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[PMID]:27728859
[Au] Autor:Van den Berg NW; Slieker MG; van Beynum IM; Bilardo CM; de Bruijn D; Clur SA; Cornette JM; Frohn-Mulder IM; Haak MC; van Loo-Maurus KE; Manten GT; Rackowitz AB; Rammeloo LA; Reimer A; Rijlaarsdam ME; Freund MW
[Ad] Endereço:University Medical Center Utrecht, Department of Pediatric Cardiology, Utrecht, The Netherlands; Academic Medical Center of Amsterdam, Heart Center, Department of Cardiology, Amsterdam, The Netherlands.
[Ti] Título:Fluorinated steroids do not improve outcome of isolated atrioventricular block.
[So] Source:Int J Cardiol;225:167-171, 2016 Dec 15.
[Is] ISSN:1874-1754
[Cp] País de publicação:Netherlands
[La] Idioma:eng
[Ab] Resumo:INTRODUCTION: Congenital atrioventricular block (CAVB) is a rare disorder with a significant morbidity and mortality. Consensus regarding the prescription and efficacy of prenatal corticosteroids is lacking. This nationwide study was initiated to evaluate the effects of prenatal treatment with corticosteroids on the outcome of CAVB in The Netherlands. METHODS: All fetuses identified with isolated congenital AVB-II° or AVB-III° in any of the eight academic fetal heart centers of The Netherlands between 2003 and 2013 were included and reviewed. RESULTS: Fifty-six fetuses were included. Fourteen (25%) fetuses were treated with dexamethasone. We found no differences between the steroid-treated and untreated cases regarding in utero progression of the AVB (63% vs 67% respectively), survival to birth (86% vs 84%), pacemaker implantations (74% vs 58%) or long-term dilated cardiomyopathy (13% vs 17%). Steroid treated fetuses demonstrated more in utero growth restriction (38% vs 11%). CONCLUSION: No benefit from prenatal corticosteroid treatment was demonstrated for fetuses with isolated CAVB in this study. However, we found negative side effects. Our data provide no evidence to support the routine administration of corticosteroids for the treatment of fetal CAVB.
[Mh] Termos MeSH primário: Bloqueio Atrioventricular/diagnóstico por imagem
Bloqueio Atrioventricular/tratamento farmacológico
Coração Fetal/efeitos dos fármacos
Coração Fetal/diagnóstico por imagem
Esteroides Fluorados/administração & dosagem
[Mh] Termos MeSH secundário: Adulto
Bloqueio Atrioventricular/epidemiologia
Feminino
Seguimentos
Seres Humanos
Países Baixos/epidemiologia
Gravidez
Diagnóstico Pré-Natal/métodos
Estudos Prospectivos
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE; MULTICENTER STUDY
[Nm] Nome de substância:
0 (Steroids, Fluorinated)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171025
[Lr] Data última revisão:
171025
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161012
[St] Status:MEDLINE


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[PMID]:26835701
[Au] Autor:Izmirly PM; Saxena A; Sahl SK; Shah U; Friedman DM; Kim MY; Buyon JP
[Ad] Endereço:Division of Rheumatology, Department of Medicine, New York University School of Medicine, New York, New York, USA.
[Ti] Título:Assessment of fluorinated steroids to avert progression and mortality in anti-SSA/Ro-associated cardiac injury limited to the fetal conduction system.
[So] Source:Ann Rheum Dis;75(6):1161-5, 2016 Jun.
