BACKGROUND: Despite secondary prevention with aspirin, patients with stable cardiovascular disease (CVD) remain at elevated long-term risk of major adverse cardiovascular events. The Cardiovascular Outcomes in People Using Anticoagulant Strategies (COMPASS) double-blind, randomized clinical trial demonstrated that aspirin plus low-dose rivaroxaban (COMPASS regime) significantly decreased the incidence of major adverse cardiovascular events by 24% compared with aspirin alone. However, the mechanisms underlying these potential synergistic/nonantithrombotic effects remain elusive. Extracellular vesicles (EVs) are crucial messengers regulating a myriad of biological/pathological processes and are highly implicated in CVD. OBJECTIVES: We hypothesized that circulating EV profiles reflect the cardioprotective properties of the COMPASS regime. METHODS: A cohort of stable CVD patients (N = 40) who participated in the COMPASS trial and were previously randomized to receive aspirin were prospectively recruited and assigned a revised regimen of open-label aspirin plus rivaroxaban. Blood samples were obtained at baseline (aspirin only) and 6-month follow-up. Plasma EV concentration, size, and origin were analyzed by nanoparticle tracking analysis and flow cytometry. EVs were enriched by ultracentrifugation for proteomic analysis. RESULTS: The COMPASS regime fundamentally altered small (<200 nm) and large (200-1000 nm) EV concentration and size compared with aspirin alone. Crucially, levels of platelet-derived and myeloperoxidase-positive EVs became significantly decreased at follow-up. Comparative proteomic characterization further revealed a significant decrease in highly proinflammatory protein expression at follow-up. CONCLUSION: The observed changes in EV subpopulations, together with the differential protein expression profiles, suggest amelioration of an underlying proinflammatory and prothrombotic state upon dual therapy, which may be of clinical relevance toward understanding the fundamental mechanism underlying the reported superior cardiovascular outcomes associated with this antithrombotic regimen.
- MeSH
- Aspirin * administration & dosage therapeutic use adverse effects MeSH
- Double-Blind Method MeSH
- Extracellular Vesicles * metabolism drug effects MeSH
- Platelet Aggregation Inhibitors * administration & dosage adverse effects therapeutic use MeSH
- Factor Xa Inhibitors * administration & dosage adverse effects therapeutic use MeSH
- Cardiovascular Diseases * blood prevention & control drug therapy MeSH
- Drug Therapy, Combination * MeSH
- Middle Aged MeSH
- Humans MeSH
- Inflammation Mediators blood MeSH
- Prospective Studies MeSH
- Proteomics methods MeSH
- Rivaroxaban * administration & dosage MeSH
- Aged MeSH
- Thrombosis blood prevention & control drug therapy MeSH
- Treatment Outcome MeSH
- Inflammation blood MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Randomized Controlled Trial MeSH
Stenotrophomonas maltophilia, Achromobacter xylosoxidans, and Burkholderia cenocepacia are considered emerging pathogens classified as a public health problem due to extensive antimicrobial resistance. Therefore, the discovery of new therapeutic strategies has become crucial. This study aimed to evaluate the antimicrobial activity of gallic acid and methyl gallate against non-fermenting bacteria. The study included five clinical isolates of Stenotrophomonas maltophilia, Achromobacter xylosoxidans, and Burkholderia cenocepacia. The minimum inhibitory concentrations of gallic acid and methyl gallate were determined by the broth microdilution method. Growth curves, metabolic activity, and biofilm formation of each bacterial strain in the presence or absence of phenolic compounds were performed. Finally, the therapeutic efficacy of the compounds was evaluated using an in vivo model. Gallic acid and methyl gallate showed antibacterial activity against bacterial strains in a concentration range of 64 to 256 μg/mL, both compounds reduced bacterial growth and metabolic activity of the strains, even at subinhibitory concentrations. Only, methyl gallate exhibited activity to inhibit the formation of bacterial biofilms. Moreover, gallic acid and methyl gallate increased larval survival by up to 60% compared to 30% survival of untreated larvae in a bacterial infection model in Galleria mellonella. Our results highlight the potential of gallic acid and methyl gallate as therapeutic alternatives for infections by emerging non-fermentative bacteria.
