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[PMID]:28461224
[Au] Autor:Li X; Obeidat M; Zhou G; Leung JM; Tashkin D; Wise R; Connett J; Joubert P; Bossé Y; van den Berge M; Brandsma CA; Nickle DC; Hao K; Paré PD; Sin DD
[Ad] Endereço:UBC Centre for Heart Lung Innovation, St. Paul's Hospital, Vancouver, British Columbia, Canada.
[Ti] Título:Responsiveness to Ipratropium Bromide in Male and Female Patients with Mild to Moderate Chronic Obstructive Pulmonary Disease.
[So] Source:EBioMedicine;19:139-145, 2017 May.
[Is] ISSN:2352-3964
[Cp] País de publicação:Netherlands
[La] Idioma:eng
[Ab] Resumo:INTRODUCTION: Although the prevalence of chronic obstructive pulmonary disease (COPD) is similar between men and women, current evidence used to support bronchodilator therapy has been generated in therapeutic trials that have predominately enrolled male patients. Here, we determined whether there is any significant sex-related differences in FEV responses to ipratropium bromide. METHODS: Data from the Lung Health Study (n=5887; 37% females) were used to determine changes in FEV with ipratropium or placebo in male and female subjects with mild to moderate COPD over 5years. Lung Expression Quantitative Trait Loci (eQTL) dataset was used to determine whether there were any sex-related differences in gene expression for muscarinic (M2 and M3) receptors in lungs of male and female patients. RESULTS: After 4months, ipratropium therapy increased FEV by 6.0% in female and 2.9% in male subjects from baseline values (p=2.42×10 ). This effect was modified by body mass index (BMI) such that the biggest improvements in FEV with ipratropium were observed in thin female subjects (p for BMI∗sex interaction=0.044). The sex-related changes in FEV related to ipratropium persisted for 2years (p=0.0134). Female compared with male lungs had greater gene expression for M3 relative to M2 receptors (p=6.86×10 ). CONCLUSION: Ipratropium induces a larger bronchodilator response in female than in male patients and the benefits are particularly notable in non-obese females. Female lungs have greater gene expression for the M3 muscarinic receptor relative to M2 receptors than male lungs. Female patients are thus more likely to benefit from ipratropium than male COPD patients.
[Mh] Termos MeSH primário: Broncodilatadores/uso terapêutico
Antagonistas Colinérgicos/uso terapêutico
Ipratrópio/uso terapêutico
Doença Pulmonar Obstrutiva Crônica/tratamento farmacológico
[Mh] Termos MeSH secundário: Adulto
Índice de Massa Corporal
Feminino
Volume Expiratório Forçado
Expressão Gênica
Seres Humanos
Masculino
Meia-Idade
Doença Pulmonar Obstrutiva Crônica/genética
Doença Pulmonar Obstrutiva Crônica/fisiopatologia
Receptor Muscarínico M2/genética
Receptor Muscarínico M3/genética
Caracteres Sexuais
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
[Nm] Nome de substância:
0 (Bronchodilator Agents); 0 (Cholinergic Antagonists); 0 (Receptor, Muscarinic M2); 0 (Receptor, Muscarinic M3); GR88G0I6UL (Ipratropium)
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180306
[Lr] Data última revisão:
180306
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170503
[St] Status:MEDLINE


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[PMID]:29341071
[Au] Autor:Bergman H; Soares-Weiser K
[Ad] Endereço:Cochrane Response, Cochrane, St Albans House, 57-59 Haymarket, London, UK, SW1Y 4QX.
[Ti] Título:Anticholinergic medication for antipsychotic-induced tardive dyskinesia.
[So] Source:Cochrane Database Syst Rev;1:CD000204, 2018 01 17.
