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Planejamento de inibidores da enzima gliceraldeído-3-fosfato desidrogenase de Trypanosoma cruzi: biologia estrutural e química medicinal; Inhibitor design for glyceraldehyde-3-phosphate dehydrogenase enzyme from Trypanosoma cruzi: structural biology and medicinal chemistry

Guido, Rafael Victório Carvalho
Fonte: Biblioteca Digitais de Teses e Dissertações da USP Publicador: Biblioteca Digitais de Teses e Dissertações da USP
Tipo: Tese de Doutorado Formato: application/pdf
Publicado em 18/04/2008 PT
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A Doença de Chagas, causada pelo parasita Trypanosoma cruzi, atinge cerca de um quarto da população da América Latina. Os fármacos disponíveis para o tratamento desta doença são inapropriados, apresentam baixa eficácia e sérios efeitos colaterais que limitam o seu uso. Esse grave panorama torna urgente a descoberta de novos agentes quimioterápicos para o tratamento seguro e eficaz da doença. A via glicolítica é principal forma de obtenção de energia de tripanosomatídeos. Um alvo molecular atrativo desta via bioquímica que desempenha papel essencial no controle do fluxo glicolítico do Trypanosoma cruzi, a enzima gliceraldeído-3-fosfato desidrogenase (GAPDH), foi selecionada neste trabalho de Tese para estudos em biologia estrutural e química medicinal visando à identificação e planejamento de novos inibidores enzimáticos. Neste contexto, triagens biológicas resultaram na identificação de compostos de origem natural e sintética com atividade inibitória in vitro frente à GAPDH de T. cruzi, ampliando a diversidade química de moduladores seletivos deste alvo. Estudos cinéticos e estruturais demonstraram o comportamento não cooperativo entre os sítios ativos da enzima GAPDH de T. cruzi em relação à interação com o cofator NAD+...

Estudo da utilização dos inibidores da enzima conversora da angiotensina, captopril e enalapril, dispensados pelas farmácias das unidades públicas de saúde do Distrito Oeste de Ribeirão Preto-SP; Study of utilization of angiotensin-converting enzyme inhibitors, captopril and enalapril dispensed by the brazilian public health system in the west sanitary district of Ribeirão Preto-SP.

Olivera, Carolina Maria Xaubet
Fonte: Biblioteca Digitais de Teses e Dissertações da USP Publicador: Biblioteca Digitais de Teses e Dissertações da USP
Tipo: Dissertação de Mestrado Formato: application/pdf
Publicado em 29/06/2009 PT
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Os inibidores da enzima conversora da angiotensina são uma classe de medicamentos freqüentemente prescrita pelos médicos e importante para o tratamento da Hipertensão Arterial Sistêmica (HAS) e da Insuficiência Cardíaca Congestiva (ICC). Os dois primeiros protótipos desta classe, o captopril e o maleato de enalapril, constam na Relação Nacional de Medicamentos Essenciais (RENAME) devido à importância terapêutica, eficácia clínica e segurança comprovada, além de seu custo-efetividade. Para cumprir o objetivo de estudar a utilização desta classe terapêutica foi realizado um levantamento no banco de dados da Secretaria Municipal de Saúde de Ribeirão Preto (SMS-RP) do estado de São Paulo (SP) para identificar os usuários do Sistema Único de Saúde (SUS) que receberam a dispensação de captopril e maleato de enalapril pelas farmácias das Unidades Básicas de Saúde (UBS) e Distritais de Saúde (UBDS) no período compreendido entre 01/03/2006 e 28/02/2007. Identificou-se que 9.560 pacientes utilizaram os inibidores da ECA, sendo que destes, 46,57% utilizaram captopril, 45,74% enalapril e 7,69% os dois fármacos simultaneamente ou não. A idade média dos usuários foi de 61 anos e houve um aumento progressivo da utilização desses agentes com o incremento da faixa etária e houve predominância para o gênero feminino. A aderência ao tratamento dos usuários das unidades de saúde do Distrito Oeste de Ribeirão Preto foi estimada em 80...

