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Phytotherapy Research : PTR Jul 2022Coronavirus disease 2019 (COVID-19) is caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), which has a high mortality rate and transmissibility. In... (Review)
Review
Coronavirus disease 2019 (COVID-19) is caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), which has a high mortality rate and transmissibility. In this context, medicinal plants have attracted attention due to the wide availability and variety of therapeutic compounds, such as alkaloids, a vast class with several proven pharmacological effects, like the antiviral and anti-inflammatory activities. Therefore, this scoping review aimed to summarize the current knowledge of the potential applicability of alkaloids for treating COVID-19. A systematic search was performed on PubMed and Scopus, from database inception to August 2021. Among the 63 eligible studies, 65.07% were in silico model, 20.63% in vitro and 14.28% clinical trials and observational studies. According to the in silico assessments, the alkaloids 10-hydroxyusambarensine, cryptospirolepine, crambescidin 826, deoxynortryptoquivaline, ergotamine, michellamine B, nigellidine, norboldine and quinadoline B showed higher binding energy with more than two target proteins. The remaining studies showed potential use of berberine, cephaeline, emetine, homoharringtonine, lycorine, narciclasine, quinine, papaverine and colchicine. The possible ability of alkaloids to inhibit protein targets and to reduce inflammatory markers show the potential for development of new treatment strategies against COVID-19. However, more high quality analyses/reviews in this field are necessary to firmly establish the effectiveness/safety of the alkaloids here described.
Topics: Alkaloids; Antiviral Agents; Humans; SARS-CoV-2; COVID-19 Drug Treatment
PubMed: 35355337
DOI: 10.1002/ptr.7442 -
Journal of Cardiothoracic Surgery Dec 2021Internal thoracic arteries (ITAs) are the gold standard conduits for coronary revascularization because of their long-term patency and anti-atherosclerotic properties.... (Review)
Review
Internal thoracic arteries (ITAs) are the gold standard conduits for coronary revascularization because of their long-term patency and anti-atherosclerotic properties. Harvesting and preparation of ITAs for revascularization is a technically demanding procedure with multiple challenges. Over the last few decades, various methods and techniques for ITAs harvesting have been introduced by different surgeons and applied in clinical practice with different results. Harvesting of ITAs in pedicled or skeletonized fashion, with electrocautery or harmonic scalpel, with open or intact pleura, with clipping the end or keeping it perfused; papaverine delivery with intraluminal injection, perivascular injection, injecting into endothoracic fascia, and papaverine topical spray are the different techniques introduced by the number of researchers. At the same time, access to the ITAs for harvesting has also been studied. Access and harvesting through median sternotomy, mini anterolateral thoracotomy, thoracoscopic, and robotic-assisted harvesting of ITAs are the different techniques used in clinical practice. However, the single standard method for harvesting and preparation of ITAs has yet to be determined. In this review article, we aimed to discuss and analyze all these techniques of harvesting and preparing ITAs with the help of literature to find the best way for ITAs harvesting and preparation for myocardial revascularization.
Topics: Humans; Mammary Arteries; Myocardial Revascularization; Papaverine; Thoracotomy; Tissue and Organ Harvesting
PubMed: 34961523
DOI: 10.1186/s13019-021-01733-2 -
Sexual Medicine Reviews Jul 2021The diagnosis of erectile dysfunction (ED) often involves a combination of patient history, questionnaire responses, and laboratory results. Penile duplex ultrasound... (Review)
Review
INTRODUCTION
The diagnosis of erectile dysfunction (ED) often involves a combination of patient history, questionnaire responses, and laboratory results. Penile duplex ultrasound (PDU) with intracavernous injection of papaverine was introduced as a noninvasive tool to aid in the evaluation of penile circulation. Although PDU is widely used in the initial workup of ED, the true value and effect of PDU on management is still unclear.
OBJECTIVE
The objective of this systematic review was to determine if PDU affects ED management.
METHODS
A systematic literature review was conducted using PUBMED-Medline databases in June 2020, which included literature from 1991 through 2019. The search strategy used MeSH terms "penile", "duplex ultrasound", or "duplex ultrasonography". The database process yielded a total of 389 terms. Systematic review followed the Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines.
RESULTS
6 studies were included in the final analysis and included a total of 386 patients. These articles each discussed the clinical utility of PDU using venous and arterial parameters and correlated treatment response to sexual functioning questionnaires. The majority of the studies demonstrated PDU was unnecessary for diagnosis and ultimately did not affect treatment decision-making.