[Is] ISSN:1469-493X
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Antipsychotic (neuroleptic) medication is used extensively to treat people with serious mental illnesses. However, it is associated with a wide range of adverse effects, including movement disorders. Because of this, many people treated with antipsychotic medication also receive anticholinergic drugs in order to reduce some of the associated movement side-effects. However, there is also a suggestion from animal experiments that the chronic administration of anticholinergics could cause tardive dyskinesia. OBJECTIVES: To determine whether the use or the withdrawal of anticholinergic drugs (benzhexol, benztropine, biperiden, orphenadrine, procyclidine, scopolamine, or trihexylphenidyl) are clinically effective for the treatment of people with both antipsychotic-induced tardive dyskinesia and schizophrenia or other chronic mental illnesses. SEARCH METHODS: We retrieved 712 references from searching the Cochrane Schizophrenia Group's Study-Based Register of Trials including the registries of clinical trials (16 July 2015 and 26 April 2017). We also inspected references of all identified studies for further trials and contacted authors of trials for additional information. SELECTION CRITERIA: We included reports identified in the search if they were controlled trials dealing with people with antipsychotic-induced tardive dyskinesia and schizophrenia or other chronic mental illness who had been randomly allocated to (a) anticholinergic medication versus placebo (or no intervention), (b) anticholinergic medication versus any other intervention for the treatment of tardive dyskinesia, or (c) withdrawal of anticholinergic medication versus continuation of anticholinergic medication. DATA COLLECTION AND ANALYSIS: We independently extracted data from included trials and we estimated risk ratios (RR) with 95% confidence intervals (CIs). We assumed that people who left early had no improvement. We assessed risk of bias and created a 'Summary of findings' table using GRADE. MAIN RESULTS: The previous version of this review included no trials. We identified two trials that could be included from the 2015 and 2017 searches. They randomised 30 in- and outpatients with schizophrenia in the USA and Germany. Overall, the risk of bias was unclear, mainly due to poor reporting: allocation concealment was not described; generation of the sequence was not explicit; studies were not clearly blinded; and outcome data were not fully reported.Findings were sparse. One study reported on the primary outcomes and found that significantly more participants allocated to procyclidine (anticholinergic) had not improved to a clinically important extent compared with those allocated to isocarboxazid (MAO-inhibitor) after 40 weeks' treatment (1 RCT, n = 20; RR 4.20, 95% CI 1.40 to 12.58; very low quality evidence); that there was no evidence of a difference in the incidence of any adverse effects (1 RCT, n = 20; RR 0.33, 95% CI 0.02 to 7.32; very low quality evidence); or acceptability of treatment (measured by participants leaving the study early) (1 RCT, n = 20; RR 0.33, 95% CI 0.02 to 7.32; very low quality evidence). The other trial compared anticholinergic withdrawal with anticholinergic continuation and found no evidence of a difference in the incidence of acceptability of treatment (measured by participants leaving the study early) (1 RCT, n = 10; RR 2.14, 95% CI 0.11 to 42.52; very low quality evidence).No trials reported on social confidence, social inclusion, social networks, or personalised quality of life - outcomes designated important to patients. No studies comparing either i. anticholinergics with placebo or no treatment, or ii. studies of anticholinergic withdrawal, were found that reported on the primary outcome 'no clinically important improvement in TD symptoms and adverse events'. AUTHORS' CONCLUSIONS: Based on currently available evidence, no confident statement can be made about the effectiveness of anticholinergics to treat people with antipsychotic-induced tardive dyskinesia. The same applies for the withdrawal of such medications. Whether the withdrawal of anticholinergics may benefit people with antipsychotic-induced TD should be evaluated in a parallel-group, placebo-controlled randomised trial, with adequate sample size and at least 6 weeks of follow-up.