Planejamento de inibidores da enzima diidroorotato desidrogenase de Trypanosoma cruzi por biocalorimetria; Biocalorimetry as a tool for Trypanosoma cruzi dihydroorotate dehydrogenase inhibitors discovery

Cheleski, Juliana
Fonte: Biblioteca Digitais de Teses e Dissertações da USP Publicador: Biblioteca Digitais de Teses e Dissertações da USP
Tipo: Tese de Doutorado Formato: application/pdf
Publicado em 04/03/2011 PT
Relevância na Pesquisa
46.28%
A doença de Chagas, causada pelo protozoário flagelado Trypanosoma cruzi, é uma doença tropical que enseja morte/morbidade de milhões de pessoas na América Latina. Por processos migratórios, vem-se estendendo ao sul dos Estados Unidos, Canadá, Europa, Austrália e Japão. Essa doença tem sido considerada super-negligenciada pela indústria farmacêutica, já que os dois fármacos disponíveis para o seu tratamento foram introduzidos há mais de quarenta anos e apresentam baixa eficácia com vários efeitos colaterais severos. Mais recentemente, a Organização Mundial da Saúde considerou a doença de Chagas, dentre outras, como a doença da pobreza! Com esse cenário completamente desfavorável aos portadores da doença, é necessária a descoberta, desenvolvimento e introdução de novos fármacos para o tratamento eficiente e seguro da doença de Chagas.
Dentro desse contexto, este trabalho representa uma importante contribuição para o entendimento das razões moleculares da ação farmacológica de substâncias químicas bioativas de interesse à farmacoterapia da doença de Chagas. Ao nível molecular, a enzima pertencente à via de síntese de novo de nucleotídeos de pirimidinas, diidroorotato desidrogenase do Trypanosoma cruzi (TcDHODH)...

Relação entre inibição da enzima de conversão da angiotensina e elevação da Troponina I cardíaca em pacientes com síndrome coronária aguda sem supradesnivelamento do segmento ST; Relationship between prior use of angiotensin-converting enzyme inhibitors and serum levels of cardiac troponin I in patients with non-ST elevation acute coronary syndrome

Minuzzo, Luiz
Fonte: Biblioteca Digitais de Teses e Dissertações da USP Publicador: Biblioteca Digitais de Teses e Dissertações da USP
Tipo: Tese de Doutorado Formato: application/pdf
Publicado em 24/04/2013 PT
Relevância na Pesquisa
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Introdução: O tratamento da Síndrome Coronária Aguda (SCA) sem supradesnivelamento do segmento ST (SSST) sofreu grandes avanços nos últimos 20 anos, com a introdução de novos medicamentos e intervenções invasivas, que reduziram significativamente os eventos clínicos graves como morte e re(infarto), em curto, médio e longo prazos, a despeito dessa entidade ainda representar uma alta taxa de mortalidade no mundo ocidental. Entre os medicamentos, os inibidores da enzima conversora da angiotensina (IECA) tiveram um papel fundamental, demonstrando redução desses eventos em pacientes com alto risco cardiovascular. Nesse período, as troponinas cardíacas consolidaram-se como os biomarcadores de necrose miocárdica de escolha para o diagnóstico e avaliação prognóstica nesses pacientes, devido às suas altas sensibilidade e especificidade. Objetivo: Determinar o efeito do uso prévio de IECA na mensuração da troponina I cardíaca em pacientes com SCASSST, e avaliar os desfechos clínicos em até 180 dias. Casuística e métodos: Estudo prospectivo, observacional, em um único centro de cardiologia, realizado entre 8 de setembro de 2009 e 10 de outubro de 2010, com 457 pacientes, consecutivamente internados no Pronto-Socorro com SCASSST. Os pacientes deveriam apresentar sintomas isquêmicos agudos...