[Is] ISSN:1468-2060
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:OBJECTIVES: Extension of disease beyond the atrioventricular (AV) node is associated with increased mortality in cardiac neonatal lupus (NL). Treatment of isolated heart block with fluorinated steroids to prevent disease progression has been considered but published data are limited and discordant regarding efficacy. This study evaluated whether fluorinated steroids given to manage isolated advanced block prevented development of disease beyond the AV node and conferred a survival benefit. METHODS: In this retrospective study of cases enrolled in the Research Registry for NL, inclusion was restricted to anti-SSA/Ro-exposed cases presenting with isolated advanced heart block in utero who either received fluorinated steroids within 1 week of detection (N=71) or no treatment (N=85). Outcomes evaluated were: development of endocardial fibroelastosis, dilated cardiomyopathy and/or hydrops fetalis; mortality and pacemaker implantation. RESULTS: In Cox proportional hazards regression analyses, fluorinated steroids did not significantly prevent development of disease beyond the AV node (adjusted HR=0.90; 95% CI 0.43 to 1.85; p=0.77), reduce mortality (HR=1.63; 95% CI 0.43 to 6.14; p=0.47) or forestall/prevent pacemaker implantation (HR=0.87; 95% CI 0.57 to 1.33; p=0.53). No risk factors for development of disease beyond the AV node were identified. CONCLUSIONS: These data do not provide evidence to support the use of fluorinated steroids to prevent disease progression or death in cases presenting with isolated heart block.
[Mh] Termos MeSH primário: Anticorpos Antinucleares/sangue
Doenças Fetais/tratamento farmacológico
Bloqueio Cardíaco/tratamento farmacológico
Esteroides Fluorados/uso terapêutico
[Mh] Termos MeSH secundário: Adulto
Progressão da Doença
Feminino
Doenças Fetais/diagnóstico por imagem
Doenças Fetais/mortalidade
Bloqueio Cardíaco/congênito
Bloqueio Cardíaco/diagnóstico por imagem
Bloqueio Cardíaco/etiologia
Bloqueio Cardíaco/mortalidade
Seres Humanos
Recém-Nascido
Estimativa de Kaplan-Meier
Lúpus Eritematoso Sistêmico/complicações
Lúpus Eritematoso Sistêmico/congênito
Masculino
Marca-Passo Artificial
Cuidado Pré-Natal/métodos
Sistema de Registros
Estudos Retrospectivos
Ultrassonografia Pré-Natal
Estados Unidos/epidemiologia
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Antibodies, Antinuclear); 0 (SS-A antibodies); 0 (Steroids, Fluorinated)
[Em] Mês de entrada:1705
[Cu] Atualização por classe:170523
[Lr] Data última revisão:
170523
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:160203
[St] Status:MEDLINE
[do] DOI:10.1136/annrheumdis-2015-208311


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[PMID]:25050975
[Au] Autor:Saxena A; Izmirly PM; Mendez B; Buyon JP; Friedman DM
[Ad] Endereço:From the *Division of Rheumatology, Department of Medicine, New York University School of Medicine, New York, NY; and †Division of Pediatric Cardiology, Department of Pediatrics, New York Medical College, Valhalla, NY.
[Ti] Título:Prevention and treatment in utero of autoimmune-associated congenital heart block.
[So] Source:Cardiol Rev;22(6):263-7, 2014 Nov-Dec.
[Is] ISSN:1538-4683
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Transplacental transfer of maternal anti-Ro and/or anti-La autoantibodies can result in fetal cardiac disease, including congenital heart block and cardiomyopathy, called cardiac neonatal lupus (NL). Thousands of women are faced with the risk of cardiac NL in their offspring, which is associated with significant morbidity and mortality. There are no known therapies to permanently reverse third-degree heart block in NL, although several treatments have shown some effectiveness in incomplete heart block and disease beyond the atrioventricular node. Fluorinated steroids taken during pregnancy have shown benefit in these situations, although adverse effects may be concerning. Published data are discordant on the efficacy of fluorinated steroids in the prevention of mortality in cardiac NL. ß-agonists have been used to increase fetal heart rates in utero. The endurance of ß-agonist effect and its impact on mortality are in question, but when used in combination with other therapies, they may provide benefit. No controlled experiments regarding the use of plasmapheresis in cardiac NL have been performed, despite its theoretical benefits. Intravenous immunoglobulin was not shown to prevent cardiac NL at a dose of 400 mg/kg, although it has shown effectiveness in the treatment of associated cardiomyopathy both in utero and after birth. Retrospective studies have shown that hydroxychloroquine may prevent the recurrence of cardiac NL in families with a previously affected child, and a prospective open-label trial is currently recruiting patients in order to fully evaluate this relationship.
