RESUMEN
Se presenta un caso femenino de dengue clásico (DC) en el marco de la epidemia 2023-2024 en la provincia de Misiones, con predominio de síntomas dermatológicos de exantemas máculo papulosos, habonosos y eritrodérmicos sobre los síntomas sindrómicos cardinales. Las lesiones presentan componente humoral y de extravasación, sin diátesis ni componentes purpúricos apreciables, presentando una rápida y efectiva evolución al eritema y la normalización con tratamiento antihistamínico y corticoide parenteral. De la misma manera se evalúan alteraciones analíticas hematológicas y hepáticas de gran magnitud, con escasa repercusión clínica, que se mensuran en función del riesgo relativo al dengue hemorrágico (DH) y el pronóstico de la paciente. (AU)
A female case of classic dengue (DC) is presented in the context of the 2023-2024 epidemic in the province of Misiones, with a predominance of dermatologic symptoms of maculopapular, hives, and erythrodermic rashes overlapping the cardinal syndromic symptoms. The lesions have a humoral and extravasation component, without any significant diathesis or purpuric components, showing rapid and effective progression to erythema and normalization with antihistamine and parenteral corticosteroid treatment. Similarly, hematologic and hepatic analytical alterations of great magnitude are evaluated, with little clinical impact, measured in terms of relative risk for hemorrhagic dengue (HD) and the prognosis of the patient. (AU)
Asunto(s)
Humanos , Femenino , Adulto , Dengue/complicaciones , Dengue/diagnóstico , Exantema/diagnóstico , Exantema/etiología , Argentina , Betametasona/uso terapéutico , Cetirizina/uso terapéutico , Dengue/terapia , Diagnóstico Diferencial , Exantema/tratamiento farmacológico , Acetaminofén/uso terapéuticoRESUMEN
CASE DESCRIPTION: 32-month-old boy, IgG positive for SARS-CoV-2, presented to the emergency department with dermatologic lesions. CLINICAL FINDINGS: Four days before admission, he presented skin eruptions with redness and pruritus on hands and feet. Generalized papular erythema was evidenced, upper extremities with diffuse erythematosquamous plaques, palmoplantar keratoderma, so he was evaluated by a dermatologist who diagnosed pityriasis rubra pilaris. TREATMENT AND OUTCOME: rehydrating cream, cetirizine 0.5 mg/kg/day every two days, and prednisolone 2 mg/kg/day in the morning. He was discharged after 14 days, the patient presented clinical improvement, but the erythematous lesion persisted on the trunk and extremities. In the evaluation, after three months, the patient did not show the described lesions, evidencing an improvement and clinical resolution of the dermatological problems. CLINICAL RELEVANCE: We report a patient with pityriasis rubra piloris associated with a post-infection by SARS-CoV-2 that had not been described before.
Asunto(s)
COVID-19/complicaciones , Pitiriasis Rubra Pilaris/etiología , Cetirizina/administración & dosificación , Preescolar , Glucocorticoides/administración & dosificación , Humanos , Inmunoglobulina G , Masculino , Pitiriasis Rubra Pilaris/diagnóstico , Pitiriasis Rubra Pilaris/tratamiento farmacológico , Prednisolona/administración & dosificaciónRESUMEN
Abstract Case description: 32-month-old boy, IgG positive for SARS-CoV-2, presented to the emergency department with dermatologic lesions. Clinical findings: Four days before admission, he presented skin eruptions with redness and pruritus on hands and feet. Generalized papular erythema was evidenced, upper extremities with diffuse erythematosquamous plaques, palmoplantar keratoderma, so he was evaluated by a dermatologist who diagnosed pityriasis rubra pilaris. Treatment and outcome: rehydrating cream, cetirizine 0.5 mg/kg/day every two days, and prednisolone 2 mg/kg/day in the morning. He was discharged after 14 days, the patient presented clinical improvement, but the erythematous lesion persisted on the trunk and extremities. In the evaluation, after three months, the patient did not show the described lesions, evidencing an improvement and clinical resolution of the dermatological problems. Clinical relevance: We report a patient with pityriasis rubra piloris associated with a post-infection by SARS-CoV-2 that had not been described before.
Resumen Descripción del caso: Niño 32 meses de vida, con IgG positivo para SARS-CoV-2, acude al servicio de emergencia por presentar lesiones dermatológicas. Hallazgos clínicos: Cuatro días antes del ingreso presentó erupciones en la piel, con enrojecimiento y prurito en manos y pies. Se evidenció eritema papular generalizado, extremidades superiores con placas eritematoescamosas difusas, queratodermia palmo-plantar por lo que es evaluado por dermatólogo quien diagnostica pitiriasis rubra pilaris. Tratamiento y resultado: Crema rehidratantes, cetirizina 0.5 mg/kg/día cada 2 días y prednisolona 2 mg/kg/día por la mañana. Fue dado de alta a los 14 días, el paciente presenta mejora clínica, pero aún persiste la lesión eritematosa en tronco y extremidades. En la evaluación a los tres meses el paciente no mostró las lesiones descritas, evidenciando una mejoría y resolución clínica de los problemas dermatológicos. Relevancia clínica: Se reporta un paciente con afectación por pitiriasis rubra piloris asociado a una post-infección por SARS-CoV-2 que no se había descrito antes.