CONCLUSION
PDU generally does not change management in men with established organic ED but may prove useful in special populations such as in younger patients or patients with anatomical abnormalities. Limitations include the small number of focused studies on the topic and paucity of randomized trials investigating PDU and clinician decision-making. Further investigations and studies are needed to determine if PDU modifies ED provider's management decision-making. Nashed A, Lokeshwar SD, Frech F, et al. The Efficacy of Penile Duplex Ultrasound in Erectile Dysfunction Management Decision-Making: A Systematic Review. Sex Med Rev 2021;9:472-477.
Topics: Erectile Dysfunction; Humans; Male; Papaverine; Penis; Surveys and Questionnaires
PubMed: 33250351
DOI: 10.1016/j.sxmr.2020.10.006 -
World Journal of Cardiology Jun 2020Cardiac catheterization is among the most performed medical procedures in the modern era. There were sporadic reports indicating that cardiac arrhythmias are common...
BACKGROUND
Cardiac catheterization is among the most performed medical procedures in the modern era. There were sporadic reports indicating that cardiac arrhythmias are common during cardiac catheterization, and there are risks of developing serious and potentially life-threatening arrhythmias, such as sustained ventricular tachycardia (VT), ventricular fibrillation (VF) and high-grade conduction disturbances such as complete heart block (CHB), requiring immediate interventions. However, there is lack of systematic overview of these conditions.
AIM
To systematically review existing literature and gain better understanding of the incidence of cardiac arrhythmias during cardiac catheterization, and their impact on outcomes, as well as potential approaches to minimize this risk.
METHODS
We applied a combination of terms potentially used in reports describing various cardiac arrhythmias during common cardiac catheterization procedures to systematically search PubMed, EMBASE and Cochrane databases, as well as references of full-length articles.
RESULTS
During right heart catheterization (RHC), the incidence of atrial arrhythmias (premature atrial complexes, atrial fibrillation and flutter) was low (< 1%); these arrhythmias were usually transient and self-limited. RHC associated with the development of a new RBBB at a rate of 0.1%-0.3% in individuals with normal conduction system but up to 6.3% in individuals with pre-existing left bundle branch block. These patients may require temporary pacing due to transient CHB. Isolated premature ventricular complexes or non-sustained VT are common during RHC (up to 20% of cases). Sustained ventricular arrhythmias (VT and/or VF) requiring either withdrawal of catheter or cardioversion occurred infrequently (1%-1.3%). During left heart catheterizations (LHC), the incidence of ventricular arrhythmias has declined significantly over the last few decades, from 1.1% historically to 0.1% currently. The overall reported rate of VT/VF in diagnostic LHC and coronary angiography is 0.8%. The risk of VT/VF was higher during percutaneous coronary interventions for stable coronary artery disease (1.1%) and even higher for patients with acute myocardial infarctions (4.1%-4.3%). Intravenous adenosine and papaverine bolus for fractional flow reserve measurement, as well as intracoronary imaging using optical coherence tomography have been reported to induce VF. Although uncommon, LHC and coronary angiography were also reported to induce conduction disturbances including CHB.
CONCLUSION
Cardiac arrhythmias are common and potentially serious complications of cardiac catheterization procedures, and it demands constant vigilance and readiness to intervene during procedures.
PubMed: 32774779
DOI: 10.4330/wjc.v12.i6.269 -
European Urology Focus Sep 2020The genesis of neurogenic sexual dysfunction (NSD) can be central, peripheral, or both. The correct stratification of the level of sexual dysfunction allows the...
CONTEXT
The genesis of neurogenic sexual dysfunction (NSD) can be central, peripheral, or both. The correct stratification of the level of sexual dysfunction allows the clinician to choose the best type of treatment, in order to reduce sexual complaints.
OBJECTIVE
The aim of our review is to focus on the management of NSD due to central nervous system disorders and peripheral neuropathy.
EVIDENCE ACQUISITION
A systematic review of the English-language literature was completed until July 2019 in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. The following terms were included: [(neurogenic sexual dysfunction) OR neurogenic erectile dysfunction)] AND (treatment OR management). An Excel file was created respecting the following criteria: participants, interventions, comparators, outcomes, and study design (PICOS).
EVIDENCE SYNTHESIS
Overall, from 505 identified records, 52 full-text articles were assessed for eligibility. Finally, 46 original researches were included in quantitative analysis.
CONCLUSIONS
The phosphodiesterase type 5 inhibitors sildenafil, tadalafil, and vardenafil were proved to be effective and safe in first-line therapy of erectile dysfunction caused by neurogenic disorders. In addition, intracavernous injections of prostaglandin E1, papaverine, or phentolamine and vacuum systems have been a mainstay of second-line treatment for NSD, extremely successful in the spinal cord injury population. Surgical therapy via penile prosthesis implantation remains a viable alternative as a third-line approach and may also be utilised to assist men with bladder management, despite higher complication rates of infections. Despite poor evidence, a better understanding of female sexual dysfunction due to neurological complaints is needed, in order to find more efficacious therapies for intercourse and orgasmic phase. Further prospective studies are required to better clarify the more successful treatment in improving sexual function and quality of life of these patients.