[Mh] Termos MeSH primário: Bloqueio Cardíaco/congênito
Lúpus Eritematoso Sistêmico/congênito
[Mh] Termos MeSH secundário: Agonistas Adrenérgicos beta/uso terapêutico
Feminino
Bloqueio Cardíaco/etiologia
Bloqueio Cardíaco/prevenção & controle
Bloqueio Cardíaco/terapia
Seres Humanos
Hidroxicloroquina/uso terapêutico
Imunoglobulinas Intravenosas/uso terapêutico
Lúpus Eritematoso Sistêmico/complicações
Lúpus Eritematoso Sistêmico/prevenção & controle
Lúpus Eritematoso Sistêmico/terapia
Plasmaferese/métodos
Gravidez
Cuidado Pré-Natal/métodos
Diagnóstico Pré-Natal/métodos
Prevenção Secundária
Esteroides Fluorados/uso terapêutico
[Pt] Tipo de publicação:JOURNAL ARTICLE; RESEARCH SUPPORT, N.I.H., EXTRAMURAL; RESEARCH SUPPORT, NON-U.S. GOV'T; REVIEW
[Nm] Nome de substância:
0 (Adrenergic beta-Agonists); 0 (Immunoglobulins, Intravenous); 0 (Steroids, Fluorinated); 4QWG6N8QKH (Hydroxychloroquine)
[Em] Mês de entrada:1506
[Cu] Atualização por classe:161215
[Lr] Data última revisão:
161215
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:140723
[St] Status:MEDLINE
[do] DOI:10.1097/CRD.0000000000000026


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[PMID]:24316163
[Au] Autor:Yang KJ; Lin SC; Huang SJ; Ching WM; Hung CH; Tzou DL
[Ad] Endereço:Institute of Chemistry, Academia Sinica, Nankang, Taipei 11529, Taiwan, ROC.
[Ti] Título:Solid-state NMR study of fluorinated steroids.
[So] Source:Steroids;80:64-70, 2014 Feb.
[Is] ISSN:1878-5867
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Solid-state {(1)H}(13)C cross-polarization/magic angle spinning (CP/MAS) NMR spectroscopy was performed to analyze two fluorinated steroids, i.e., betamethasone (BMS) and fludrocortisone acetate (FCA), that have fluorine attached to C9, as well as two non-fluorinated analogs, i.e., prednisolone (PRD) and hydrocortisone 21-acetate (HCA). The (13)C signals of BMS revealed multiplet patterns with splittings of 16-215Hz, indicating multiple ring conformations, whereas the (13)C signals of FCA, HCA, and PRD exhibited only singlet patterns, implying a unique conformation. In addition, BMS and FCA exhibited substantial deviation (>3.5ppm) in approximately half of the (13)C signals and significant deviation (>45ppm) in the (13)C9 signal compared to PRD and HCA, respectively. In this study, we demonstrate that fluorinated steroids, such as BMS and FCA, have steroidal ring conformation(s) that are distinct from non-fluorinated analogs, such as PRD and HCA.
[Mh] Termos MeSH primário: Esteroides Fluorados/química
[Mh] Termos MeSH secundário: Espectroscopia de Ressonância Magnética
Conformação Molecular
Padrões de Referência
[Pt] Tipo de publicação:JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T
[Nm] Nome de substância:
0 (Steroids, Fluorinated)
[Em] Mês de entrada:1501
[Cu] Atualização por classe:140120
[Lr] Data última revisão:
140120
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:131210
[St] Status:MEDLINE


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[PMID]:22001566
[Au] Autor:Yoshimoto FK; Desilets MC; Auchus RJ
[Ad] Endereço:Division of Endocrinology & Metabolism, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX 75390-8857, United States.
