzimidazole carbamate compound, is currently in use for human medical practice against soil-transmitted helminthiasis (STH) and enterobiasis. However, it has been demonstrated that its spectrum of activity is broad and goes beyond those infections. Several studies provide evidence that this drug, taken at higher doses than used for STH and enterobiasis, could be sufficiently effective on some protozoa, nematodes and cestodes.
Assuntos
Antiparasitários/uso terapêutico , Giardíase/tratamento farmacológico , Helmintíase/tratamento farmacológico , Malária/tratamento farmacológico , Mebendazol/uso terapêutico , Vaginite por Trichomonas/tratamento farmacológico , Adolescente , Animais , Criança , Pré-Escolar , Países em Desenvolvimento , Relação Dose-Resposta a Droga , Esquema de Medicação , Feminino , Humanos , Masculino , Mebendazol/economia , Resultado do TratamentoRESUMO
A cross-sectional study was carried out in 200 children aged 5-15 years, to examine the presence of intestinal parasitic infections (IPIs) and to assess the risk factors and clinical features associated with them in children in San Juan y Martinez (SJM), Cuba. Three fresh faecal samples were collected from each child and were examined by direct wet mount, brine flotation, formalin-ether and Kato-Katz techniques. Data relating to demography, source of drinking water, personal hygiene habits and clinical features were also collected. Living in the rural area was significantly associated with the highest infection rates (p < 0.01). According to clinical features and laboratory examinations, children with abdominal pain were about four times more likely to have IPIs (OR 4.05, CI, 1.11, 13.18) especially soil-transmitted helminths (STH). We suggest that IPIs, especially STH, in SJM should be strongly suspected in children with abdominal pain from rural areas. Targeted and frequent interventions to control these infections are needed in this municipality.
Se llevó a cabo un estudio transversal en 200 niños de 5-15 años para examinar la presencia de infecciones parasitarias intestinales (IPI) y evaluar los factores de riesgo y los aspectos clínicos asociados con ellas, en niños de San Juan y Martinez (SJM), Cuba. Tres muestras fecales frescas de cada niño fueron recogidas y examinadas mediante preparación fresca directa, flotación en salmuera, éter-formalina y técnicas de Kato-Katz. También se recogieron datos en relación con la demografía, fuentes de abastecimiento de agua potable, hábitos de higiene personal y características clínicas. El vivir en el área rural estaba significativamente asociado con las más altas tasas de infección (p < 0.01). De acuerdo con las características clínicas y los exámenes de laboratorio, los niños con dolor abdominal tenían una probabilidad cuatro veces mayor de tener IPI (OR 4.05, CI, 1.11, 13.18) especialmente helmintos transmitidos por el suelo (HTS). Sugerimos sospechar fuertemente la presencia de IPIs, especialmente de HTS en SJM, en niños con dolor abdominal, provenientes de las áreas rurales. Se necesitan intervenciones frecuentes, dirigidas a controlar estas infecciones en esta municipalidad.
Assuntos
Adolescente , Animais , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Enteropatias Parasitárias/epidemiologia , População Rural/estatística & dados numéricos , Solo/parasitologia , Água/parasitologia , Dor Abdominal/diagnóstico , Dor Abdominal/parasitologia , Intervalos de Confiança , Estudos Transversais , Cuba/epidemiologia , Fezes/parasitologia , Helmintíase/diagnóstico , Helmintíase/epidemiologia , Higiene , Enteropatias Parasitárias/diagnóstico , Razão de Chances , Prevalência , Fatores de Risco , Abastecimento de Água/normasRESUMO
Giardia lamblia is among the commonest intestinal protozoa world-wide and may cause significant morbidity, especially in children. Although 5-nitroimidazole compounds have formed the mainstay of giardiasis treatment for several years, the increasing number of reports of refractory cases given these and other antigiardial agents has raised concern and led to a search for other compounds. The aim of the present study was to compare the efficacy and safety, in the treatment of children infected with G. lamblia, of nitazoxanide, given at a dose of 7.5 mg/kg twice a day for 3 days, with those of tinidazole, given as a single dose of 50 mg/kg. Overall, 166 children, each proven to be infected with G. lamblia by the microscopical examination of a faecal sample, were included in the open and randomized trial, each being allocated to receive nitazoxanide or tinidazole. The parents of each treated child were asked to collect two faecal samples from the child between 5 and 10 days after the completion of treatment, for the parasitological follow-up. Only if no G. lamblia were found in both post-treatment samples from a child was that child considered cured. Among the 137 children who completed the study (74 given nitazoxanide and 63 given tinidazole), the frequency of parasitological cure following a single dose of tinidazole was significantly higher than that following six doses of nitazoxanide (90.5% v. 78.4%; P<0.05). Both treatment schedules were well accepted and well tolerated, with only mild, transient and self-limited side-effects reported. The commonest symptom on enrolment, diarrhoea, generally cleared 2-6 days after the initiation of treatment. Although apparently less efficacious than tinidazole, nitazoxanide remains a good candidate for the treatment of children with G. lamblia infection.