Oral drugs for hypertensive urgencies: systematic review and meta-analysis

Souza, Luciana Mendes; Riera, Rachel; Saconato, Humberto; Demathé, Adriana; Atallah, Álvaro Nagib
Fonte: Associação Paulista de Medicina (APM) Publicador: Associação Paulista de Medicina (APM)
Tipo: Artigo de Revista Científica Formato: 366-372
ENG
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CONTEXTO E OBJETIVO: Urgências hipertensivas são definidas como elevações graves na pressão arterial sem evidência de danos agudos ou progressivos a órgãos-alvo. A necessidade de tratamento é considerada urgente, mas permite um controle gradual, utilizando-se drogas orais ou sublinguais. Se o aumento na pressão arterial não está associado a risco de vida ou danos a órgãos alvo, o controle pressórico deve ser feito lentamente durante 24 horas. em relação às urgências hipertensivas, não é conhecida qual a classe de drogas anti-hipertensivas que promove os melhores resultados e há controvérsia em relação a quando e quais as drogas devem ser utilizadas nestas situações. O objetivo desta revisão foi avaliar a efetividade e a segurança de drogas orais para urgências hipertensivas. METODOS: Esta revisão sistemática da literatura foi desenvolvida no Centro Cochrane do Brasil, e na Disciplina de Medicina de Urgência e Medicina Baseada em Evidências da Universidade Federal de São Paulo (UNIFESP) - Escola Paulista de Medicina (Unifesp-EPM), de acordo com a metodologia da Colaboração Cochrane. RESULTADOS: Os 16 ensaios clínicos aleatórios selecionados incluíram 769 participantes e demonstraram um efeito superior dos inibidores da enzima conversora de angiotensina no tratamento da urgência hipertensiva...

Oral drugs for hypertensive urgencies: systematic review and meta-analysis

Souza,Luciana Mendes; Riera,Rachel; Saconato,Humberto; Demathé,Adriana; Atallah,Álvaro Nagib
Fonte: Associação Paulista de Medicina - APM Publicador: Associação Paulista de Medicina - APM
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/11/2009 EN
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CONTEXT AND OBJECTIVE: Hypertensive urgencies are defined as severe elevations in blood pressure without evidence of acute or progressive target-organ damage. The need for treatment is considered urgent but allows for slow control using oral or sublingual drugs. If the increase in blood pressure is not associated with risk to life or acute target-organ damage, blood pressure control must be implemented slowly over 24 hours. For hypertensive urgencies, it is not known which class of antihypertensive drug provides the best results and there is controversy regarding when to use antihypertensive drugs and which ones to use in these situations. The aim of this review was to assess the effectiveness and safety of oral drugs for hypertensive urgencies. METHODS: This systematic review of the literature was developed at the Brazilian Cochrane Center, and in the Discipline of Emergency Medicine and Evidence-Based Medicine at the Universidade Federal de São Paulo - Escola Paulista de Medicina (Unifesp-EPM), in accordance with the methodology of the Cochrane Collaboration. RESULTS: Sixteen randomized clinical trials including 769 participants were selected. They showed that angiotensin-converting enzyme inhibitors had a superior effect in treating hypertensive urgencies...

The effects of angiotensin-converting enzyme inhibitors on peritoneal protein loss and solute transport in peritoneal dialysis patients

Basturk,Taner; Unsal,Abdulkadir; Koc,Yener; Nezaket,Eren; Ahbap,Elbis; Sakaci,Tamer; Sevinc,Mustafa
Fonte: Faculdade de Medicina / USP Publicador: Faculdade de Medicina / USP
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/08/2012 EN
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OBJECTIVE: The objective of this study was to examine the effects of angiotensin-converting enzyme inhibitors on peritoneal membrane transport, peritoneal protein loss, and proteinuria in peritoneal dialysis patients. METHODS: Fifty-four peritoneal dialysis patients were included in the study. The patients were divided into two groups. Group 1 (n = 34) was treated with angiotensin-converting enzyme inhibitors. Group 2 (n = 20) did not receive any antihypertensive drugs during the entire follow-up. Eleven patients were excluded from the study thereafter. Thus, a total of 30 patients in Group 1 and 13 patients in Group 2 completed the study. We observed the patients for six months. Group 1 patients received maximal doses of angiotensin-converting enzyme inhibitors for six months. Parameters at the beginning of study and at the end of six months were evaluated. RESULTS: At the end of six months, total peritoneal protein loss in 24-hour dialysate effluent was significantly decreased in Group 1, whereas it was increased in Group 2. Compared to the baseline level, peritoneal albumin loss in 24-hour dialysate effluent and 4-hour D/P creatinine were significantly increased in Group 2 but were not significantly changed in Group 1. A covariance analysis between the groups revealed a significant difference only in the decreased amount of total protein loss in 24-hour dialysate. Proteinuria was decreased significantly in Group 1. CONCLUSION: This study suggests that angiotensin-converting enzyme inhibitors reduce peritoneal protein loss and small-solute transport and effectively protect peritoneal membrane transport in peritoneal dialysis patients.