[Ti] Título:Synthesis of halogenated pregnanes, mechanistic probes of steroid hydroxylases CYP17A1 and CYP21A2.
[So] Source:J Steroid Biochem Mol Biol;128(1-2):38-50, 2012 Jan.
[Is] ISSN:1879-1220
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:The human steroidogenic cytochromes P450 CYP17A1 (P450c17, 17α-hydroxylase/17,20-lyase) and CYP21A2 (P450c21, 21-hydroxylase) are required for the biosynthesis of androgens, glucocorticoids, and mineralocorticoids. Both enzymes hydroxylate progesterone at adjacent, distal carbon atoms and show limited tolerance for substrate modification. Halogenated substrate analogs have been employed for many years to probe cytochrome P450 catalysis and to block sites of reactivity, particularly for potential drugs. Consequently, we developed efficient synthetic approaches to introducing one or more halogen atom to the 17- and 21-positions of progesterone and pregnenolone. In particular, novel 21,21,21-tribromoprogesterone and 21,21,21-trichloroprogesterone were synthesized using the nucleophilic addition of either bromoform or chloroform anion onto an aldehyde precursor as the key step to introduce the trihalomethyl moieties. When incubated with microsomes from yeast expressing human CYP21A2 or CYP17A1 with P450-oxidoreductase, CYP21A2 metabolized 17-fluoroprogesterone to a single product, whereas incubations with CYP17A1 gave no products. Halogenated steroids provide a robust system for exploring the substrate tolerance and catalytic plasticity of human steroid hydroxylases.
[Mh] Termos MeSH primário: Microssomos/enzimologia
Pregnanos/síntese química
Esteroide 17-alfa-Hidroxilase/química
Esteroide 21-Hidroxilase/química
Esteroides Bromados/síntese química
Esteroides Clorados/síntese química
Esteroides Fluorados/síntese química
[Mh] Termos MeSH secundário: Colesterol Oxidase/química
Cromatografia Líquida de Alta Pressão
Ensaios Enzimáticos
Seres Humanos
Microssomos/química
Oxirredução
Pregnanos/química
Proteínas Recombinantes/química
Proteínas Recombinantes/metabolismo
Esteroide 17-alfa-Hidroxilase/metabolismo
Esteroide 21-Hidroxilase/metabolismo
Esteroides Bromados/química
Esteroides Clorados/química
Esteroides Fluorados/química
Especificidade por Substrato
Leveduras
[Pt] Tipo de publicação:JOURNAL ARTICLE; RESEARCH SUPPORT, N.I.H., EXTRAMURAL; RESEARCH SUPPORT, NON-U.S. GOV'T
[Nm] Nome de substância:
0 (Pregnanes); 0 (Recombinant Proteins); 0 (Steroids, Brominated); 0 (Steroids, Chlorinated); 0 (Steroids, Fluorinated); EC 1.1.3.6 (Cholesterol Oxidase); EC 1.14.14.16 (CYP21A2 protein, human); EC 1.14.14.16 (Steroid 21-Hydroxylase); EC 1.14.14.19 (CYP17A1 protein, human); EC 1.14.14.19 (Steroid 17-alpha-Hydroxylase)
[Em] Mês de entrada:1202
[Cu] Atualização por classe:170220
[Lr] Data última revisão:
170220
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:111018
[St] Status:MEDLINE
[do] DOI:10.1016/j.jsbmb.2011.09.007


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[PMID]:17039663
[Au] Autor:American Academy of Allergy, Asthma and Immunology; American College of Allergy, Asthma and Immunology
[Ti] Título:Contact dermatitis: a practice parameter.
[So] Source:Ann Allergy Asthma Immunol;97(3 Suppl 2):S1-38, 2006 Sep.