Asunto(s)
Preescolar , Humanos , Masculino , Pitiriasis Rubra Pilaris/etiología , COVID-19/complicaciones , Pitiriasis Rubra Pilaris/diagnóstico , Pitiriasis Rubra Pilaris/tratamiento farmacológico , Inmunoglobulina G , Prednisolona/administración & dosificación , Cetirizina/administración & dosificación , Glucocorticoides/administración & dosificaciónRESUMEN
La gingivoestomatitis herpética corres-ponde a la manifestación primaria de la infección por virus herpes simple tipo I que se presenta con mayor frecuencia en lactantes mayores y preescolares. Objeti-vo: describir abordaje y manejo de gingi-vo estomatitis herpética en una paciente con cardiopatía congénita y cuadro de desnutrición severa. El caso se refiere a paciente femenina de 16 meses de edad a quien le fue realizado anamnesis, exa-men clínicoe interconsultas con servicios de pediatría, patología, medicina bucal, infectología. El diagnóstico incluyó co-municación intraventricular, desnutrición severa y gingivoestomatitis herpética. Se realizó tratamiento paliativo para el dolor, terapia antiviral (aciclovir en suspensión 1cc cada 6 horas por 7 días) y tratamiento tópico (sucralfato en suspensión 1g/5ml mezclado en partes iguales con cetirizina en suspensión. 5 mg / 5 ml, 3 veces al día directamente sobre las lesiones) durante 14 días logrando reducción de la sintoma-tologia. Conclusiones: el correcto manejo multidisciplinario permitió lograr dismi-nución en tamaño y número de las lesio-nes en cavidad oral, orientación dietética y canalización apropiada.
A gengivoestomatite herpética correspon-de à manifestação primária da infecção pelo vírus herpes simplex tipo I, que ocorre com mais frequência em bebês e em idade pré-escolar. Objetivo: descrever a aborda-gem e o tratamento da estomatite herpética gengival em um paciente com cardiopatia congênita e desnutrição grave. O caso re-fere-se a uma paciente de 16 meses de ida-de, submetida a anamnese, exame clínico e interconsultas com serviços de pediatria, patologia, medicina bucal, infectologia. O diagnóstico incluiu comunicação intraven-tricular, desnutrição grave e gengivosto-matite herpética. Foram realizados trata-mento paliativo para dor, terapia antiviral (suspensão de aciclovir 1cc a cada 6 horas por 7 dias) e tratamento tópico (suspensão de sucralfato 1g / 5ml misturado em partes iguais com suspensão de cetirizina 5mg / 5ml, 3 vezes ao dia diretamente. lesões) por 14 dias, alcançando redução dos sintomas. Conclusões: o correto manejo multidisci-plinar permitiu diminuir o tamanho e o número de lesões na cavidade oral, orien-tação alimentar e canalização adequada.
Herpetic gingivostomatitis is the pri-mary manifestation of herpes simplex virus type I infection, common in older infants and preschoolers. Objective: to describe the approach and management of herpetic stomatitis in a patient with congenital heart disease and severe mal-nutrition. The case refers to a 16-mon-th-old female patient who underwent an anamnesis, clinical examination, and inter-consultations with pediatric, pa-thological, oral medicine services, and Diagnosis included intraventricular communication, severe malnutrition, and herpetic gingivostomatitis. Palliati-ve treatment for pain, antiviral therapy (acyclovir suspension 1cc every 6 hours for 7 days) and topical treatment (sucral-fate suspension 1g / 5ml mixed in equal parts with cetirizine suspension 5mg / 5ml, 3 times a day directly, were perfor-med. about injuries) for 14 days. Conclu-sions: multidisciplinary, management, allowed to obtain, clinical diagnosis and establish a treatment plan with positive outcome,decreasing oral cavity dietary guidance and appropriate channeling.
Asunto(s)
Humanos , Femenino , Lactante , Antivirales , Cardiopatías Congénitas , Herpes Simple , Estomatitis Herpética , Sucralfato , Aciclovir , Cetirizina , Simplexvirus , Medicina Oral , AnamnesisAsunto(s)
Cetirizina/administración & dosificación , Dapsona/administración & dosificación , Eosinofilia/complicaciones , Eritema/tratamiento farmacológico , Hidroxicloroquina/administración & dosificación , Prednisona/administración & dosificación , Enfermedades Cutáneas Genéticas/tratamiento farmacológico , Femenino , Humanos , Persona de Mediana EdadRESUMEN
Muitos estudos sugerem que a urticária crônica espontânea (UCE) seja uma doença autoimune. A primeira linha de tratamento consiste no uso de anti-histamínicos H1 de segunda geração, que podem ser empregados em até quatro vezes a dose recomendada. A Dapsona diaminodifenil sulfona (DDS) é um quimioterápico com propriedades antimicrobianas e anti-inflamatórias. Em dermatologia, a DDS é usada em doenças nas quais predominam neutrófilos. O omalizumabe é um anticorpo monoclonal, que se liga às moléculas de IgE na circulação e impede que estas IgEs se liguem aos seus receptores. Omalizumabe é recomendado como terceira linha de tratamento de pacientes com UCE, refratários a anti-histamínicos em doses quadriplicadas, na dose de 300 mg a cada quatro semanas. Paciente do sexo feminino, com 41 anos, com UCE sem períodos de remissão por mais de um ano, tratada sem sucesso, com diferentes anti-histamínicos. Existia uma extensa investigação laboratorial. Foi-lhe administrada Cetirizina (anti-histamínico H1 de segunda geração), em elevada dose (40 mg/dia) associada a antileucotrieno (10 mg/dia) por um período de duas semanas. No final do período, a UCE manteve-se completamente inalterada. Foi realizada biopsias das urticas com diagnóstico histopatológico "Dermatite neutrofílica com infiltrado intersticial neutrofílico, sem vasculite ativa e sem eosinófilos". Na falta de omalizumabe, a paciente continuou o tratamento com Cetirizina (40 mg/dia), agora associado a 100 mg/dia de DDS. Atualmente, após 16 semanas de observação, seu quadro mantém-se estável, com urticas ausentes, afora alguns surtos leves, intermitentes. Poder-se-ia usar a DDS na UCE refratária a anti-histamínicos? Alguns estudos bem conduzidos oferecem essa oportunidade.