[Mh] Termos MeSH primário: Antipsicóticos/efeitos adversos
Antagonistas Colinérgicos/uso terapêutico
Discinesia Induzida por Medicamentos/tratamento farmacológico
[Mh] Termos MeSH secundário: Biperideno/efeitos adversos
Biperideno/uso terapêutico
Antagonistas Colinérgicos/efeitos adversos
Discinesia Induzida por Medicamentos/etiologia
Seres Humanos
Isocarboxazida/efeitos adversos
Isocarboxazida/uso terapêutico
Prociclidina/efeitos adversos
Prociclidina/uso terapêutico
Ensaios Clínicos Controlados Aleatórios como Assunto
Esquizofrenia/tratamento farmacológico
Suspensão de Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE; META-ANALYSIS; RESEARCH SUPPORT, NON-U.S. GOV'T; REVIEW
[Nm] Nome de substância:
0 (Antipsychotic Agents); 0 (Cholinergic Antagonists); 0FRP6G56LD (Biperiden); 34237V843T (Isocarboxazid); C6QE1Q1TKR (Procyclidine)
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180301
[Lr] Data última revisão:
180301
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180118
[St] Status:MEDLINE
[do] DOI:10.1002/14651858.CD000204.pub2


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[PMID]:27775976
[Au] Autor:Grey KR; Warshaw EM
[Ad] Endereço:From the *University of Minnesota Medical School; †HCMC Parkside Occupational and Contact Dermatitis Clinic; ‡Department of Dermatology, Minneapolis Veterans Affairs Medical Center; and §Department of Dermatology, University of Minnesota Medical School, Minneapolis.
[Ti] Título:Allergic Contact Dermatitis to Ophthalmic Medications: Relevant Allergens and Alternative Testing Methods.
[So] Source:Dermatitis;27(6):333-347, 2016 Nov/Dec.
[Is] ISSN:2162-5220
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Allergic contact dermatitis is an important cause of periorbital dermatitis. Topical ophthalmic agents are relevant sensitizers. Contact dermatitis to ophthalmic medications can be challenging to diagnose and manage given the numerous possible offending agents, including both active and inactive ingredients. Furthermore, a substantial body of literature reports false-negative patch test results to ophthalmic agents. Subsequently, numerous alternative testing methods have been described. This review outlines the periorbital manifestations, causative agents, and alternative testing methods of allergic contact dermatitis to ophthalmic medications.
[Mh] Termos MeSH primário: Dermatite Alérgica de Contato/etiologia
Dermatoses Faciais/etiologia
Lubrificantes Oftálmicos/efeitos adversos
Soluções Oftálmicas/efeitos adversos
[Mh] Termos MeSH secundário: Administração Oftálmica
Agonistas de Receptores Adrenérgicos alfa 1/efeitos adversos
Antagonistas Adrenérgicos beta/efeitos adversos
Antibacterianos/efeitos adversos
Anti-Infecciosos Locais/efeitos adversos
Anti-Inflamatórios/efeitos adversos
Antineoplásicos/efeitos adversos
Antivirais/efeitos adversos
Inibidores da Anidrase Carbônica/efeitos adversos
Antagonistas Colinérgicos/efeitos adversos
Glaucoma/tratamento farmacológico
Antagonistas dos Receptores Histamínicos/efeitos adversos
Seres Humanos
Agonistas Muscarínicos/efeitos adversos
Antagonistas Muscarínicos/efeitos adversos
Prostaglandinas Sintéticas/efeitos adversos
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Nm] Nome de substância:
0 (Adrenergic alpha-1 Receptor Agonists); 0 (Adrenergic beta-Antagonists); 0 (Anti-Bacterial Agents); 0 (Anti-Infective Agents, Local); 0 (Anti-Inflammatory Agents); 0 (Antineoplastic Agents); 0 (Antiviral Agents); 0 (Carbonic Anhydrase Inhibitors); 0 (Cholinergic Antagonists); 0 (Histamine Antagonists); 0 (Lubricant Eye Drops); 0 (Muscarinic Agonists); 0 (Muscarinic Antagonists); 0 (Ophthalmic Solutions); 0 (Prostaglandins, Synthetic)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180212
[Lr] Data última revisão:
180212
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161025
[St] Status:MEDLINE


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[PMID]:28449397
[Au] Autor:Baghel MS; Thakur MK
[Ad] Endereço:Department of Zoology, Biochemistry and Molecular Biology Laboratory, Centre of Advanced Study, Banaras Hindu University, Varanasi, 221005, India.