[Is] ISSN:1081-1206
[Cp] País de publicação:United States
[La] Idioma:eng
[Mh] Termos MeSH primário: Dermatite de Contato/diagnóstico
Dermatite de Contato/terapia
[Mh] Termos MeSH secundário: Administração Oral
Administração Tópica
Adulto
Algoritmos
Antialérgicos/administração & dosagem
Anti-Inflamatórios/administração & dosagem
Criança
Pré-Escolar
Cosméticos/efeitos adversos
Dermatite Alérgica de Contato/diagnóstico
Dermatite Alérgica de Contato/terapia
Dermatite de Contato/fisiopatologia
Diagnóstico Diferencial
Suscetibilidade a Doenças
Feminino
Glucocorticoides/efeitos adversos
Antagonistas dos Receptores Histamínicos H1/administração & dosagem
Seres Humanos
Imunossupressores/administração & dosagem
Masculino
Testes do Emplastro
Plantas/efeitos adversos
Plantas/química
Prognóstico
Próteses e Implantes/efeitos adversos
Esteroides Fluorados/administração & dosagem
Esteroides Fluorados/uso terapêutico
[Pt] Tipo de publicação:JOURNAL ARTICLE; PRACTICE GUIDELINE; RESEARCH SUPPORT, NON-U.S. GOV'T
[Nm] Nome de substância:
0 (Anti-Allergic Agents); 0 (Anti-Inflammatory Agents); 0 (Cosmetics); 0 (Glucocorticoids); 0 (Histamine H1 Antagonists); 0 (Immunosuppressive Agents); 0 (Steroids, Fluorinated)
[Em] Mês de entrada:0611
[Cu] Atualização por classe:070117
[Lr] Data última revisão:
070117
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:061017
[St] Status:MEDLINE


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[PMID]:17011766
[Au] Autor:Wahren-Herlenius M; Sonesson SE
[Ad] Endereço:Rheumatology Unit, Department of Medicine, Karolinska Institutet, SE-171 76 Stockholm, Sweden. marie.wahren@ki.se
[Ti] Título:Specificity and effector mechanisms of autoantibodies in congenital heart block.
[So] Source:Curr Opin Immunol;18(6):690-6, 2006 Dec.
[Is] ISSN:0952-7915
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:Complete congenital atrio-ventricular (AV) heart block develops in 2-5% of fetuses of Ro/SSA and La/SSB autoantibody-positive pregnant women. During pregnancy, the Ro/SSA and La/SSB antibodies are transported across the placenta and affect the fetus. Emerging data suggest that this happens by a two-stage process. In the first step, maternal autoantibodies bind fetal cardiomyocytes, dysregulate calcium homestasis and induce apoptosis in affected cells. This step might clinically correspond to a first-degree heart block, and be reversible. La/SSB antibodies can bind apoptotic cardiomyocytes and thus increase Ig deposition in the heart. The tissue damage could, as a second step, lead to spread of inflammation in genetically pre-disposed fetuses, progressing to fibrosis and calcification of the AV-node and subsequent complete congenital heart block. Early intrauterine treatment of an incomplete AV-block with fluorinated steroids has been shown to prevent progression of the heart block, making it clinically important to find specific markers to identify the high-risk pregnancies.