PATIENT SUMMARY
Management of neurogenic sexual dysfunction includes phosphodiesterase type 5 inhibitors, intracavernous injections/vacuum devices, and penile prosthesis implantation. Female sexual dysfunction due to neurological disease needs to be better investigated.
Topics: Central Nervous System Diseases; Female; Humans; Male; Peripheral Nervous System Diseases; Sexual Dysfunction, Physiological
PubMed: 31879263
DOI: 10.1016/j.euf.2019.12.002 -
Journal of Intensive Care Medicine Feb 2020Intensive care patients with nonocclusive mesenteric ischemia (NOMI) show mortality rates of 70% to 90%. Besides emergency surgery, different interventional local... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Intensive care patients with nonocclusive mesenteric ischemia (NOMI) show mortality rates of 70% to 90%. Besides emergency surgery, different interventional local vasodilatory treatment (LVT) attempts have been described. We performed a systematic review and a meta-analysis to evaluate feasibility, efficacy, and tolerability of LVT in patients with life-threatening NOMI.
METHODS
Searches of PubMed, EMBASE, Web of Science, and Cochrane Library databases were performed until February 2019. Measured outcomes included immediate technical success rates (as indicated by mesenteric vasodilation on angiography or clinical improvement) and adverse events (AEs). Therapeutic efficacy was measured by the assessment of overall mortality.
RESULTS
Twelve studies (335 patients, 245 received LVT) from 1977 to 2018 were included. All studies were retrospective (4 comparative and 8 noncomparative). Different intra-arterial vasodilators (4× papaverine, 6× prostaglandin E1, 1× tolazoline/heparin, 1× tolazoline + iloprost) were reported. Initial technical success rate was 75.9% (95% confidence interval [CI], 55.1%-89%, = .017) with an AE rate of 2.9% (95% CI: 1.3%-6.6%; = .983). Overall mortality in LVT patients was 40.3% (95% CI: 28.7%-53%, = .134). In 4 studies, outcomes were compared between patients receiving LVT to those who received standard of care (odds ratio for death in LVT patients was 0.261 [95% CI: 0.095-0.712, = .009]).
CONCLUSIONS
Local vasodilatory treatment appears to be safe in patients with NOMI and might have the potential to at least partially reverse mesenteric vasoconstriction features in control angiographies. However, with no randomized and prospective studies available yet, the overall quality of published studies has to be considered as low; therefore, it is not possible to draw generalizable conclusions from the present data concerning clinical end points. Its application might hold promise as a rescue treatment strategy and deserves further evaluation in randomized controlled trials.
Topics: Critical Care; Humans; Intensive Care Units; Mesenteric Ischemia; Odds Ratio; Retrospective Studies; Standard of Care; Treatment Outcome; Vasodilation; Vasodilator Agents
PubMed: 31645176
DOI: 10.1177/0885066619879884 -
Sexual Medicine Reviews Jul 2016Despite improvements in the care of patients after spinal cord injury (SCI), permanent impairment of locomotion, sensation, and autonomic function remains a major... (Meta-Analysis)
Meta-Analysis Review
INTRODUCTION
Despite improvements in the care of patients after spinal cord injury (SCI), permanent impairment of locomotion, sensation, and autonomic function remains a major hurdle. After the acute stage of injury, recovering sexual function is a high priority.
AIM
To review the efficacy of intracavernous injections (ICIs) in men with SCI and to identify prognostic factors affecting the efficacy of ICIs in this population.
METHODS
Systematic review of the literature was conducted using the PubMed-Medline, Embase, EBSCO, Web of Science, and Cochrane Library databases. The literature search was restricted to articles published in English, French, and Spanish up to November 2014 using the key words alprostadil, papaverine, moxisylite, alpha-blocking agent, phentolamine, intracavernous injection, spinal cord injuries, paraplegia, quadriplegia, and erectile dysfunction. Studies involving patients with SCI and erectile dysfunction treated with ICIs of alprostadil, papaverine, and α-blocking agents, including retrospective and prospective cohorts, population studies, and randomized controlled trials, were included.
MAIN OUTCOME MEASURE
Overall response rate to ICI for erectile dysfunction in patients with SCI.
RESULTS
Of 283 studies identified, 23 involved 713 patients with SCI. ICIs resulted in successful erections in 88% of patients (n = 713, 95% CI = 83%-92%). Erections were obtained in 93% of patients (n = 101, 95% CI = 83%-99%) with the combination of papaverine and phentolamine, in 91% (n = 274, 95% CI = 78%-97%) with papaverine alone, and in 80% (n = 119, 95% CI = 64%-90%) with alprostadil. Type of injected drug, doses, level of injury (complete or incomplete), extent of injury, age, time since injury, and persistence or transience of erections were evaluated, but statistical analysis could not identify specific factors predictive of a response to ICI.