Many studies suggest that chronic spontaneous urticaria (CSU) is an autoimmune disease. The first line of treatment consists of the use of second-generation H1 antihistamines, which can be used at up to four times the recommended dose. dapsone diaminodiphenyl sulfone (DDS) is a chemotherapeutic agent with antimicrobial and anti-inflammatory properties. In dermatology, DDS is used to treat diseases in which neutrophils predominate. Omalizumab is a monoclonal antibody that binds to IgE molecules in the circulation and prevents these IgEs from binding to their receptors. Omalizumab is recommended as a third-line treatment for patients with CSU refractory to antihistamines in quadruplicate doses, at a dose of 300 mg every four weeks. A 41 year-old female patient with CSU without remission periods for more than one year was unsuccessfully treated with different antihistamines. An extensive laboratory investigation was conducted. She was given a high dose (40 mg/day) of cetirizine (second-generation H1 antihistamine) associated with antileukotriene (10 mg/ day) for a period of two weeks. At the end of the period, CSU remained completely unchanged. Wheal biopsies were performed, with histopathological diagnosis: neutrophilic dermatitis with neutrophilic interstitial infiltrate, without active vasculitis and without eosinophils. In the absence of omalizumab, the patient continued treatment with cetirizine (40 mg/day), now associated with 100 mg/day of DDS. Currently, after 16 weeks of observation, her condition remains stable and the wheals disappeared, apart from some mild, intermittent outbreaks. Could DDS be used in the CSU refractory to antihistamines? Some well-conducted studies offer this opportunity.
Asunto(s)
Humanos , Femenino , Adulto , Cetirizina , Dapsona , Omalizumab , Urticaria Crónica , Pacientes , Terapéutica , Inmunoglobulina E , Antagonistas de los Receptores Histamínicos H1 , Anticuerpos MonoclonalesRESUMEN
Gabapentin (GBP) is an organic cation mainly eliminated unchanged in urine, and active drug secretion has been suggested to contribute to its renal excretion. Our objective was to evaluate the potential drug-drug interaction between GBP and cetirizine (CTZ), an inhibitor of transporters for organic cations. An open-label, 2-period, crossover, nonrandomized clinical trial was conducted in patients with neuropathic pain to evaluate the effect of CTZ on GBP pharmacokinetics. Twelve participants were treated with a single dose of 300 mg GBP (treatment A) or with 20 mg/d of CTZ for 5 days and 300 mg GBP on the last day of CTZ treatment (treatment B). Blood sampling and pain intensity evaluation were performed up to 36 hours after GBP administration. The interaction of GBP and CTZ with transporters for organic cations was studied in human embryonic kidney (HEK) cells expressing the organic cation transporters (OCTs), multidrug and toxin extrusion proteins (MATEs), and OCTN1. CTZ treatment resulted in reduced area under the concentration-time curve and peak concentration compared with treatment A. In treatment B, the lower plasma concentrations of GBP resulted in reduced pain attenuation. GBP renal clearance was similar between treatments. GBP has low apparent affinity for OCT2 (concentration of an inhibitor where the response [or binding] is reduced by half [IC50 ] 237 µmol/L) and a high apparent affinity for hMATE1 (IC50 1.1 nmol/L), hMATE2-K (IC50 39 nmol/L), and hOCTN1 (IC50 2.1 nmol/L) in HEK cells. At therapeutic concentrations, CTZ interacts with hMATE1 and OCTN1. In summary, CTZ reduced the systemic exposure to GBP and its effect on neuropathic pain attenuation. However, CTZ × GBP interaction is not mediated by the renal transporters.