Čtyřletý chlapec s dosud bezvýznamnou anamnézou byl přijat pro krční lymfadenopatii a febrilie. Od 3. dne hospitalizace výsev drobnopapulozního exantému a bolesti břicha, pro které byla nutná laparoskopická revize, nález flegmonózní apendicitidy, provedena apendektomie. Pro suspektní toxoalergický exantém byla opakovaně měněna antibiotická léčba. I přes širokospektrá antibiotika stále stoupaly zánětlivé markery, transaminázy, lymfadenopatie výrazněji neregredovala, exantém a febrilie přetrvávaly, objevila se konjunktivitida, rozpraskané rty, artralgie. Diferenciálně diagnosticky zvažována EB viróza, parainfekční exantém, vysloveno podezření na Kawasakiho syndrom. I přes negativní nález při kardiologickém vyšetření zahájena standardní terapie Kawasakiho syndromu - jednou dávkou imunoglobulinu (IVIG) a kyselinou acetylsalicylovou (ASA). Po podání IVIG promptně poklesly teploty, regredoval exantém, lymfadenopatie, normalizoval se laboratorní nález. Uzavíráme jako Kawasakiho syndrom.
A 4-year-old boy with a previously unremarkable medical history was admitted for cervical lymphadenopathy and fever. From the 3rd day of hospitalization a small-papulous exanthema and abdominal pain for which laparoscopic revision was necessary, phlegmonous appendicitis was found, and appendectomy was performed. Antibiotic treatment was repeatedly changed for suspected toxoallergic exanthema. Despite broad-spectrum antibiotics, inflammatory markers, transaminases continued to rise, lymphadenopathy did not significantly regress, exanthema, febrile persisted, conjunctivitis, chapped lips, arthralgia appeared. Differential diagnostic consideration was given to EB virosis, parainfectious exanthema, Kawasaki syndrome was suspected. Despite of negative findings on cardiological examination the treatment with one dose of intravenous immunoglobulins (IVIG) and acetylsalicylic acid (ASA) was administered. After administration of IVIG followed prompt decrease in temperature, regression of exanthema, nodal syndrome, normalization of laboratory findings. We concluded as Kawasaki syndrome.
- MeSH
- Appendicitis surgery diagnosis etiology MeSH
- Aspirin pharmacology therapeutic use MeSH
- Diagnosis, Differential MeSH
- Exanthema diagnosis etiology MeSH
- Fever of Unknown Origin diagnosis etiology MeSH
- Immunoglobulins, Intravenous pharmacology therapeutic use MeSH
- Mucocutaneous Lymph Node Syndrome * diagnosis epidemiology drug therapy blood MeSH
- Humans MeSH
- Lymphadenopathy diagnosis etiology MeSH
- Child, Preschool MeSH
- Check Tag
- Humans MeSH
- Male MeSH
- Child, Preschool MeSH
- Publication type
- Case Reports MeSH
- Research Support, Non-U.S. Gov't MeSH
Prokinetika jsou skupinou léčiv, které díky schopnosti stimulace hladké svaloviny zvyšují motilitu trávicího traktu, a to především v jeho proximální části. V současnosti se prokinetika využívají primárně pro léčbu funkční dyspepsie, ale uplatnění mohou nalézt i u jiných indikací. Pozitivního účinku na motilitu dosahují prostřednictvím mechanismů, které jsou v rámci skupiny prokinetik do značné míry heterogenní. Článek poskytuje čtenářům základní přehled informací vztahujícím se k jednotlivým prokinetikům aktuálně registrovaných na trhu v České republice, blíže popisuje jejich farmakologické účinky a diskutuje užití prokinetik v léčbě funkční dyspepsie a refluxní nemoci jícnu, což jsou nejčastější indikace k užití prokinetik v klinické praxi.
Prokinetics are a group of drugs that, due to their ability to stimulate smooth muscle contraction, enhance the motility of the digestive tract, particularly in its proximal part. Currently, prokinetics are primarily used to treat functional dyspepsia, though they may also be prescribed for other indications. They exert their positive effects on motility through mechanisms that vary within this drug class. This article provides readers with a basic overview of the prokinetic agents currently registered on the market in the Czech Republic, describes their pharmacological effects in more detail, and discusses the use of prokinetics in the treatment of functional dyspepsia and gastroesophageal reflux disease, which are the most common indications for the use of prokinetics in clinical practice.