Bronchial hyperreactivity in patients who cough after receiving angiotensin converting enzyme inhibitors

Bucknall, Christine E; Neilly, J Brian; Carter, Roger; Stevenson, Robert D; Semple, Peter F
Fonte: PubMed Publicador: PubMed
Tipo: Artigo de Revista Científica
Publicado em 09/01/1988 EN
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Angiotensin converting enzyme inhibitors cause cough in some patients, but the mechanism of this effect is not known. Six patients in whom these inhibitors had caused cough and a further two patients in whom they were suspected to have caused worsening of bronchial asthma were studied. Nine patients in whom angiotensin converting enzyme inhibitors had not been associated with cough served as controls. In the controls lung function and bronchial reactivity were measured once; for the study patients these and the cough index were measured twice before rechallenge for two weeks with an angiotensin enzyme inhibitor and once afterwards. Rechallenge with drug for two weeks caused a significant decrease in the mean concentration of histamine causing a 35% fall in airways conductance and a significant increase in the cough index. Patients with cough showed bronchial hyperactivity compared with the controls, which increased after rechallenge with the inhibitors.

Improved Peak Capacity for Capillary Electrophoretic Separations of Enzyme Inhibitors with Activity-Based Detection Using Magnetic Bead Microreactors

Yan, Xiaoyan; Gilman, S. Douglass
Fonte: PubMed Publicador: PubMed
Tipo: Artigo de Revista Científica
Publicado em /01/2010 EN
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A technique for separating and detecting enzyme inhibitors was developed using capillary electrophoresis with an enzyme microreactor. The on-column enzyme microreactor was constructed using NdFeB magnet(s) to immobilize alkaline phosphatase-coated superparamagnetic beads (2.8 μm diameter) inside a capillary before the detection window. Enzyme inhibition assays were performed by injecting a plug of inhibitor into a capillary filled with the substrate, AttoPhos. Product generated in the enzyme microreactor was detected by laser-induced fluorescence. Inhibitor zones electrophoresed through the capillary, passed through the enzyme microreactor, and were observed as negative peaks due to decreased product formation. The goal of this study was to improve peak capacities for inhibitor separations relative to previous work, which combined continuous engagement electrophoretically mediated microanalysis (EMMA) and transient engagement EMMA to study enzyme inhibition. The effects of electric field strength, bead injection time and inhibitor concentrations on peak capacity and peak width were investigated. Peak capacities were increased to ≥20 under optimal conditions of electric field strength and bead injection time for inhibition assays with arsenate and theophylline. Five reversible inhibitors of alkaline phosphatase (theophylline...

Procedure to determine enzyme inhibitors activity in cereal seeds

Pagnussatt, Fernanda Arnhold; Meza, Silvia Leticia Rivero; Buffon, Jaqueline Garda; Furlong, Eliana Badiale
Fonte: Universidade Federal do Rio Grande Publicador: Universidade Federal do Rio Grande
Tipo: Artigo de Revista Científica
ENG
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This work established a procedure for commercial fungal amylase usage as indicator of enzyme inhibitors presence in cereals, intending to screening antifungal resistance properties in cereals. Firstly, the inhibitive effects of oat, wheat and rice protein extracts were assessed against different amylase sources. It was found that the fungal amylase (Fungamyl®) was the most affected by the inhibition property of the extracts. The best conditions for inhibitor-extract-enzyme interaction were established (pH, temperature, starch concentration). Inhibition kinetic allowed their classification as mixed inhibitors. A high quocient (1.7) was observed between enzyme inhibition and Fusarium graminearum multiplication reduction. Fungamyl® amylase demonstrated its potential to detect the protein inhibitor presence in different cereals and might be employed in screening natural resistance to fungal contamination.