Asunto(s)
Analgésicos/farmacocinética , Cetirizina/metabolismo , Cetirizina/farmacocinética , Gabapentina/farmacocinética , Proteínas de Transporte de Catión Orgánico/metabolismo , Adulto , Analgésicos/administración & dosificación , Analgésicos/sangre , Analgésicos/orina , Área Bajo la Curva , Cationes/metabolismo , Cetirizina/administración & dosificación , Estudios Cruzados , Interacciones Farmacológicas , Femenino , Gabapentina/administración & dosificación , Gabapentina/sangre , Gabapentina/orina , Células HEK293 , Humanos , Masculino , Persona de Mediana Edad , Neuralgia/tratamiento farmacológico , Proteínas de Transporte de Catión Orgánico/genética , Transportador 2 de Cátion Orgánico/genética , Dimensión del Dolor/efectos de los fármacos , Polimorfismo Genético , Eliminación Renal/efectos de los fármacos , Simportadores/genética , Simportadores/metabolismoRESUMEN
Introdução: A urticária crônica é caracterizada pela presença de placas eritematosas cutâneas com prurido por mais de 6 semanas, com ou sem angioedema. Estudos indicam que essa afecção afeta cerca de 1% da população mundial, sendo que a maior parte desses casos de causas idiopáticas. A qualidade de vida em pacientes com urticária pode ser gravemente prejudicada. Os objetivos desse estudo são caracterizar o perfil epidemiológico da urticária crônica dentro de um serviço especializado público no estado da Bahia, bem como avaliar a influência dessa disfunção na qualidade de vida desses pacientes. Métodos: Trata-se de um estudo descritivo observacional a partir de informações extraídas dos prontuários de 135 pacientes atendidos no serviço de Alergia e Imunologia do Ambulatório Magalhães Neto, pertencente ao Complexo do Hospital Universitário Edgard Santos da Universidade Federal da Bahia. Resultados: Indivíduos do sexo feminino representam 80,0% do número total de participantes desse estudo; 71 indivíduos (52,6%) têm mais de 45 anos de idade; foi verificada a presença de angioedema associado à urticária em 52,0% dos participantes. O tempo médio do início dos sintomas associados à doença foi de 7,3 anos, e o tempo médio de diagnóstico da doença foi de 4,4 anos. Com relação à presença de comorbidades, a mais prevalente foi a rinite alérgica (27,0%). O fármaco mais utilizado no tratamento desses participantes foi a Cetirizina, que foi prescrita em 36,0% dos casos. Para 31% a urticária crônica espontânea afeta muito a sua qualidade de vida. Conclusões: O perfil dos participantes desse estudo se assemelha ao de outros em estudos realizados no mundo. A urticária crônica impacta predominantemente de forma moderada a qualidade de vida, e mais fortemente as dimensões sono/estado mental e alimentação.
Introduction: Chronic urticaria is characterized by the presence of erythematous skin plaques with pruritus for more than 6 weeks, with or without angioedema. Studies indicate that this condition affects about 1% of the world population, with idiopathic causes accounting for most cases. Quality of life in patients with urticaria can be severely impaired. The objectives of this study were to characterize the epidemiological profile of chronic urticaria within a specialized public service in the state of Bahia and to evaluate the influence of this disorder on the quality of life of these patients. Methods: This was an observational descriptive study based on information extracted from the medical records of 135 patients seen at the Department of Allergy and Immunology of the Magalhaes Neto Outpatient Clinic, which belongs to the Edgard Santos University Hospital Complex of the Federal University of Bahia. Results: Women accounted for 80.0% of the sample; 71 individuals (52.6%) were over 45 years of age. Presence of angioedema was associated with urticaria in 52.0% of participants. The mean time to the onset of disease-associated symptoms was 7.3 years, and the mean time to disease diagnosis was 4.4 years. Regarding the presence of comorbidities, allergic rhinitis was the most prevalent disorder (27.0%). Cetirizine was the most commonly used drug for treatment, being prescribed in 36.0% of cases. Chronic spontaneous urticaria was reported to greatly affect quality of life by 31% of participants. Conclusions: The profile of the participants in this study resembles that of participants in studies conducted worldwide. Overall, chronic urticaria has a moderate impact on quality of life and a stronger impact on the dimensions of sleep / mental state and diet.
Asunto(s)
Humanos , Cetirizina , Rinitis Alérgica , Urticaria Crónica , Angioedema , Pacientes , Calidad de Vida , Signos y Síntomas , Terapéutica , Preparaciones Farmacéuticas , Diagnóstico , Alergia e Inmunología , Hospitales UniversitariosRESUMEN
Abstract Introduction Oral antihistamines and intranasal corticosteroids have been shown to be effective and safe for the treatment of allergic rhinitis; however, the evidence suggests a level of superiority of corticosteroids, so they should be preferred over the former. Objective To know the prescription profile of two second generation antihistamines (cetirizine and levocetirizine) and two nasal corticosteroids (mometasone and furoateciclesonide) in a cohort of patients with allergic rhinitis, and to compare the clinical outcomes obtained. Methods A cohort study was carried including patients with allergic rhinitis treated with cetirizine, levocetirizine, mometasone furoate or ciclesonide. The improvement was evaluated with the total nasal symptoms score (TNSS). This scale yields results between 0 and 12. Zero indicates absence of symptoms. Results A total of 314 patients completed 12 weeks of follow-up. Seventy-five percent were treated with antihistamines, 20% with corticosteroids, and 5% with a combination of the above. The TNSS median for corticosteroid was 2.5 points; for antihistamines, its was 5 points, and for combination, it was 4 points. We found differences between corticosteroids and antihistamines. Conclusion The prescription percentage of second generation oral antihistamines is higher than that of intranasal corticosteroids. However, patients with allergic rhinitis treated with the second option obtained better control of symptoms.