[Ti] Título:Differential proteome profiling in the hippocampus of amnesic mice.
[So] Source:Hippocampus;27(8):845-859, 2017 Aug.
[Is] ISSN:1098-1063
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Amnesia or memory loss is associated with brain aging and several neurodegenerative pathologies including Alzheimer's disease (AD). This can be induced by a cholinergic antagonist scopolamine but the underlying molecular mechanism is poorly understood. This study of proteome profiling in the hippocampus could provide conceptual insights into the molecular mechanisms involved in amnesia. To reveal this, mice were administered scopolamine to induce amnesia and memory impairment was validated by novel object recognition test. Using two-dimensional gel electrophoresis coupled with MALDI-MS/MS, we have analyzed the hippocampal proteome and identified 18 proteins which were differentially expressed. Out of these proteins, 11 were downregulated and 7 were upregulated in scopolamine-treated mice as compared to control. In silico analysis showed that the majority of identified proteins are involved in metabolism, catalytic activity, and cytoskeleton architectural functions. STRING interaction network analysis revealed that majority of identified proteins exhibit common association with Actg1 cytoskeleton and Vdac1 energy transporter protein. Furthermore, interaction map analysis showed that Fascin1 and Coronin 1b individually interact with Actg1 and regulate the actin filament dynamics. Vdac1 was significantly downregulated in amnesic mice and showed interaction with other proteins in interaction network. Therefore, we silenced Vdac1 in the hippocampus of normal young mice and found similar impairment in recognition memory of Vdac1 silenced and scopolamine-treated mice. Thus, these findings suggest that Vdac1-mediated disruption of energy metabolism and cytoskeleton architecture might be involved in scopolamine-induced amnesia.
[Mh] Termos MeSH primário: Amnésia/patologia
Regulação da Expressão Gênica/fisiologia
Hipocampo/metabolismo
Proteoma/metabolismo
[Mh] Termos MeSH secundário: Actinas/genética
Actinas/metabolismo
Amnésia/induzido quimicamente
Animais
Antagonistas Colinérgicos/toxicidade
Modelos Animais de Doenças
Expressão Gênica/efeitos dos fármacos
Regulação da Expressão Gênica/efeitos dos fármacos
Hipocampo/efeitos dos fármacos
Masculino
Camundongos
Proteínas dos Microfilamentos/genética
Proteínas dos Microfilamentos/metabolismo
Mapas de Interação de Proteínas
Proteoma/genética
RNA Interferente Pequeno/farmacologia
Receptores Odorantes/genética
Receptores Odorantes/metabolismo
Recognição (Psicologia)/efeitos dos fármacos
Hidrobrometo de Escopolamina/toxicidade
Fatores de Tempo
Canal de Ânion 1 Dependente de Voltagem/química
Canal de Ânion 1 Dependente de Voltagem/metabolismo
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Actins); 0 (Cholinergic Antagonists); 0 (Microfilament Proteins); 0 (Proteome); 0 (RNA, Small Interfering); 0 (Receptors, Odorant); 0 (fascin1 protein, mouse); 145420-64-0 (coronin proteins); 451IFR0GXB (Scopolamine Hydrobromide); EC 1.6.- (Voltage-Dependent Anion Channel 1)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180202
[Lr] Data última revisão:
180202
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170428
[St] Status:MEDLINE
[do] DOI:10.1002/hipo.22735


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[PMID]:29235767
[Au] Autor:Brown RS; Rhodes BH; Siewe MS; Matthews TJ
[Ti] Título:Severe Xerostomia Secondary to Anticholinergic Drug Therapy: Case Report.