Epidemiological study of angioedema and ACE inhibitors

Gabb, G.; Ryan, P.; Wing, L.; Hutchinson, K.
Fonte: Wiley Publicador: Wiley
Tipo: Artigo de Revista Científica
Publicado em //1996 EN
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BACKGROUND: Angioedema is an uncommon and poorly recognised adverse reaction to angiotensin converting enzyme inhibitors (ACE-Is). The epidemiology of this association has not been described. AIMS: To examine the epidemiology of angioedema and its relation to ACE inhibitor prescribing. To examine the characteristics of angioedema occurring in patients taking ACE inhibitors. METHODS: A retrospective case control study and a case note audit were conducted of 40 patients who presented to a teaching hospital Accident and Emergency Department with angioedema on 48 occasions. One hundred and sixty control subjects presenting to the same Accident and Emergency Department but without angioedema were matched to cases by age, sex and presentation date. An ecological study comparing the numbers of angioedema admissions by age cohorts to South Australian (SA) public hospitals with the prescription volumes of ACE-Is in Australia was also undertaken. RESULTS: Case control study: In patients presenting with angioedema compared with controls, the exposure odds ratio for ACE-Is was 5.1 (95% CI 2.03–12.89) and for nonsteroidal anti-inflammatory drugs (NSAIDs) was 4.13 (95% CI 1.28–13.39). CASE NOTE AUDIT: 15/40 (38%) patients presenting with angioedema on 19/48 (40%) occasions were taking an ACE-I. These patients were older and less likely to have an atopic history than those not taking an ACE-I. The onset of angioedema after starting an ACE-I was delayed for greater than six months in nine patients. ACE-I therapy was continued after 53% of presentations. ECOLOGICAL STUDY: The number of admissions with angioedema to SA public hospitals increased between 1985–86 and 1994–95...

A comparison of outcomes with angiotensin-converting-enzyme inhibitors and diuretics for hypertension in the elderly

Wing, L.; Reid, C.; Ryan, P.; Beilin, L.; Brown, M.; Jennings, G.; Johnston, C.; McNeil, J.; MacDonald, G.; Marley, J.; Morgan, T.; West, M.
Fonte: Massachusetts Medical Soc Publicador: Massachusetts Medical Soc
Tipo: Artigo de Revista Científica
Publicado em //2003 EN
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Background Treatment of hypertension with diuretics, beta-blockers, or both leads to improved outcomes. It has been postulated that agents that inhibit the renin–angiotensin system confer benefit beyond the reduction of blood pressure alone. We compared the outcomes in older subjects with hypertension who were treated with angiotensin-converting–enzyme (ACE) inhibitors with the outcomes in those treated with diuretic agents. Methods We conducted a prospective, randomized, open-label study with blinded assessment of end points in 6083 subjects with hypertension who were 65 to 84 years of age and received health care at 1594 family practices. Subjects were followed for a median of 4.1 years, and the total numbers of cardiovascular events in the two treatment groups were compared with the use of multivariate proportional-hazards models. Results At base line, the treatment groups were well matched in terms of age, sex, and blood pressure. By the end of the study, blood pressure had decreased to a similar extent in both groups (a decrease of 26/12 mm Hg). There were 695 cardiovascular events or deaths from any cause in the ACE-inhibitor group (56.1 per 1000 patient-years) and 736 cardiovascular events or deaths from any cause in the diuretic group (59.8 per 1000 patient-years; the hazard ratio for a cardiovascular event or death with ACE-inhibitor treatment was 0.89 [95 percent confidence interval...

Toleration of high doses of angiotensin-converting enzyme inhibitors in patients with chronic heart failure - Results from the ATLAS trial

Massie, B.; Armstrong, P.; Cleland, J.; Horowitz, J.; Packer, M.; Poole-Wilson, P.; Ryden, L.
Fonte: Amer Medical Assoc Publicador: Amer Medical Assoc
Tipo: Artigo de Revista Científica
Publicado em //2001 EN
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BACKGROUND: Treatment with angiotensin-converting enzyme (ACE) inhibitors reduces mortality and morbidity in patients with chronic heart failure (CHF), but most affected patients are not receiving these agents or are being treated with doses lower than those found to be efficacious in trials, primarily because of concerns about the safety and tolerability of these agents, especially at the recommended doses. The present study examines the safety and tolerability of high- compared with low-dose lisinopril in CHF. METHODS: The Assessment of Lisinopril and Survival study was a multicenter, randomized, double-blind trial in which patients with or without previous ACE inhibitor treatment were stabilized receiving medium-dose lisinopril (12.5 or 15.0 mg once daily [OD]) for 2 to 4 weeks and then randomized to high- (35.0 or 32.5 mg OD) or low-dose (5.0 or 2.5 mg OD) groups. Patients with New York Heart Association classes II to IV CHF and left ventricular ejection fractions of no greater than 0.30 (n = 3164) were randomized and followed up for a median of 46 months. We examined the occurrence of adverse events and the need for discontinuation and dose reduction during treatment, with a focus on hypotension and renal dysfunction. RESULTS: Of 405 patients not previously receiving an ACE inhibitor...