Assuntos
Antiparasitários/administração & dosagem , Giardíase/tratamento farmacológico , Tiazóis/administração & dosagem , Tinidazol/administração & dosagem , Dor Abdominal/parasitologia , Adolescente , Criança , Pré-Escolar , Cuba , Diarreia/tratamento farmacológico , Diarreia/parasitologia , Fezes/parasitologia , Feminino , Giardíase/complicações , Humanos , Nitrocompostos , Resultado do TratamentoRESUMO
A cross-sectional study was carried out in 200 children aged 5-15 years, to examine the presence of intestinal parasitic infections (IPIs) and to assess the risk factors and clinical features associated with them in children in San Juan y Martinez (SIM), Cuba. Three fresh faecal samples were collected from each child and were examined by direct wet mount, brine flotation, formalin-ether and Kato-Katz techniques. Data relating to demography, source of drinking water, personal hygiene habits and clinical features were also collected Living in the rural area was significantly associated with the highest infection rates (p < 0.01). According to clinical features and laboratory examinations, children with abdominal pain were about four times more likely to have IPIs (OR 4.05, CI, 1.11, 13.18) especially soil-transmitted helminths (STH). We suggest that IPIs, especially STH, in SJM should be strongly suspected in children with abdominal pain from rural areas. Targeted and frequent interventions to control these infections are needed in this municipality.
Assuntos
Enteropatias Parasitárias/epidemiologia , População Rural/estatística & dados numéricos , Solo/parasitologia , Água/parasitologia , Dor Abdominal/diagnóstico , Dor Abdominal/parasitologia , Adolescente , Animais , Criança , Pré-Escolar , Intervalos de Confiança , Estudos Transversais , Cuba/epidemiologia , Fezes/parasitologia , Feminino , Helmintíase/diagnóstico , Helmintíase/epidemiologia , Humanos , Higiene , Enteropatias Parasitárias/diagnóstico , Masculino , Razão de Chances , Prevalência , Fatores de Risco , Abastecimento de Água/normasRESUMO
To compare the efficacy of the two drugs in the treatment of giardiasis, 146 children (aged 5-15 years) with confirmed Giardia lamblia infection were randomly allotted to treatment with mebendazole (200 mg three times daily for 3 days) or secnidazole (30 mg/kg, in a single dose). Parasitological response to treatment was evaluated in each child by the microscopical examination of faecal samples collected 3, 5 and 7 days after he or she had completed treatment. Although the frequency of cure was higher for secnidazole (79.4%) than for mebendazole (78.1%), the difference was not statistically significant (P > 0.05). Both treatment regimens were well tolerated, with only mild, transient and self-limiting side-effects reported. Mebendazole may be preferable to secnidazole in the treatment of giardiasis cases who have an history of intolerance to 5-nitromidazoles, and where infections with Giardia and soil-transmitted helminths frequently co-occur.
Assuntos
Giardíase/tratamento farmacológico , Mebendazol/uso terapêutico , Metronidazol/análogos & derivados , Metronidazol/uso terapêutico , Adolescente , Antiprotozoários/efeitos adversos , Antiprotozoários/uso terapêutico , Criança , Pré-Escolar , Fezes/parasitologia , Feminino , Giardíase/parasitologia , Humanos , Masculino , Mebendazol/efeitos adversos , Metronidazol/efeitos adversos , Resultado do TratamentoRESUMO
PURPOSE: To analyse the transseptal catheterization technique, its indications and possible complications. METHODS: The transseptal catheterization has been undertaken in 233 patients, 202 children (aged 0.1 to 16 years) with congenital heart disease and 31 adults (aged 37 to 73 years) submitted to mitral valvuloplasty. The Mullins technique was employed to access left heart chambers. RESULTS: In the pediatric group, the indications for transseptal catheterization were coarctation of the aorta and valvular or subvalvular aortic stenosis. By this technique, multiple diagnostic analysis and therapeutic procedures, such as blade atrioseptostomy and mitral valvuloplasty, became available. Among the complications in the 2 groups, pericardial perforation was the most frequent, depending on the laboratory practice with this technique. CONCLUSION: The transseptal cardiac catheterization is a safe and effective technique to investigate hemodynamic data in several congenital heart diseases and is essential to many therapeutic procedures. The technique has a low incidence of complications when employed by experienced teams.
Assuntos
Cateterismo Cardíaco/métodos , Cateterismo , Cardiopatias Congênitas/terapia , Septos Cardíacos/cirurgia , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Feminino , Cardiopatias Congênitas/diagnóstico , Hemodinâmica/fisiologia , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Estenose da Valva Mitral/terapiaRESUMO
A isquemia e a necrose miocárdica podem ser causas de insuficiência cardíaca no lactante. O diagnóstico diferencial no lactante das enfermedades secundárias à isquemia miocárdica realiza-se fundamentalmente com as miocardiopatias congestivas. A utilizaçäo de radioisótopos, pode ser de grande utilidade no diagnóstico diferencial dessas patologias, principalmente nos casos em que as alteraçöes eletrocardiográficas traduzam dúvidas quanto à possibilidade de uma causa isquêmica. Entre estudos com radioisótopos, a captaçäo com tálio 201 se mostra de grande utilidade no diagnóstico diferencial dessas patologias, pois sua distribuiçäo miocárdica observa estreita relaçäo a perfusäo coronária. Apresentaremos três lactentes nos quais a insuficiência cardíaca foi a manifestaçäo principal de seus sintomas, e discutiremos o significado da captaçäo do tálio 201 no estudo desses três casos