CONCLUSION
ICIs are an effective treatment of erectile dysfunction in men with SCI. No predictive factor for efficacy could be identified. Studies comparing the response to ICI in upper vs lower motor neuron lesions could improve our understanding of ICI failure.
Topics: Alprostadil; Erectile Dysfunction; Humans; Male; Moxisylyte; Papaverine; Penile Erection; Prospective Studies; Retrospective Studies; Spinal Cord Injuries; Vasodilator Agents
PubMed: 27871959
DOI: 10.1016/j.sxmr.2016.02.005 -
Minerva Anestesiologica Nov 2015Post-traumatic vasospasm (PTV) remains a poorly understood entity. Using a systematic review approach, we examined the incidence, mechanisms, risk factors, impact on... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Post-traumatic vasospasm (PTV) remains a poorly understood entity. Using a systematic review approach, we examined the incidence, mechanisms, risk factors, impact on outcome and potential therapies of PTV.
METHODS
A search on Medline database up to 2015 performed with "traumatic brain injury" and "vasospasm" key-words retrieved 429 references. This systematic review was reported and analysed following the PRISMA criteria and according to the relevance in human clinical practice.
RESULTS
The research retrieved 429 references of which 226 were excluded from analysis because of their irrelevance and 87 finally included in the review.
CONCLUSION
Mechanical stretching, inflammation, calcium dysregulation, endotelin, contractile proteins, products of cerebral metabolism and cortical spreading depolarization have been involved in PTV pathophysiology. PTV occurs in up to 30-40% of the patients after severe traumatic brain injury. Usually, PTV starts within the first 3 days following head trauma and may last 5 to 10 days. Young age, low Glasgow Coma Score at admission and subarachnoid hemorrhage have been identified as risk factors of PTV. Suspected on transcranial Doppler, PTV diagnosis is best confirmed by angiography, CT angiography or MR angiography, and perfusion and ischaemic consequences by perfusion CT or MRI. Early PTV is associated with poor outcome. No PTV prevention strategy has proved efficient up to now. Regarding PTV treatment, only nimodipine and intra-arterial papaverine have been studied up to now. Treatment with milrinone has been described in a few cases reports and may represent a new therapeutic option.
Topics: Brain Injuries, Traumatic; Humans; Vasospasm, Intracranial
PubMed: 26372114
DOI: No ID Found -
Plastic and Reconstructive Surgery Aug 2015Intraoperative vasospasm during reconstructive microsurgery is common, often unpredictable, and potentially devastating with regard to flap survival. Current methods of... (Review)
Review
BACKGROUND
Intraoperative vasospasm during reconstructive microsurgery is common, often unpredictable, and potentially devastating with regard to flap survival. Current methods of pharmacologic management vary, and may be shifting as a result of changes in the availability of individual medications. This review aims to provide a concise examination of the published literature regarding use, efficacy, and adverse effects of the agents described for local management of vascular spasm during microsurgery.
METHODS
A systematic review of the literature was performed to identify articles relevant to pharmacologic treatment of intraoperative vasospasm in vivo. An additional review of the literature was performed with regard to each agent identified in order to provide clinical background information.
RESULTS
Systematic review identified 20 articles, in which 14 vasodilator agents were evaluated. Drugs were classified into five pharmacologic categories: phosphodiesterase inhibitors (papaverine, pentoxifylline, and amrinone), local anesthetics (lidocaine), calcium channel blockers (nicardipine, verapamil, nifedipine, and magnesium sulfate), direct vasodilators (sodium nitroprusside, prostaglandin E1, nitroglycerin, and hydralazine), and alpha antagonists (phentolamine and chlorpromazine). Despite a variety of methods, these studies indicate some degree of experimental evidence of efficacy for each of these agents.
CONCLUSIONS
Available literature regarding use of topical vasodilating agents for intraoperative management of vasospasm during microsurgery is limited and largely based on animal models, which may not reliably generalize to the reconstructive patient population. Well-controlled translational study in clinically applicable and reproducible models is needed to guide evidence-based clinical management of this important phenomenon.
Topics: Administration, Topical; Constriction, Pathologic; Female; Follow-Up Studies; Hospital Mortality; Humans; Intraoperative Complications; Male; Microsurgery; Plastic Surgery Procedures; Risk Assessment; Survival Rate; Treatment Outcome; Vasoconstriction; Vasodilator Agents
PubMed: 25909299
DOI: 10.1097/PRS.0000000000001431