Asunto(s)
Humanos , Masculino , Femenino , Lactante , Preescolar , Niño , Adolescente , Adulto , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Corticoesteroides/uso terapéutico , Rinitis Alérgica/tratamiento farmacológico , Antagonistas de los Receptores Histamínicos/uso terapéutico , Prescripciones de Medicamentos , Administración Intranasal , Estudios de Cohortes , Resultado del Tratamiento , Cetirizina/uso terapéutico , Corticoesteroides/administración & dosificación , Colombia , Furoato de Mometasona/uso terapéuticoRESUMEN
BACKGROUND: Lichen planopilaris (LPP) is characterized by lymphocytic infiltrate, fibrosis and potential destruction of the hair follicle. Demographic and clinical studies in LPP are limited, and racial differences have not been thoroughly investigated. AIM: To analyse epidemiological data and clinical profiles of Chilean adults with LPP, and report on the treatments used. METHODS: This was a retrospective review of medical records and clinical follow-up of Chilean adults with a clinical and histopathological diagnosis of LPP. Treatment response was categorized clinically as none (with progression of condition), mild or satisfactory. RESULTS: The study assessed 103 patients with LPP [67 women (mean age 54.1 years) and 36 men (mean age 39.1 years)]. Of the 103 patients, 41 women and 34 men were diagnosed with classic LPP (CLPP) and 26 women and 1 man with frontal fibrosing alopecia (FFA), while Graham-Little-Piccardi-Lassueur syndrome (GLPLS) was identified in 1 man. Men with CLPP had a significantly (P < 0.001) earlier age of onset than women. Scalp dysaesthesia, erythema and peripilar hyperkeratosis were common findings, and 51 (66%) of patients with CLPP had cicatricial patches, most of which were circumscribed in the vertex area. All patients with FFA had band-like scarring in the frontal and temporal hairlines. Morbidities associated with LPP were hypothyroidism, dyslipidaemia, hypertension and depression. For most patients, treatment halted or improved their inflammatory/scarring condition. A sustained combination of at least one topical (clobetasol, minoxidil and salicylic acid) and one systemic (cetirizine, hydroxychloroquine, finasteride, methotrexate and isotretinoin) medication was necessary in all of our patients with LPP. CONCLUSION: This investigation is one of the first to describe the demographic, clinical and therapeutic features of LPP in a Latin American population. Similar profiles to previous reports may encourage research in larger multicentre international studies.
Asunto(s)
Liquen Plano/tratamiento farmacológico , Liquen Plano/epidemiología , Dermatosis del Cuero Cabelludo/tratamiento farmacológico , Dermatosis del Cuero Cabelludo/epidemiología , Administración Tópica , Adulto , Edad de Inicio , Alopecia/etiología , Cetirizina/uso terapéutico , Chile/epidemiología , Clobetasol/uso terapéutico , Quimioterapia Combinada , Femenino , Glucocorticoides/uso terapéutico , Humanos , Liquen Plano/complicaciones , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Distribución por Sexo , Factores SexualesRESUMEN
BACKGROUND: Histamine receptors are known to participate in spinal cord nociceptive transmission, and previous studies have suggested that histaminergic receptors are involved in the analgesic effects of morphine. Herein, we investigated the effect of intrathecal injection of histaminergic agonists and antagonists in a model of acute articular inflammation and their interaction with morphine. METHODS: After carrageenan injection in the right knee joint, articular incapacitation was measured hourly, for up to 6 hours, by the paw elevation time during 1-minute periods of stimulated walking. Inflammatory edema was also assessed hourly by determining an increase in articular diameter. Spinal treatments were administered 20 minutes before knee-joint carrageenan injection and were compared with the saline-treated control group. RESULTS: Intrathecally injected histamine increased incapacitation and articular edema, whereas the H1R antagonist, cetirizine, decreased both parameters. The H3R agonist, immepip, decreased both incapacitation and edema, but the H3R antagonist, thioperamide, increased both incapacitation and edema. Morphine inhibited both incapacitation and edema. Furthermore, combining a subeffective dose of morphine with cetirizine or immepip potentiated the analgesic and antiedematogenic effect. CONCLUSIONS: Histamine seems to act at the spinal level via H1 and H3 receptors to modulate acute arthritis in rats. An H1R antagonist and H3R agonist were found to potentiate the analgesic and antiedematogenic effects of morphine, suggesting that histaminergic and opioid spinal systems may be explored for means of improving analgesia, as well as peripheral anti-inflammatory effects.