- Keywords
- prokinetika, cinitaprid, itoprid,
- MeSH
- Benzamides administration & dosage pharmacology MeSH
- Dyspepsia drug therapy MeSH
- Gastroesophageal Reflux drug therapy MeSH
- Gastrointestinal Agents * administration & dosage classification MeSH
- Gastrointestinal Motility * drug effects MeSH
- Gastrointestinal Diseases drug therapy MeSH
- Humans MeSH
- Metoclopramide pharmacology therapeutic use MeSH
- Check Tag
- Humans MeSH
- Publication type
- Review MeSH
- MeSH
- Aspirin * pharmacokinetics pharmacology therapeutic use MeSH
- Diabetes Mellitus * drug therapy pathology MeSH
- Platelet Aggregation Inhibitors MeSH
- Diabetes Complications MeSH
- Humans MeSH
- Megakaryocytes pathology MeSH
- Blood Platelets pathology drug effects MeSH
- Dose-Response Relationship, Drug MeSH
- Check Tag
- Humans MeSH
Virové bradavice jsou celosvětově časté onemocnění způsobené lidským papilomavirem, který má řadu genotypů. Mnoho z těchto virů je komenzálních a u imunokompetentních hostitelů nevyvolávají žádné projevy. Za vhodných podmínek některé způsobují klinické změny na kůži nebo na sliznicích v anogenitální či orofaryngeální oblasti. U dětí se nejčastěji setkáváme s verruca vulgaris, verruca plantaris a verruca plana. Řada těchto projevů samovolně vymizí, problémem jsou perzistentní či úporně recidivující bradavice. Léčbou se snažíme nejen zlikvidovat viditelné změny za minimalizace bolesti a bez jizvení, ale také o prevenci recidivy ať již v místě původní bradavice nebo kdekoli jinde na těle.
Viral warts are a common disease worldwide caused by the human papillomavirus, which has a number of genotypes. Many of these viruses are commensal and do not cause any symptoms in immunocompetent hosts. Under appropriate conditions, however, some cause clinical changes on the skin or mucous membranes in the anogenital or oropharyngeal part. Verruca vulgaris, verruca plantaris and verruca plana are most often encountered in children. Many of these manifestations disappear on their own, the problem is persistent or stubbornly recurring warts. With the treatment, we try not only to eliminate visible changes while minimizing pain and without scarring, but also to prevent recurrence, whether at the site of the original wart or anywhere else on the body.
- MeSH
- Warts * drug therapy therapy MeSH
- Child * MeSH
- Fluorouracil pharmacology therapeutic use MeSH
- Papillomavirus Infections transmission therapy MeSH
- Keratinocytes pathology MeSH
- Cryotherapy methods MeSH
- Salicylic Acid therapeutic use MeSH
- Trichloroacetic Acid therapeutic use MeSH
- Lasers MeSH
- Humans MeSH
- Podophyllin pharmacology therapeutic use MeSH
- Check Tag
- Child * MeSH
- Humans MeSH
With an increasing focus on sustainable technologies in the pharmaceutical industry, milling provides a solvent-free approach to improve drug dissolution. Milling of drugs with an excipient offers additional opportunities to achieve supersaturation kinetics. Therefore, this work aims to present insights of co-milling fenofibrate and apremilast, two good glass formers with low and high glass transition temperatures (Tgs) respectively. Drugs were co-milled with croscarmellose sodium for various process durations followed by thermal analysis, investigation of crystallinity, surface area and dissolution. The dissolution enhancement of the low-Tg glass former fenofibrate highly correlated with the process-induced increase in surface area of co-milled systems (R2 = 0.96). In contrast, the high-Tg glass former apremilast lost its crystalline order gradually after ≥ 10 min of co-milling, and favourable supersaturation kinetics during biorelevant dissolution testing were observed. Interestingly, the melting point of co-milled apremilast decreased and linearly correlated with the highest measured drug concentration (cmax) during in vitro dissolution (onset temperature R2 = 0.98; peak temperature R2 = 0.96). The melting point depression remained stable after 90 days for apremilast, whereas fenofibrate co-milled for 20 min or more showed an increase in melting point upon storage. This study demonstrated that co-milling with croscarmellose sodium is ideally suited to good glass formers with a high Tg. The melting point depression is thereby proposed as an easily accessible critical quality attribute to estimate likely dissolution performance of drugs in dry co-milled formulations.