[Mh] Termos MeSH primário: Autoanticorpos/imunologia
Autoantígenos/imunologia
Doenças Fetais/imunologia
Bloqueio Cardíaco/congênito
Bloqueio Cardíaco/imunologia
[Mh] Termos MeSH secundário: Animais
Feminino
Terapias Fetais
Bloqueio Cardíaco/prevenção & controle
Seres Humanos
Miócitos Cardíacos/imunologia
Miócitos Cardíacos/patologia
Gravidez
Esteroides Fluorados/uso terapêutico
[Pt] Tipo de publicação:JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T; REVIEW
[Nm] Nome de substância:
0 (Autoantibodies); 0 (Autoantigens); 0 (Steroids, Fluorinated)
[Em] Mês de entrada:0701
[Cu] Atualização por classe:061030
[Lr] Data última revisão:
061030
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:061003
[St] Status:MEDLINE


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[PMID]:16487557
[Au] Autor:Clerici C; Castellani D; Asciutti S; Pellicciari R; Setchell KD; O'Connell NC; Sadeghpour B; Camaioni E; Fiorucci S; Renga B; Nardi E; Sabatino G; Clementi M; Giuliano V; Baldoni M; Orlandi S; Mazzocchi A; Morelli A; Morelli O
[Ad] Endereço:Clinica di Gastroenterologia ed Epatologia, Dipartimento di Medicina Clinica e Sperimentale Università degli Studi di Perugia, 06122 Perugia, Italy. clerici@unipg.it
[Ti] Título:3alpha-6alpha-Dihydroxy-7alpha-fluoro-5beta-cholanoate (UPF-680), physicochemical and physiological properties of a new fluorinated bile acid that prevents 17alpha-ethynyl-estradiol-induced cholestasis in rats.
[So] Source:Toxicol Appl Pharmacol;214(2):199-208, 2006 Jul 15.
[Is] ISSN:0041-008X
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:3alpha-6alpha-Dihydroxy-7alpha-fluoro-5beta-cholanoate (UPF-680), the 7alpha-fluorine analog of hyodeoxycholic acid (HDCA), was synthesized to improve bioavailability and stability of ursodeoxycholic acid (UDCA). Acute rat biliary fistula and chronic cholestasis induced by 17alpha-ethynyl-estradiol (17EE) models were used to study and compare the effects of UPF-680 (dose range 0.6-6.0 micromol/kg min) with UDCA on bile flow, biliary bicarbonate (HCO(3)(-)), lipid output, biliary bile acid composition, hepatic enzymes and organic anion pumps. In acute infusion, UPF-680 increased bile flow in a dose-related manner, by up to 40.9%. Biliary HCO(3)(-) output was similarly increased. Changes were observed in phospholipid secretion only at the highest doses. Treatment with UDCA and UPF-680 reversed chronic cholestasis induced by 17EE; in this model, UDCA had no effect on bile flow in contrast to UPF-680, which significantly increased bile flow. With acute administration of UPF-680, the biliary bile acid pool became enriched with unconjugated and conjugated UPF-680 (71.7%) at the expense of endogenous cholic acid and muricholic isomers. With chronic administration of UPF-680 or UDCA, the main biliary bile acids were tauro conjugates, but modification of biliary bile acid pool was greater with UPF-680. UPF-680 increased the mRNA for cytochrome P450 7A1 (CYP7A1) and cytochrome P450 8B (CYP8B). Both UDCA and UPF-680 increased the mRNA for Na(+) taurocholate co-transporting polypeptide (NCTP). In conclusion, UPF-680 prevented 17EE-induced cholestasis and enriched the biliary bile acid pool with less detergent and cytotoxic bile acids. This novel fluorinated bile acid may have potential in the treatment of cholestatic liver disease.