[So] Source:Dent Today;36(2):136-8, 2017 Feb.
[Is] ISSN:8750-2186
[Cp] País de publicação:United States
[La] Idioma:eng
[Mh] Termos MeSH primário: Antagonistas Colinérgicos/efeitos adversos
Ácidos Mandélicos/efeitos adversos
Incontinência Urinária/tratamento farmacológico
Xerostomia/induzido quimicamente
[Mh] Termos MeSH secundário: Idoso de 80 Anos ou mais
Feminino
Seres Humanos
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Cholinergic Antagonists); 0 (Mandelic Acids); K9P6MC7092 (oxybutynin)
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180115
[Lr] Data última revisão:
180115
[Sb] Subgrupo de revista:D
[Da] Data de entrada para processamento:171214
[St] Status:MEDLINE


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[PMID]:28458431
[Au] Autor:Ali S; Omer MO; Chaudhry MA; Ashraf M; Bukhsh A
[Ad] Endereço:Department of Pharmacology and Toxicology, University of Veterinary and Animal Sciences, Lahore, 54000, Punjab, Pakistan.
[Ti] Título:A pharmacological evidence for the presence of antihistaminic and anticholinergic activities in Roxb.
[So] Source:Indian J Pharmacol;49(1):98-101, 2017 Jan-Feb.
[Is] ISSN:1998-3751
[Cp] País de publicação:India
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: The study was designed to evaluate possible antihistaminic and anticholinergic activities of . MATERIALS AND METHODS: Effects of crude ethanolic (Ed.Eth) and effects of crude aqueous (Ed.Aq) extracts of were studied using isolated guinea pig ileum, rabbit jejunum, and rabbit trachea. Tissue responses were recorded using isotonic and isometric transducers, connected with PowerLab data acquisition system. RESULTS: A dose-dependent (0.1-0.3 mg/ml) rightward shift was demonstrated in histamine concentration-response curves. Whereas a complete relaxation of carbachol (1 µM)-induced contractions in isolated rabbit jejunum (3 mg/ml) and tracheal (10 mg/ml) preparations was observed, similar to dicyclomine at 1 and 3 µM, respectively. However, no significant difference between the effects of Ed.Eth and Ed.Aq was observed. CONCLUSION: Study provides pharmacological evidence for the presence of antihistaminic and anticholinergic activities in crude extracts of and also highlight its medicinal significance in the management of airway and gastrointestinal disorders.
[Mh] Termos MeSH primário: Antagonistas Colinérgicos/farmacologia
Equisetum/química
Antagonistas dos Receptores Histamínicos/farmacologia
Extratos Vegetais/farmacologia
[Mh] Termos MeSH secundário: Animais
Antagonistas Colinérgicos/administração & dosagem
Antagonistas Colinérgicos/isolamento & purificação
Diciclomina/administração & dosagem
Diciclomina/farmacologia
Relação Dose-Resposta a Droga
Feminino
Cobaias
Antagonistas dos Receptores Histamínicos/administração & dosagem
Íleo/efeitos dos fármacos
Íleo/metabolismo
Jejuno/efeitos dos fármacos
Jejuno/metabolismo
Masculino
Extratos Vegetais/administração & dosagem
Coelhos
Traqueia/efeitos dos fármacos
Traqueia/metabolismo
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Cholinergic Antagonists); 0 (Histamine Antagonists); 0 (Plant Extracts); 4KV4X8IF6V (Dicyclomine)
[Em] Mês de entrada:1712
[Cu] Atualização por classe:171229
[Lr] Data última revisão:
171229
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170502
[St] Status:MEDLINE
[do] DOI:10.4103/0253-7613.201017


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[PMID]:28458421
[Au] Autor:Saikia B; Barua CC; Haloi P; Patowary P
[Ad] Endereço:Department of Pharmacology and Toxicology, College of Veterinary Science, Assam Agricultural University, Guwahati, Assam, India.