- MeSH
- Aspirin chemistry analogs & derivatives MeSH
- Fenofibrate * chemistry MeSH
- Excipients chemistry MeSH
- Drug Compounding methods MeSH
- Solubility MeSH
- Glass * chemistry MeSH
- Thalidomide analogs & derivatives MeSH
- Transition Temperature MeSH
- Drug Liberation MeSH
- Publication type
- Journal Article MeSH
- Comparative Study MeSH
Gynekomastie je benigní zvětšení prsní žlázy u mužů, které může mít významný psychologický dopad, zejména u dětí a adolescentů. Tento článek se zabývá farmakologicky indukovanou gynekomastií a nejčastějšími léky, které mohou přispět k jejímu vzniku. V rámci naší analýzy jsme identifikovali a přezkoumali relevantní studie a kazuistiky publikované v databázi PubMed, které se zabývají různými aspekty gynekomastie u dětských pacientů. Důležitým krokem v prevenci gynekomastie je informovanost zdravotnického personálu, rodičů a pacientů o potenciálních rizicích spojených s užíváním určitých léků. Je nevyhnutelné, aby při předepisovaní léčby byly zohledněny veškeré možné vedlejší účinky, a aby se provedlo důkladné zhodnocení poměru přínosů a rizik. Mimo jiné se doporučuje provádět pravidelné kontroly a hodnocení pacientů, kteří užívají rizikové léky, aby bylo možné včas identifikovat a řešit případné příznaky gynekomastie. Tento článek zdůrazňuje potřebu zvýšené pozornosti k vybraným lékům, které jsou nejčastěji uváděny v odborné literatuře, a multidisciplinární přístup k léčbě. Informovanost o farmakologických rizicích a podpora ze strany zdravotnických odborníků jsou klíčové pro prevenci a zvládnutí tohoto stavu, ale také pro psychologickou pohodu dětských pacientů trpících touto diagnózou.
Gynecomastia is a benign enlargement of breast tissue in males that can have significant psychological impacts, especially in children and adolescents. This article focuses on pharmacologically induced gynecomastia and the most common medications that may contribute to its development. In our analysis, we identified and examined relevant studies and case reports published in the PubMed database that discuss various aspects of gynecomastia in pediatric patients. An important step in the prevention of gynecomastia is the awareness of healthcare professionals, parents, and patients regarding the potential risks associated with the use of certain medications. It is essential that all possible side effects are considered when prescribing treatment and that a thorough assessment of the benefits and risks is conducted. Additionally, it is recommended to carry out regular check-ups and evaluations of patients who are taking high-risk medications to identify and address any symptoms of gynecomastia in a timely manner. This article emphasizes the need for increased attention to selected medications commonly cited in the scientific literature and a multidisciplinary approach to treatment. Awareness of pharmacological risks and support from healthcare professionals are crucial for the prevention and management of this condition, as well as for the psychological well-being of pediatric patients suffering from this diagnosis.
- MeSH
- Anticonvulsants pharmacology adverse effects MeSH
- Antipsychotic Agents pharmacology adverse effects MeSH
- Child MeSH
- Gynecomastia * etiology MeSH
- Isoniazid pharmacology adverse effects MeSH
- Humans MeSH
- Metoclopramide pharmacology adverse effects MeSH
- Drug-Related Side Effects and Adverse Reactions * drug therapy MeSH
- Omeprazole pharmacology adverse effects MeSH
- Check Tag
- Child MeSH
- Humans MeSH
Virové bradavice jsou celosvětově časté onemocnění způsobené lidským papilomavirem, který má řadu genotypů. Mnoho z těchto virů je komenzálních a u imunokompetentních hostitelů nevyvolávají žádné projevy. Za vhodných podmínek některé způsobují klinické změny na kůži nebo na sliznicích v anogenitální či orofaryngeální oblasti. U dětí se nejčastěji setkáváme s verruca vulgaris, verruca plantaris a verruca plana. Řada těchto projevů samovolně vymizí, problémem jsou perzistentní či úporně recidivující bradavice. Léčbou se snažíme nejen zlikvidovat viditelné změny za minimalizace bolesti a bez jizvení, ale také o prevenci recidivy ať již v místě původní bradavice nebo kdekoli jinde na těle.