[Mh] Termos MeSH primário: Colanos/farmacologia
Colestase/prevenção & controle
Ácido Desoxicólico/análogos & derivados
Etinilestradiol/toxicidade
Esteroides Fluorados/farmacologia
[Mh] Termos MeSH secundário: Animais
Bile/química
Bile/efeitos dos fármacos
Ductos Biliares/efeitos dos fármacos
Ductos Biliares/metabolismo
Colanos/administração & dosagem
Colanos/química
Colestase/induzido quimicamente
Colestase/metabolismo
Colesterol 7-alfa-Hidroxilase/genética
Colesterol 7-alfa-Hidroxilase/metabolismo
Cromatografia Líquida de Alta Pressão
Ácido Desoxicólico/administração & dosagem
Ácido Desoxicólico/química
Ácido Desoxicólico/farmacologia
Relação Dose-Resposta a Droga
Etinilestradiol/antagonistas & inibidores
Cromatografia Gasosa-Espectrometria de Massas
Masculino
Micelas
Estrutura Molecular
Fosfolipídeos/secreção
RNA Mensageiro/genética
RNA Mensageiro/metabolismo
Ratos
Ratos Sprague-Dawley
Esteroide 12-alfa-Hidroxilase/genética
Esteroide 12-alfa-Hidroxilase/metabolismo
Esteroides Fluorados/administração & dosagem
Esteroides Fluorados/química
Ácido Ursodesoxicólico/administração & dosagem
Ácido Ursodesoxicólico/farmacologia
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE
[Nm] Nome de substância:
0 (3,6-dihydroxy-7-fluorocholanoic acid); 0 (Cholanes); 0 (Micelles); 0 (Phospholipids); 0 (RNA, Messenger); 0 (Steroids, Fluorinated); 005990WHZZ (Deoxycholic Acid); 423D2T571U (Ethinyl Estradiol); 724L30Y2QR (Ursodeoxycholic Acid); EC 1.14.14.23 (Cholesterol 7-alpha-Hydroxylase); EC 1.14.18.8 (Steroid 12-alpha-Hydroxylase)
[Em] Mês de entrada:0609
[Cu] Atualização por classe:161124
[Lr] Data última revisão:
161124
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:060221
[St] Status:MEDLINE


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[PMID]:12972484
[Au] Autor:Costedoat-Chalumeau N; Amoura Z; Le Thi Hong D; Wechsler B; Vauthier D; Ghillani P; Papo T; Fain O; Musset L; Piette JC
[Ad] Endereço:Centre Hospitalier, Universitaire Pitié-Salpêtrière, Paris, France. nathalie.costedoat@psl.ap-hop-paris.fr
[Ti] Título:Questions about dexamethasone use for the prevention of anti-SSA related congenital heart block.
[So] Source:Ann Rheum Dis;62(10):1010-2, 2003 Oct.
[Is] ISSN:0003-4967
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Mothers with anti-SSA/Ro antibodies who have had a previous fetus with congenital heart block (CHB) have a risk of recurrence estimated to be up to 16%. OBJECTIVE: To improve the management of these "high risk patients" by determining (a) whether or not prophylactic treatment is efficient; (b) whether or not fluorinated steroids (betametasone and dexamethasone) that do cross the placenta in an active form are safe for the fetus; and (c) which prophylactic treatment should be used. METHODS: Retrospective study performed on seven mothers sent to a university hospital owing to a past history of one (six mothers) or two children (one mother) with CHB. RESULTS: 13 subsequent pregnancies occurred. No CHB was observed. All four pregnancies in women treated with 10 mg/day prednisone were uneventful. Three pregnancies in women receiving no steroids resulted in two early spontaneous abortions and one live birth. The six pregnancies in women treated with dexamethasone (4-5 mg/day) ended in one early and one late spontaneous abortion, two stillbirths, and two live births with intrauterine growth restriction and mild adrenal insufficiency. A histological study of one stillbirth disclosed intrauterine growth restriction and marked adrenal hypoplasia. CONCLUSION: Adverse obstetric outcomes were often seen here and major concerns have been raised by paediatricians about the safety of fluorinated steroids, owing to the results of animals studies, retrospective data, and randomised trials. Because fluorinated steroids have not been shown to improve prophylactic treatment of CHB in pregnant women at high risk, their use is questionable.