Inhibitors of types I and II dehydroquinase

Le Sann, C.; Gower, M.; Abell, A.
Fonte: Bentham Science Publishers Ltd. Publicador: Bentham Science Publishers Ltd.
Tipo: Artigo de Revista Científica
Publicado em //2004 EN
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Inhibitors of varying potency have been developed for types I and II 3-dehydroquinate dehydratase (dehydroquinase), enzymes from the shikimate and quinate pathways that catalyse the dehydration of dehydroquinate to dehydroshikimate. These inhibitors have resulted from enzyme mechanistic studies and from the direct search for enzyme inhibitors with herbicidal, fungicidal or antimicrobial potential. This review discusses the design of the various inhibitors that have been produced so far and some structure-activity relationships. The majority of these inhibitors are based on dehydroquinate analogues, although some work has also been carried out on dehydroshikimate and bissulfonamides. Some discussion is also presented on advances in the synthesis of these types of compounds.; http://www.bentham.org/mrmc/ContentAbstract_body.htm; Christine Le Sann, Mary A. Gower and Andrew D. Abell

In silico Identifizierung neuartiger Redoxenzym-Inhibitoren zur Entwicklung von Medikamenten gegen Parasitosen und Krebs; In silico identification of novel redox enzyme inhibitors for the development of antiparasitic and anticancer drugs

Krasky, Andreas
Fonte: Universidade de Tubinga Publicador: Universidade de Tubinga
Tipo: Dissertação
DE_DE
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Die Methoden der Bio- und der Chemoinformatik sind heutzutage aus der modernen Wirkstoffforschung nicht mehr wegzudenken. Dies belegen zahlreiche Erfolgsbeispiele wie Gleevec oder Tamiflu, bei deren Entwicklung solche in silico-Methoden maßgeblich beteiligt waren. Da die dabei durchgeführten Berechnungen sehr ressourcenintensiv sind, werden leistungsfähige Computer benötigt. Neben den Grid-Computing-Systemen bieten Linux-Cluster eine probate Möglichkeit, die benötigten Ressourcen zur Verfügung zu stellen. Im Rahmen der vorliegenden Arbeit wurde eine Linux-Cluster-Umgebung für virtuelles Hochdurchsatz-Screening validiert und das Setup optimiert. Mit diesem System konnten im Anschluss sowohl Literaturdaten reproduziert, als auch neue bioaktive Enzym-Inhibitoren identifiziert werden. Darüber hinaus konnte eine bemerkenswerte Geschwindigkeitssteigerung bei gleicher Qualität der Ergebnisse gegenüber der bisher verwendeten Hardware erzielt werden. Tropische Infektionskrankheiten wie Malaria, Trypanosomiasis und Lei¬sh¬¬maniose, welche durch Protozoen der Gattungen Plasmodium sp., Trypanosoma sp. und Leishmania sp. hervorgerufen werden, haben massive Auswirkungen auf die Gesundheit des Menschen sowie auf den Wohlstand vieler Länder. Sie fordern pro Jahr mehrere Millionen Todesopfer. Da viele der zurzeit zugelassenen Medikamente für die Betroffenen nicht erschwinglich sind und sie zudem aufgrund von stärker werdenden Resistenzen immer mehr an Wirkung verlieren...

Analysis of the Cochrane Review: Angiotensin Converging Enzyme Inhibitors Versus Angiotensin Receptor Blockers for Primary Hypertension. Cochrane Database Syst Rev. 2014,8: CD009096.; Análise da Revisão Cochrane: Inibidores da Enzima de Conversão da Angiotensina Versus Antagonistas do Receptor da Angiotensina como Prevenção Cardiovascular na Hipertensão Essencial. Cochrane Database Syst Rev. 2014,8: CD009096.