[Ti] Título:Anticholinergic, antihistaminic, and antiserotonergic activity of n-hexane extract of seeds on isolated tissue preparations: An study.
[So] Source:Indian J Pharmacol;49(1):42-48, 2017 Jan-Feb.
[Is] ISSN:1998-3751
[Cp] País de publicação:India
[La] Idioma:eng
[Ab] Resumo:OBJECTIVES: The aim of this study was to evaluate anticholinergic, antihistaminic, and antiserotonergic activity of the n-hexane extract of the seeds of (ZAHE) on isolated ileum of rat and guinea pig and fundus of rat. MATERIALS AND METHODS: ZAHE was prepared using soxhlet extraction and cumulative concentration response curves were constructed using various doses on the tissues for acetylcholine (ACh), 5-hydroxytryptamine (5-HT), and histamine with or without n-hexane extract. Atropine, ketanserin, and pheniramine maleate were used as antagonists for ACh, serotonin, and histamine, respectively. RESULTS: ZAHE-induced concentration-dependent inhibition of isolated ileum and fundus in rat and ileum of guinea pig. The half maximal effective concentration (EC ) of ACh in the presence of atropine (10 M; < 0.05) and ZAHE (1000 µg/ml; < 0.01) was significantly higher than EC of ACh alone. The EC of 5-HT in the presence of ketanserin (10 M; < 0.01) and ZAHE (1000 µg/ml; < 0.05) was higher than EC of 5-HT alone. Similarly, the EC of histamine in the presence of pheniramine maleate (10 M; < 0.01) and ZAHE (300 µg/ml; < 0.01 and 1000 µg/ml; < 0.05) was also significantly higher than EC of histamine alone. CONCLUSION: From the study, it was observed that ZAHE shows significant anticholinergic, antiserotonergic, and antihistaminic activity. The study provides sufficient evidence that the seeds can be used in gastric disorders, cough, chest infection, etc., as per folklore claims.
[Mh] Termos MeSH primário: Antagonistas Colinérgicos/farmacologia
Antagonistas dos Receptores Histamínicos/farmacologia
Extratos Vegetais/farmacologia
Antagonistas da Serotonina/farmacologia
Zanthoxylum/química
[Mh] Termos MeSH secundário: Acetilcolina/metabolismo
Animais
Antagonistas Colinérgicos/administração & dosagem
Antagonistas Colinérgicos/isolamento & purificação
Relação Dose-Resposta a Droga
Fundo Gástrico/efeitos dos fármacos
Fundo Gástrico/metabolismo
Cobaias
Hexanos/química
Histamina/metabolismo
Antagonistas dos Receptores Histamínicos/administração & dosagem
Antagonistas dos Receptores Histamínicos/isolamento & purificação
Íleo/efeitos dos fármacos
Íleo/metabolismo
Masculino
Extratos Vegetais/administração & dosagem
Ratos
Ratos Wistar
Sementes
Serotonina/metabolismo
Antagonistas da Serotonina/administração & dosagem
Antagonistas da Serotonina/isolamento & purificação
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Cholinergic Antagonists); 0 (Hexanes); 0 (Histamine Antagonists); 0 (Plant Extracts); 0 (Serotonin Antagonists); 2DDG612ED8 (n-hexane); 333DO1RDJY (Serotonin); 820484N8I3 (Histamine); N9YNS0M02X (Acetylcholine)
[Em] Mês de entrada:1712
[Cu] Atualização por classe:171229
[Lr] Data última revisão:
171229
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170502
[St] Status:MEDLINE
[do] DOI:10.4103/0253-7613.201025


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[PMID]:29067433
[Au] Autor:Lukacz ES; Santiago-Lastra Y; Albo ME; Brubaker L
[Ad] Endereço:Department of Reproductive Medicine, University of California-San Diego, La Jolla.