Asunto(s)
Analgésicos Opioides/administración & dosificación , Antiinflamatorios/administración & dosificación , Edema/tratamiento farmacológico , Agonistas de los Receptores Histamínicos/farmacología , Antagonistas de los Receptores Histamínicos/farmacología , Histamina/metabolismo , Articulaciones/inervación , Morfina/administración & dosificación , Osteoartritis/tratamiento farmacológico , Médula Espinal/efectos de los fármacos , Animales , Carragenina , Cetirizina/farmacología , Modelos Animales de Enfermedad , Relación Dosis-Respuesta a Droga , Edema/inducido químicamente , Edema/metabolismo , Edema/fisiopatología , Antagonistas de los Receptores Histamínicos H1 no Sedantes/farmacología , Antagonistas de los Receptores Histamínicos H3/farmacología , Imidazoles/farmacología , Inyecciones Espinales , Masculino , Osteoartritis/inducido químicamente , Osteoartritis/metabolismo , Osteoartritis/fisiopatología , Piperidinas/farmacología , Ratas Wistar , Receptores Histamínicos H1/efectos de los fármacos , Receptores Histamínicos H1/metabolismo , Receptores Histamínicos H3/efectos de los fármacos , Receptores Histamínicos H3/metabolismo , Médula Espinal/metabolismo , Médula Espinal/fisiopatologíaRESUMEN
Objetivos: Comparar el crecimiento de Streptococus mutans antes y después de la aplicación de cetirizina y prednisona con y sin sacarosa a las 6, 12, 24 y 36 horas. Métodos: Diseño experimental, para ello se utilizó una muestra de 84 tubos de ensayo, 6 tubos por cada una de las medicinas o controles utilizados. Las variables que se consideraron fueron medicinas pediátricas con edulcorantes divididas en dos grupos: cetirizinas y prednisonas. En el grupo de las cetirizinas se consideraron las cetirizinas comerciales Hisaler®, Lergium® y Rigotax®, así como los preparados de cetirizina con xilitol, sacarosa y aspartame. En el grupo de las prednisonas se consideraron las prednisonas comerciales: Cortiprex® y Nisona® así como los preparados de prednisona con sacarosa y otros edulcorantes. La técnica que se empleó fue la de turbimetría la cual nos da el indicador absorvancia. Resultados: los resultados fueron leídos a las 6, 12, 24 y 36 horas. Conclusiones: Las medicinas comerciales que presentaron menor crecimiento de Streptococcus mutans fueron Rigotax® y Nisona®. Los preparados que presentaron menor crecimiento de Streptoccoccus mutans fueron cetirizina con aspartame y prednisona con edulcorante. Las medicinas comerciales presentaron diferencias estadísticamente significativas con sus respectivos preparados, produciéndose menor crecimiento de Streptococcus mutans en las medicinas comerciales.
Objetives: To compare the growth of Streptococcus mutans, before and after the application of cetirizine and prednisone with and without sucrose at 6, 12, 24 and 36 hours. Methods: The type of study was experimental. To carry it on, a sample of 84 test tubes was used, 6 tubes for each of the medications or controls. The variables considered were pediatric medication with sweeteners, divided in two groups: cetirizines and prednisones. In the cetirizines groups, those over the counter were: Hisaler®, Lergium® and Rigotax®; those that in their formulas included cetirizine with xylitol, sucrose, and aspartame. In the prednisone groups, which are over the counter, the following were found: Cortiprex® and Nisona®, as well as those that in their formulas included prednisone with saccarose and other sweeteners. The method used was turbimetry with the spectrophotometer, to meassure: absorbency. Results: The results were read at 6, 12, 24 and 36 hours. Conclusions: The commercial medications that showed less growth of the Streptococcus mutans, were Rigotax® and Nisona®. The preparation that showed less growth of the Streptococcus mutans were cetirizine with aspartame and prednisone with sorbitol. Over the counter medications showed significant statistical differences with their respective preparation, producing less growth of the Streptococcus mutans in over the counter medications.
Asunto(s)
Cetirizina , Crecimiento Bacteriano , Técnicas In Vitro , Prednisona , Streptococcus mutans/crecimiento & desarrolloRESUMEN
We developed a capillary electrophoresis (CE) and dispersive liquid-liquid microextraction (DLLME) method to stereoselectively analyze hydroxyzine (HZ) and cetirizine (CTZ) in liquid culture media. The CE analyses were performed on an uncoated fused-silica capillary; 50mmolL(-1) sodium borate buffer (pH 9.0) containing 0.8% (w/v) S-ß-CD was used as the background electrolyte. The applied voltage and temperature were +6 kV and 15 °C, respectively, and the UV detector was set to 214 nm. Chloroform (300 µL) and ethanol (400 µL) were used as the extraction and disperser solvents, respectively, for the DLLME. Following the formation of a cloudy solution, the samples were subjected to vortex agitation at 2000 rpm for 30s and to centrifugation at 3000 rpm for 5 min. The recoveries ranged from 87.4 to 91.7%. The method was linear over a concentration range of 250-12,500 ng mL(-1) for each HZ enantiomer (r>0.998) and 125-6250 ng mL(-1) for each CTZ enantiomer (r>0.998). The limits of quantification were 125 and 250 ng mL(-1) for CTZ and HZ, respectively. Among the six fungi studied, three species were able to convert HZ to CTZ enantioselectively, particularly the fungus Cunninghamella elegans ATCC 10028B, which converted 19% of (S)-HZ to (S)-CTZ with 65% enantiomeric excess.