[Mh] Termos MeSH primário: Anticorpos Antinucleares/sangue
Dexametasona/efeitos adversos
Bloqueio Cardíaco/congênito
Bloqueio Cardíaco/prevenção & controle
Gravidez de Alto Risco/imunologia
Esteroides Fluorados/efeitos adversos
[Mh] Termos MeSH secundário: Insuficiência Adrenal/etiologia
Dexametasona/uso terapêutico
Feminino
Retardo do Crescimento Fetal/etiologia
Bloqueio Cardíaco/imunologia
Seres Humanos
Recém-Nascido
Prednisolona/uso terapêutico
Gravidez
Estudos Retrospectivos
Esteroides Fluorados/uso terapêutico
Falha de Tratamento
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Antibodies, Antinuclear); 0 (SS-A antibodies); 0 (Steroids, Fluorinated); 7S5I7G3JQL (Dexamethasone); 9PHQ9Y1OLM (Prednisolone)
[Em] Mês de entrada:0312
[Cu] Atualização por classe:131121
[Lr] Data última revisão:
131121
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:030916
[St] Status:MEDLINE


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[PMID]:12796167
[Au] Autor:Rodrigo GJ; Rodrigo C
[Ad] Endereço:Departamento de Emergencia, Hospital Central de las Fuerzas Armadas, Montevideo, Uruguay. gurodrig@adinet.com.uy
[Ti] Título:Triple inhaled drug protocol for the treatment of acute severe asthma.
[So] Source:Chest;123(6):1908-15, 2003 Jun.
[Is] ISSN:0012-3692
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:STUDY OBJECTIVE: This study tests the hypothesis that the administration of multiple doses of inhaled albuterol (A), ipratropium bromide (IB), and flunisolide (F) provides an additional benefit to adults with acute severe asthma compared with the administration of A plus IB (A/IB) or A plus F (A/F). DESIGN: Randomized, double-blind, prospective trial. PATIENTS AND INTERVENTIONS: One hundred seventy-two patients who presented to an emergency department were assigned to receive A, IB, and F (ie, triple drug treatment [TDG]; 56 patients), A/IB (60 patients), or A/F (56 patients). All drugs were administered through a metered-dose inhaler and spacer at 10-min intervals for 3 h. RESULTS: Patients who received TDG had an overall 64% greater improvement (95% confidence interval [CI], 24 to 103%; p = 0.002) in FEV(1) (mean [+/- SD], 2.1 +/- 0.6 L) than those who received A/F (mean, 1.7 +/- 0.6 L), and a 41% greater improvement (95% CI, 1 to 80%; p = 0.04) than those who received A/IB (mean, 1.8 +/- 0.6 L). Differences between groups increased with time (p = 0.001). At 3 h, there was a trend toward a reduction in hospital admission rates (A/IB group, 25%; A/F group, 20%; and TDG group, 11%). The patients who were the most likely to benefit (ie, those with a greater improvement in pulmonary function and a significant reduction in the hospitalization rate) from TDG were those with more severe obstruction (ie, FEV(1), < 30% of predicted). The benefit of TDG was equally evident independent of the patient's previous use of corticosteroids. CONCLUSIONS: The data suggest that there was a therapeutic benefit from the addition of IB and F to A administered in high doses, particularly in those patients in whom the FEV(1) was < 30% of the predicted value.
[Mh] Termos MeSH primário: Asma/tratamento farmacológico
Fluocinolona Acetonida/análogos & derivados
[Mh] Termos MeSH secundário: Doença Aguda
Administração por Inalação
Agonistas Adrenérgicos beta/administração & dosagem
Adulto
Albuterol/administração & dosagem
Broncodilatadores/administração & dosagem
Método Duplo-Cego
Quimioterapia Combinada
Feminino
Fluocinolona Acetonida/administração & dosagem
Volume Expiratório Forçado
Seres Humanos
Ipratrópio/administração & dosagem
Masculino
Estudos Prospectivos
Esteroides Fluorados/administração & dosagem
[Pt] Tipo de publicação:CLINICAL TRIAL; COMPARATIVE STUDY; JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
[Nm] Nome de substância:
0 (Adrenergic beta-Agonists); 0 (Bronchodilator Agents); 0 (Steroids, Fluorinated); 0CD5FD6S2M (Fluocinolone Acetonide); GR88G0I6UL (Ipratropium); QF8SVZ843E (Albuterol); QK4DYS664X (flunisolide)
[Em] Mês de entrada:0307
[Cu] Atualização por classe:161124
[Lr] Data última revisão:
161124
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:030611
[St] Status:MEDLINE



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