Current pharmaceutical design
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Review
Anesthetic neuroprotection: antecedents and an appraisal of preclinical and clinical data quality.
Anesthetics have been studied for nearly fifty years as potential neuroprotective compounds in both perioperative and resuscitation medicine. Although anesthetics present pharmacologic properties consistent with preservation of brain viability in the context of an ischemic insult, no anesthetic has been proven efficacious for neuroprotection in humans. After such effort, it could be concluded that anesthetics are simply not neuroprotective in humans. ⋯ In publications intended to define anesthetic neuroprotection, we found overall poor quality of both preclinical efficacy analysis portfolios and clinical trial designs and conduct. Hence, using current translational research standards, it was not possible to conclude from existing data whether anesthetics ameliorate perioperative ischemic brain injury. Incorporation of advances in translational neuroprotection research conduct may provide a basis for more definitive and potentially successful clinical trials of anesthetics as neuroprotectants.
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Review
Is time to change to halogenated drugs in cardiac surgery, what do we have to do with propofol?
There is initial evidence, at least in cardiac surgery, that total intra-venous anesthesia (usually a propofol-based total intravenous anesthesia) is associated with an increased mortality when compared to an anesthetic plan including a halogenated anesthetics. The cardiac protective properties of halogenated agents (desflurane, isoflurane and sevoflurane) have not been confirmed in non-cardiac surgery and mixed results exist for patients admitted in postoperative intensive care units. This article summarizes the papers with the most impressive findings in favor of halogenated anesthetics, but it recognizes that, at the same time, there is no evidence based medicine against the use of propofol, highlighting the need for large randomized trials that should focus on survival.
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P2Y12 inhibitors constitute an essential part of the antithrombotic treatment, with proven clinical benefit in acute coronary syndromes and after percutaneous coronary interventions. Substantial evidence has emerged that, apart from their primary antiplatelet action, P2Y12 receptor inhibitors exhibit several off-target effects. In this review, we present the supporting evidence of P2Y12 inhibitors' pleiotropic actions, discuss their clinical implications and underscore the necessity for further research on this issue.
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General anesthesia-induced pharmacological protection of the central nervous system following injury has been under intense investigations during the past four decades. Indeed, if general anesthetics could provide therapeutic benefit in the event of hypoxia, ischemia or any other kinds of brain lesions, that would be of tremendous clinical importance. The potential for anesthesia-related brain protection, however, has been seriously challenged during the past 10 years. ⋯ The biological rational for anesthesia neurotoxicity will then be explored together with existing experimental and clinical evidence in favor of this possibility. Finally, insights into the increasing number of both experimental and clinical data suggesting that general anesthetics, especially ketamine, support the therapeutic value of these drugs in major depressive disorders. When taken together, these seemingly contradictory observations suggest the intriguing possibility that general anesthetics could stand as valuable context-dependent modulators of neural plasticity.
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Tuberculosis caused by Mycobacterium tuberculosis is an infectious bacterial disease which is a leading cause of mortality affecting more than 9 million people worldwide. The current standard regimens that are available for the treatment of TB are severely hampered due to the occurrence of multidrug-resistant (MDR-TB) and extensively drug-resistant (XDR-TB) strains of Mycobacterium tuberculosis. In the past few years, a huge and constantly expanding effort has been developed to understand the chemical-biological interaction of many new anti-tubercular drugs and their targets in mathematical terms. Here, we have elected to review only those studies concerning 2D and 3D QSAR models that contain different DFT based descriptors as their parameters.