Viral warts are a common disease worldwide caused by the human papillomavirus, which has a number of genotypes. Many of these viruses are commensal and do not cause any symptoms in immunocompetent hosts. Under appropriate conditions, however, some cause clinical changes on the skin or mucous membranes in the anogenital or oropharyngeal part. Verruca vulgaris, verruca plantaris and verruca plana are most often encountered in children. Many of these manifestations disappear on their own, the problem is persistent or stubbornly recurring warts. With the treatment, we try not only to eliminate visible changes while minimizing pain and without scarring, but also to prevent recurrence, whether at the site of the original wart or anywhere else on the body.
- MeSH
- Warts * therapy MeSH
- Child * MeSH
- Immunotherapy methods MeSH
- Papillomavirus Infections drug therapy therapy MeSH
- Keratinocytes drug effects MeSH
- Cryotherapy methods MeSH
- Salicylic Acid pharmacology therapeutic use MeSH
- Lasers MeSH
- Humans MeSH
- Retinoids pharmacology therapeutic use MeSH
- Check Tag
- Child * MeSH
- Humans MeSH
IMPORTANCE: The Aspirin and Hemocompatibility Events With a Left Ventricular Assist Device in Advanced Heart Failure (ARIES-HM3) study demonstrated that aspirin may be safely eliminated from the antithrombotic regimen after HeartMate 3 (HM3 [Abbott Cardiovascular]) left ventricular assist device (LVAD) implantation. This prespecified analysis explored whether conditions requiring aspirin (prior percutaneous coronary intervention [PCI], coronary artery bypass grafting [CABG], stroke, or peripheral vascular disease [PVD]) would influence outcomes differentially with aspirin avoidance. OBJECTIVE: To analyze aspirin avoidance on hemocompatibility-related adverse events (HRAEs) at 1 year after implant in patients with a history of CABG, PCI, stroke, or PVD. DESIGN, SETTING, AND PARTICIPANTS: This was an international, multicenter, prospective, double-blind, placebo-controlled, randomized clinical trial including patients implanted with a de novo HM3 LVAD across 51 centers. Data analysis was conducted from April to July 2024. INTERVENTIONS: Patients were randomized in a 1:1 ratio to receive aspirin (100 mg per day) or placebo, in addition to a vitamin K antagonist (VKA) targeted to an international normalized ratio of 2 to 3 in both groups. MAIN OUTCOMES AND MEASURES: Primary end point (assessed for noninferiority) was a composite of survival free of any nonsurgical (>14 days after implant) HRAEs including stroke, pump thrombosis, bleeding, and arterial peripheral thromboembolism at 12 months. Secondary end points included nonsurgical bleeding, stroke, and pump thrombosis events. RESULTS: Among 589 of 628 patients (mean [SD] age, 57.1 [13.7] years; 456 male [77.4%]) who contributed to the primary end point analysis, a history of PCI, CABG, stroke, or PVD was present in 41% (240 of 589 patients). There was no interaction between the presence of an atherosclerotic vascular condition and effect of aspirin compared with placebo (P for interaction= .23). The preset 10% noninferiority margin was not crossed for the studied subgroup of patients. Thrombotic events were rare, with no differences between aspirin and placebo in patients with and without vascular disease (P for interaction = .77). Aspirin treatment was associated with a higher rate of nonsurgical major bleeding events in the group with prior vascular condition history compared with those without aspirin (rate ratio for placebo compared with aspirin, 0.52; 95% CI, 0.35-0.79). CONCLUSIONS AND RELEVANCE: Results of this prespecified analysis of the ARIES-HM3 randomized clinical trial demonstrate that in patients with advanced heart failure who have classical indications for antiplatelet therapy use at the time of LVAD implantation, aspirin avoidance was safe and not associated with increased thrombosis risk. Importantly, elimination of aspirin was associated with no increased thrombosis but a reduction in nonsurgical bleeding events in patients with a history of PCI, CABG, stroke, or PVD. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04069156.
- MeSH
- Aspirin * therapeutic use MeSH
- Atherosclerosis MeSH
- Stroke prevention & control MeSH
- Double-Blind Method MeSH
- Fibrinolytic Agents therapeutic use MeSH
- Platelet Aggregation Inhibitors therapeutic use MeSH
- Percutaneous Coronary Intervention methods MeSH
- Hemorrhage chemically induced MeSH
- Middle Aged MeSH
- Humans MeSH
- Heart-Assist Devices * MeSH
- Prospective Studies MeSH
- Aged MeSH
- Heart Failure MeSH
- Thrombosis prevention & control MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Comment MeSH
- Multicenter Study MeSH
- Randomized Controlled Trial MeSH