Asunto(s)
Antialérgicos/aislamiento & purificación , Cetirizina/aislamiento & purificación , Cunninghamella/metabolismo , Hidroxizina/aislamiento & purificación , Microextracción en Fase Líquida/métodos , Antialérgicos/química , Antialérgicos/metabolismo , Biotransformación , Cetirizina/química , Cetirizina/metabolismo , Cloroformo/química , Medios de Cultivo , Electroforesis Capilar , Etanol/química , Concentración de Iones de Hidrógeno , Hidroxizina/química , Hidroxizina/metabolismo , Solventes/química , EstereoisomerismoRESUMEN
UNLABELLED: Formalin injected in the knee joint of rats produces concentration-dependent nociception, edema, and plasma leakage (PL). Herein, we investigated the effect of histamine H1 receptor (H1R) antagonists in this model. Articular nociception was inferred from the paw elevation time (PET; seconds) during 1-minute periods of stimulated walking, determined every 5 minutes, throughout a 60-minute experimental session. Edema was evaluated by the increase in articular diameter (AD; mm), and PL was measured by the amount of Evans blue dye in the synovial fluid (PL; µg/mL). Loratadine and cetirizine, given systemically, both increased the PET. None of the treatments changed the AD and PL. Loratadine given locally with formalin increased the PET but was without effect when given in the contralateral knee. Systemic loratadine was also without effect when formalin was coinjected with sodium cromoglycate. Histamine and the selective H1R agonist 2-pyridylethylamine decreased the PET and potentiated morphine spinal analgesia, but did not affect the AD and PL. Cetirizine prevented the antinociceptive effect of the H1R agonist. The N-methyl-D-aspartate/histamine-site agonist tele-methylhistamine coinjected with formalin only increased PET. Serotonin alone had no effect on the PET and increased the AD, and the highest dose increased the PL. When coinjected with formalin, serotonin only caused hypernociception, and the highest dose also increased AD. NAN 190, cyproheptadine, and ondansetron (respectively, 5-HT1, 5-HT2, and 5-HT3 receptor antagonists) decreased the PET without changing the AD or PL. Collectively, these results suggest that in rats, the H1R plays an antinociceptive role within the knee joint, while serotonin receptors play a pronociceptive role. PERSPECTIVE: The present study revealed an antinociceptive mechanism that has previously not been detected by traditional nociceptive tests. Our observations may help to improve the development of new pharmacological strategies for the treatment of clinically relevant pains that generally originate in deep structures.
Asunto(s)
Histamina/farmacología , Articulación de la Rodilla/efectos de los fármacos , Serotonina/farmacología , Análisis de Varianza , Animales , Cetirizina , Edema/inducido químicamente , Edema/terapia , Azul de Evans , Formaldehído/toxicidad , Antagonistas de los Receptores Histamínicos H1/farmacología , Articulación de la Rodilla/inervación , Masculino , Trastornos del Movimiento/dietoterapia , Trastornos del Movimiento/etiología , Dolor/tratamiento farmacológico , Dimensión del Dolor , Ratas , Ratas Wistar , Serotoninérgicos/farmacologíaRESUMEN
OBJECTIVE: Bilastine is a non-sedating second-generation H(1) antihistamine with proven efficacy and safety in the treatment of patients with seasonal allergic rhinitis and urticaria. The objective of this study was to demonstrate the efficacy and safety of bilastine in patients with perennial allergic rhinitis (PAR). METHODS: In a multicenter, randomized, placebo-controlled, double-blind, parallel-group study, patients with symptomatic PAR (n = 650) from Argentina, Europe, and South Africa received bilastine 20 mg, cetirizine 10 mg, or placebo once daily for 4 weeks. The primary efficacy outcome was the mean area under the curve (AUC) of reflective total 6-symptom scores (rT6SS) from baseline visit to day 28 (D28). Secondary outcome measures included mean AUC of instantaneous total 6-symptom scores (iT6SS), and mean AUCs of reflective and instantaneous total 4-nasal symptom scores (T4NSS) and total 2-ocular symptom scores (T2OSS) from baseline to D28. An open-label extension phase evaluated the safety of bilastine 20 mg administered to patients (n = 513) for one year. RESULTS: In the overall population no significant differences in efficacy outcomes were found between active treatments and placebo. On account of the high placebo response in South Africa, a post-hoc analysis was conducted. This analysis demonstrated that statistically significant differences existed between active treatments and placebo in the mean AUC of rT6SS (p < 0.05) and T4NSS (p < 0.02), respectively, from baseline to D28 visit for the intent-to-treat population in patients from Europe and Argentina, whereas the difference was not statistically significant in South Africa. Whether this is related to differences in the demographic or clinical characteristics of South African patients (they had PAR for longer and reported more severe symptoms) and/or the disease management process compared with their European and Argentinean counterparts warrants further investigation. CONCLUSIONS: A post-hoc analysis indicated that bilastine and cetirizine were similarly effective and more effective than placebo during a 4-week treatment period in patients with PAR. In addition, bilastine was shown to be safe and well-tolerated over a 1-year treatment period. CLINICAL TRIAL REGISTRY NUMBER: NCT01127620.
Asunto(s)
Bencimidazoles/administración & dosificación , Bencimidazoles/efectos adversos , Cetirizina/administración & dosificación , Cetirizina/efectos adversos , Piperidinas/administración & dosificación , Piperidinas/efectos adversos , Rinitis Alérgica Perenne/tratamiento farmacológico , Adolescente , Adulto , Anciano , Antialérgicos/administración & dosificación , Antialérgicos/efectos adversos , Argentina , Niño , Formas de Dosificación , Método Doble Ciego , Esquema de Medicación , Europa (Continente) , Femenino , Humanos , Masculino , Persona de Mediana Edad , Placebos , Sudáfrica , Resultado del Tratamiento , Adulto JovenRESUMEN
La Pitiriasis Rubra Pilaris (PRP) es una dermatosis papuloescamosa crónica, de etiología desconocida. Se caracteriza por la presencia de pápulas foliculares hiperqueratósicas que coalescen formando placas eritematoescamosas, dejando islotes de piel sana entre las lesiones. Puede llegar a una eritrodermia. Se clasifica en base a la edad de presentación, características morfológicas, evolución y pronóstico. Existen múltiples opciones de tratamiento descritas en la literatura, siendo los retinoides sistémicos el tratamiento de primera línea en estos pacientes. Presentamos dos casos de pacientes con PRP eritrodérmica tratados exitosamente con Acitretín y revisión de la literatura a la fecha.