[Ti] Título:Urinary Incontinence in Women: A Review.
[So] Source:JAMA;318(16):1592-1604, 2017 Oct 24.
[Is] ISSN:1538-3598
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Importance: Urinary incontinence, the involuntary loss of urine, is a common health condition that may decrease quality of life. Ten to twenty percent of women and up to 77% of women residing in nursing homes have urinary incontinence, yet only 25% seek or receive treatment. Observations: This review summarizes the evaluation and therapeutic options for women affected by urinary incontinence. The initial assessment should focus on understanding the effect of incontinence on quality of life, the patient's goals and preferences for treatment, the results of previous treatments, and the presence of concomitant conditions, such as advanced pelvic organ prolapse, that may require referral. Infection and hematuria need to be ruled out. In the absence of urinary infection or serious underlying pathology (such as cancer or serious neurologic disease) associated with urinary incontinence, the clinician should initiate unsupervised pelvic muscle exercises and lifestyle modifications appropriate to the patient to reduce her symptoms. These recommendations can include weight loss, adequate hydration, avoidance of excessive fluids, and regular voiding intervals that reduce urgency incontinence episodes. Urgency incontinence medications, with timely reassessment of symptoms, can be started without extensive evaluation. Specialist treatments for urgency incontinence include onabotulinumtoxinA and percutaneous or implanted neuromodulators. Stress incontinence surgery, the midurethral sling, is associated with symptom improvement in 48% to 90% of women and has low rates of mesh complications (<5%). Conclusions and Relevance: Urinary incontinence is common in women, although few seek care despite many effective treatment options. Clinicians should prioritize urinary incontinence detection, identify and treat modifiable factors, incorporate patient preference into evaluation and treatment, initiate conservative and medical therapy, and refer to specialists when underlying pathology is identified or conservative measures are ineffective.
[Mh] Termos MeSH primário: Antagonistas Colinérgicos/uso terapêutico
Incontinência Urinária por Estresse/cirurgia
Incontinência Urinária de Urgência/tratamento farmacológico
Incontinência Urinária/terapia
[Mh] Termos MeSH secundário: Exercício
Feminino
Procedimentos Cirúrgicos em Ginecologia
Seres Humanos
Estilo de Vida
Qualidade de Vida
Slings Suburetrais
Incontinência Urinária/diagnóstico
Incontinência Urinária por Estresse/terapia
Incontinência Urinária de Urgência/etiologia
Incontinência Urinária de Urgência/microbiologia
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Nm] Nome de substância:
0 (Cholinergic Antagonists)
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171101
[Lr] Data última revisão:
171101
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:171026
[St] Status:MEDLINE
[do] DOI:10.1001/jama.2017.12137


  9 / 4089 MEDLINE  
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[PMID]:28889761
[Au] Autor:Araklitis G; Cardozo L
[Ad] Endereço:a Department of Urogynaecology , King's College Hospital , London , UK.
[Ti] Título:Safety issues associated with using medication to treat overactive bladder.
[So] Source:Expert Opin Drug Saf;16(11):1273-1280, 2017 Nov.
[Is] ISSN:1744-764X
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:INTRODUCTION: The mainstay of overactive bladder treatment is the use of anticholinergic medication with its common side effects well known. This review focused on three less well-known safety issues when treating OAB. Areas covered: Patients with increased anticholinergic load are at risk of cognitive decline, dementia or even death. The elderly are particularly at risk due to polypharmacy. Botulinum toxin carries the risk of high urinary residuals, urinary tract infection and need to self catheterise. The use of vaginal oestrogens may improve OAB symptoms, but there is concern in those with a history of breast cancer. Studies have shown that the systemic absorption is negligible and does not increase the risk of recurrence. Expert Opinion: Improvement in assessing anticholinergic load is needed with the development of a universal drug scale. To avoid increasing load, Mirabegron or botulinum toxin can be used instead. There is no consensus of the use of prophylactic antibiotics when injecting botulinum toxin and at what residual to initiate self catheterisation. Despite evidence showing that the use of vaginal oestrogens is safe in those with a history of cancer, it is not fully supported by any health body. Further work is needed in those using aromatase inhibitors.