Nogueira-Silva, Luís; Serviço de Medicina Interna. Centro Hospitalar S. João., E.P.E. Porto. Portugal. Centro de Investigação em Tecnologias e Sistemas de Informação em Saúde. Faculdade de Medicina. Universidade do Porto. Porto. Portugal.; Fonseca
Fonte: Ordem dos Médicos Publicador: Ordem dos Médicos
Tipo: Artigo de Revista Científica Formato: application/pdf
Publicado em 30/06/2015 POR
Relevância na Pesquisa
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Angiotensin converting enzyme inhibitors and angiotensin receptor blockers are first line drugs in the treatment of hypertension. The aim of this review was to assess if there are differences between these drug classes regarding the prevention of total mortality, occurrence of cardiovascular events and of adverse effects. A systematic review and metanalysis was performed, searching for studies that compare angiotensin converting enzyme inhibitors and angiotensin receptor blockers face-to-face, in several databases until July 2014. The study selection and data extraction were performed by 2 independent researchers. Nine studies were included, with a total of 10 963 participants, 9 398 of which participated in the same study and had high cardiovascular risk. No differences were observed regarding total mortality, cardiovascular mortality or total cardiovascular events. A slightly smaller risk was observed with angiotensin receptor blockers regarding withdrawal due to adverse effects (55 people were needed to be treated with angiotensin receptor blockers for 4.1 years to avoid one withdrawal due to adverse effect), mainly due to the occurrence of dry cough with angiotensin converting enzyme inhibitors. Thus, no differences were observed between angiotensin converting enzyme inhibitors and angiotensin receptor blockers in the prevention of total mortality and cardiovascular events...

Association between Angiotensin-Converting Enzyme Inhibitors and Troponin in Acute Coronary Syndrome

Minuzzo,Luiz; Santos,Elizabete Silva dos; Timerman,Ari
Fonte: Sociedade Brasileira de Cardiologia - SBC Publicador: Sociedade Brasileira de Cardiologia - SBC
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/12/2014 EN
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Background:Cardiovascular disease is the leading cause of mortality in the western world and its treatment should be optimized to decrease severe adverse events.Objective:To determine the effect of previous use of angiotensin-converting enzyme inhibitors on cardiac troponin I measurement in patients with acute coronary syndrome without ST-segment elevation and evaluate clinical outcomes at 180 days.Methods:Prospective, observational study, carried out in a tertiary center, in patients with acute coronary syndrome without ST-segment elevation. Clinical, electrocardiographic and laboratory variables were analyzed, with emphasis on previous use of angiotensin-converting enzyme inhibitors and cardiac troponin I. The Pearson chi-square tests (Pereira) or Fisher's exact test (Armitage) were used, as well as the non-parametric Mann-Whitney's test. Variables with significance levels of <10% were submitted to multiple logistic regression model.Results:A total of 457 patients with a mean age of 62.1 years, of whom 63.7% were males, were included. Risk factors such as hypertension (85.3%) and dyslipidemia (75.9%) were the most prevalent, with 35% of diabetics. In the evaluation of events at 180 days, there were 28 deaths (6.2%). The statistical analysis showed that the variables that interfered with troponin elevation (> 0.5 ng / mL) were high blood glucose at admission (p = 0.0034) and ST-segment depression ≥ 0.5 mm in one or more leads (p = 0.0016). The use of angiotensin-converting inhibitors prior to hospitalization was associated with troponin ≤ 0.5 ng / mL (p = 0.0482). The C-statistics for this model was 0.77.Conclusion:This study showed a correlation between prior use of angiotensin-converting enzyme inhibitors and reduction in the myocardial necrosis marker troponin I in patients admitted for acute coronary syndrome without ST-segment elevation. However...

Dyspnoea, asthma, and bronchospasm in relation to treatment with angiotensin converting enzyme inhibitors.

Lunde, H.; Hedner, T.; Samuelsson, O.; Lötvall, J.; Andrén, L.; Lindholm, L.; Wiholm, B. E.
Fonte: BMJ Group Publicador: BMJ Group
Tipo: Artigo de Revista Científica
Publicado em 01/01/1994 EN
Relevância na Pesquisa
46.24%
OBJECTIVE--To evaluate the occurrence of asthma and dyspnoea precipitated or worsened by angiotensin converting enzyme inhibitors. DESIGN--Summary of reports of adverse respiratory reaction in relation to treatment with angiotensin converting enzyme inhibitors that were submitted to Swedish Adverse Drug Reactions Advisory Committee and to World Health Organisation's international drug information system until 1992. Sales of angiotensin converting enzyme inhibitors in Sweden were also summarised. SUBJECTS--Patients receiving angiotensin converting enzyme inhibitors who reported adverse respiratory reactions. MAIN OUTCOME MEASURES--Clinical characteristics of adverse reactions of asthma, bronchospasm, and dyspnoea. RESULTS--In Sweden 424 adverse respiratory reactions were reported, of which most (374) were coughing. However, 36 patients had adverse drug reactions diagnosed as asthma, bronchospasm, or dyspnoea. In 33 of these cases the indication for treatment with angiotensin converting enzyme inhibitors was hypertension, in only three heart failure. The respiratory symptoms occurred in about half of the patients within the first two weeks of treatment, and about one third needed hospitalisation or drug treatment. Dyspnoea symptoms occurred in conjunction with other symptoms from the airways or skin in 23 out of the 36 cases. In the WHO database there were 318 reports of asthma or bronchospasm...