Pityriasis Rubra Pilaris is a chronic inflammatory dermatosis of unknown etiology, characterized by the presence of multiple follicular papules that coalesce into large erythematous or salmon colored plaques with islands of non-involved skin between them. It can eventually evolve into erythroderma. Descriptions and therapeutic experiences are mainly based on case reports. Today retinoids have become de first line treatment in these patients. We present two cases of erythrodermic PRP treated successfully with Acitretin and an updated review of the literature.
Asunto(s)
Humanos , Masculino , Femenino , Adolescente , Persona de Mediana Edad , Pitiriasis Rubra Pilaris/diagnóstico , Pitiriasis Rubra Pilaris/patología , Pitiriasis Rubra Pilaris/tratamiento farmacológico , Acitretina/uso terapéutico , Cetirizina/uso terapéutico , Dermatitis Exfoliativa , Diagnóstico Diferencial , Pitiriasis Rubra Pilaris/clasificación , Queratolíticos/uso terapéutico , Retinoides/uso terapéuticoRESUMEN
BACKGROUND: With the current increasing incidence of allergies worldwide, new treatments showing efficacy and long term safety are needed for chronic conditions such as persistent allergic rhinitis (PER). New generation H1-antihistamines have demonstrated anti-allergic properties, which could possibly enhance their effectiveness in long-term periods of treatment. OBJECTIVE: To investigate the efficacy of rupatadine, in controlling symptoms of PER over a 12-week period. METHODS: A randomized, double blind, parallel-group, placebo-controlled study was carried out in patients aged older than 12 years with PER. Main inclusion criteria were: instantaneous total symptom score (i6TSS) >or=45, nasal obstruction score
Asunto(s)
Antialérgicos/uso terapéutico , Cetirizina/uso terapéutico , Ciproheptadina/análogos & derivados , Rinitis Alérgica Perenne/tratamiento farmacológico , Adolescente , Adulto , Antialérgicos/administración & dosificación , Antialérgicos/efectos adversos , Cetirizina/administración & dosificación , Cetirizina/efectos adversos , Ciproheptadina/administración & dosificación , Ciproheptadina/efectos adversos , Ciproheptadina/uso terapéutico , Método Doble Ciego , Femenino , Humanos , Masculino , Índice de Severidad de la Enfermedad , Factores de Tiempo , Resultado del TratamientoRESUMEN
We describe a liquid chromatography-tandem mass spectrometric method (LC-MS/MS) for levocetirizine quantification (I) in human plasma. Sample preparation was made using a fexofenadine (II) addition as internal standard (IS), liquid-liquid extraction using cold dichloromethane, and dissolving the final extract in acetonitrile. I and II (IS) were injected in a C18 column and the mobile phase composed of acetonitrile:water:formic acid (80.00:19.90:0.10, v/v/v) and monitored using positive electrospray source with tandem mass spectrometry analyses. The selected reaction monitoring (SRM) was set using precursor ion and product ion combinations of m/z 389>201 for I and m/z 502>467 for II. The limit of quantification and the dynamic range achieved were 0.5ng/mL and 0.5-500.0ng/mL. Validation results on linearity, specificity, accuracy, precision and stability, as well as its application to the analysis of plasma samples taken up to 48h after oral administration of 5mg of levocetirizine dichloridrate in healthy volunteers demonstrate its applicability to bioavailability studies.
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Cetirizina/sangre , Antagonistas de los Receptores Histamínicos H1/sangre , Piperazinas/sangre , Espectrometría de Masa por Ionización de Electrospray/métodos , Adolescente , Adulto , Disponibilidad Biológica , Cetirizina/farmacocinética , Estudios Cruzados , Antagonistas de los Receptores Histamínicos H1/farmacocinética , Humanos , Persona de Mediana Edad , Piperazinas/farmacocinética , Reproducibilidad de los Resultados , Sensibilidad y Especificidad , Equivalencia TerapéuticaRESUMEN
OBJECTIVES: To perform a critical evaluation of the more recent H1 antihistamines and the various terms used to describe them, based on a review of evidence on their role in the treatment of allergic disorders. SOURCES OF DATA: Original articles, reviews and consensus documents published from 1998 to 2006 and indexed in the MEDLINE and PubMed databases. Keyword: antihistamines. SUMMARY OF THE FINDINGS: Second-generation antihistamines differ from first-generation ones because of their elevated specificity and affinity for peripheral H1 receptors and because of their lower penetration of the central nervous system (CNS), having fewer sedative effects as a result. Whilst second-generation antihistamines are in general better tolerated than their predecessors, some adverse effects, principally cardiotoxicity, have been observed with some of them. Over the last 20 years, new compounds with different pharmacokinetic properties have been synthesized. The majority of these exhibit anti-inflammatory properties that are independent of their action on the H1 receptor. More recent improvements, generally in the form of active metabolites, led to the use of the term third-generation antihistamines. This term emerged spontaneously, with no clear definition of its meaning or clinical implications, creating great confusion among healthcare professionals. CONCLUSION: On the basis of the evidence on H1 antihistamines, none of them deserve the title "third-generation antihistamine." As the Consensus Group on New Generation Antihistamines concluded, to merit this definition, a new class of antihistamines would have to demonstrate distinct clinical advantages over existing compounds and fulfill at least three prerequisites: they should be free from cardiotoxicity, drug interactions and effects on the CNS.