[Mh] Termos MeSH primário: Antagonistas Colinérgicos/efeitos adversos
Bexiga Urinária Hiperativa/tratamento farmacológico
Agentes Urológicos/efeitos adversos
[Mh] Termos MeSH secundário: Acetanilidas/administração & dosagem
Acetanilidas/efeitos adversos
Idoso
Toxinas Botulínicas/administração & dosagem
Toxinas Botulínicas/efeitos adversos
Antagonistas Colinérgicos/administração & dosagem
Estrogênios/administração & dosagem
Estrogênios/efeitos adversos
Seres Humanos
Polimedicação
Tiazóis/administração & dosagem
Tiazóis/efeitos adversos
Agentes Urológicos/administração & dosagem
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Nm] Nome de substância:
0 (Acetanilides); 0 (Cholinergic Antagonists); 0 (Estrogens); 0 (Thiazoles); 0 (Urological Agents); EC 3.4.24.69 (Botulinum Toxins); MVR3JL3B2V (mirabegron)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171023
[Lr] Data última revisão:
171023
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170912
[St] Status:MEDLINE
[do] DOI:10.1080/14740338.2017.1376646


  10 / 4089 MEDLINE  
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[PMID]:28699790
[Au] Autor:Hosp C; Hamm H
[Ad] Endereço:a Department of Dermatology, Venereology and Allergology , University Hospital Würzburg , Würzburg , Germany.
[Ti] Título:Safety of available and emerging drug therapies for hyperhidrosis.
[So] Source:Expert Opin Drug Saf;16(9):1039-1049, 2017 Sep.
[Is] ISSN:1744-764X
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:INTRODUCTION: Hyperhidrosis affects 4.8% of the U.S. population and has been underestimated by physicians for long time despite considerable interference with quality of life. Many patients suffer from primary (idiopathic) hyperhidrosis which results from over-activity of sympathetic nerves and is restricted to specific body areas, mostly the axillae, palms, soles, or head. Secondary hyperhidrosis is caused by an underlying disease or the intake of medications and often involves large parts of the body. Numerous effective therapies with topical or systemic drugs and surgical options are available. Areas covered: Efficacy and safety data on aluminum salts, anticholinergic drugs for topical or systemic application, and on intradermal botulinum toxin injections used to treat hyperhidrosis are critically evaluated, including data from clinical trials with focus on possible side effects and long-term complications in dispute. Expert opinion: Hyperhidrosis often responds well to available therapies. Depending on the type of hyperhidrosis treatment should be topical/local or systemic. Most of the side effects are mild, transient and easily manageable. In case of systemic treatment with anticholinergics low dosing and up-titration of medication is necessary to avoid severe adverse effects. Concerns about the promotion of breast cancer and Alzheimer disease by topical aluminum salts are unsolved.
[Mh] Termos MeSH primário: Hiperidrose/tratamento farmacológico
Qualidade de Vida
[Mh] Termos MeSH secundário: Administração Tópica
Compostos de Alumínio/administração & dosagem
Compostos de Alumínio/efeitos adversos
Animais
Toxinas Botulínicas/administração & dosagem
Toxinas Botulínicas/efeitos adversos
Antagonistas Colinérgicos/administração & dosagem
Antagonistas Colinérgicos/efeitos adversos
Seres Humanos
Hiperidrose/fisiopatologia
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Nm] Nome de substância:
0 (Aluminum Compounds); 0 (Cholinergic Antagonists); EC 3.4.24.69 (Botulinum Toxins)
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170904
[Lr] Data última revisão:
170904
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170713
[St] Status:MEDLINE
[do] DOI:10.1080/14740338.2017.1354983



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