Angio-oedema in relation to treatment with angiotensin converting enzyme inhibitors.

Hedner, T.; Samuelsson, O.; Lunde, H.; Lindholm, L.; Andrén, L.; Wiholm, B. E.
Fonte: PubMed Publicador: PubMed
Tipo: Artigo de Revista Científica
Publicado em 11/04/1992 EN
Relevância na Pesquisa
46.26%
OBJECTIVE--To evaluate and describe the clinical course of angio-oedema reactions induced by angiotensin converting enzyme inhibitors. DESIGN AND METHODS--All reports of angio-oedema reactions associated with angiotensin converting enzyme inhibitors submitted to Swedish Adverse Reactions Advisory Committee were reviewed and the clinical courses summarised. Numbers of cases judged to be induced by angiotensin converting enzyme inhibitors were related to their annual usage, estimated from total sales of defined daily doses, as well as to the estimated number of new patients. All cases of angio-oedema associated with angiotensin converting enzyme inhibitors reported to the World Health Organisation's international drug information system were also summarised. RESULTS--36 of the 38 reported cases in Sweden between 1981 and 1990 were judged to be related to angiotensin converting enzyme inhibitors. During 1981 through 1990, altogether 1309 cases of angio-oedema associated with angiotensin converting enzyme inhibitors were registered with the international drug information system. The incidence of reported cases of angio-oedema increased largely in parallel with the increased sales (usage) of angiotensin converting enzyme inhibitors. Of the 36 Swedish patients...

The effects of angiotensin-converting enzyme inhibitors on peritoneal protein loss and solute transport in peritoneal dialysis patients

Basturk, Taner; Unsal, Abdulkadir; Koc, Yener; Nezaket, Eren; Ahbap, Elbis; Sakaci, Tamer; Sevinc, Mustafa
Fonte: Universidade de São Paulo. Faculdade de Medicina Publicador: Universidade de São Paulo. Faculdade de Medicina
Tipo: info:eu-repo/semantics/article; info:eu-repo/semantics/publishedVersion; ; Formato: application/pdf
Publicado em 01/08/2012 ENG
Relevância na Pesquisa
66.19%
OBJECTIVE: The objective of this study was to examine the effects of angiotensin-converting enzyme inhibitors on peritoneal membrane transport, peritoneal protein loss, and proteinuria in peritoneal dialysis patients. METHODS: Fifty-four peritoneal dialysis patients were included in the study. The patients were divided into two groups. Group 1 (n = 34) was treated with angiotensin-converting enzyme inhibitors. Group 2 (n = 20) did not receive any antihypertensive drugs during the entire follow-up. Eleven patients were excluded from the study thereafter. Thus, a total of 30 patients in Group 1 and 13 patients in Group 2 completed the study. We observed the patients for six months. Group 1 patients received maximal doses of angiotensin-converting enzyme inhibitors for six months. Parameters at the beginning of study and at the end of six months were evaluated. RESULTS: At the end of six months, total peritoneal protein loss in 24-hour dialysate effluent was significantly decreased in Group 1, whereas it was increased in Group 2. Compared to the baseline level, peritoneal albumin loss in 24-hour dialysate effluent and 4-hour D/P creatinine were significantly increased in Group 2 but were not significantly changed in Group 1. A covariance analysis between the groups revealed a significant difference only in the decreased amount of total protein loss in 24-hour dialysate. Proteinuria was decreased significantly in Group 1. CONCLUSION: This study suggests that angiotensin-converting enzyme inhibitors reduce peritoneal protein loss and small-solute transport and effectively protect peritoneal membrane transport in peritoneal dialysis patients.