Despigmentação precoce em caso de ceratopigmentação / Early depigmentation in case of keratopigmentation

RESUMO A ceratopigmentação teve seu primeiro registro pelo filósofo Galeno há muitos séculos como uma estratégia utilizada para o tratamento estético de pacientes com leucomas. As córneas com leucoma são patológicas e, muitas vezes, intolerantes a lentes de contato cosméticas ou próteses oculares, sendo comum a queixa de desconforto excessivo, proporcionado pela superfície corneana irregular. Assim, a ceratopigmentação é uma alternativa para a melhora estética de pacientes com opacidades corneanas. Descrevemos o caso de um paciente do sexo masculino, 39 anos, que apresentou despigmentação precoce em caso de ceratopigmentação associado a quadro de ceratite herpética necrotizante. O paciente foi submetido ao tratamento com aciclovir 2g ao dia e doxiciclina 200mg ao dia, evoluindo com melhora do quadro clínico, apesar da má adesão medicamentosa.

ABSTRACT Keratopigmentation was first recorded many centuries ago by the philosopher Galeno, as a strategy used for the aesthetic treatment of patients with leukomas. Corneas with leucoma are pathological and often intolerant of cosmetic contact lenses or ocular prostheses, with complaints of excessive discomfort provided by the irregular corneal surface being common. Therefore, keratopigmentation is an alternative for the aesthetic improvement of patients with corneal opacities. We describe the case of a 39-year old male patient, who presented early depigmentation in a case of keratopigmentation associated with necrotizing herpetic keratitis. The patient was treated with Acyclovir 2g/day and Doxycycline 200mg/day, evolving with clinical improvement, despite poor medication adherence.

Encefalitis por Virus Herpes Simplex con PCR persistentemente positivo en líquido cefalorraquídeo. A propósito de un caso neonatal

RESUMEN Las infecciones por herpes virus en la etapa neonatal pueden causar una alta morbimortalidad. La persistencia del virus, a pesar del tratamiento de primera línea, puede llevar a consecuencias devastadoras para el paciente. Presentamos el caso de un paciente neonato con persistencia de Virus Herpes Simplex en LCR, en el cual fue necesario iniciar foscarnet para contener la infección.

ABSTRACT Herpes virus infections in the neonatal stage can cause high morbidity and mortality. The persistence of the virus, despite first-line treatment, can lead to devastating consequences for the patient. We present the case of a neonatal patient with persistence of Herpes Simplex Virus in the CSF, in whic foscarnet treatment was required to contain the infection.

Encefalopatía como forma de presentación de la COVID-19

RESUMEN Introducción: El virus SARS-CoV-2, responsable de la COVID-19 presenta una alta tasa de contagio y es capaz de producir afecciones a diferentes niveles en el organismo, e incluye el sistema nervioso central, con manifestaciones como crisis convulsiva febril y afebril, estado de mal epiléptico, encefalopatías y encefalitis. Objetivo: Describir un paciente con encefalopatía, como forma de presentación de la COVID-19. Caso clínico: Paciente de 25 años con antecedentes de hidrocefalia obstructiva postraumática, con derivación ventrículo - peritoneal, positivo a la COVID-19, quien desarrolló manifestaciones neurológicas, en ausencia de manifestaciones respiratorias. Fue tratado según el protocolo para pacientes con la COVID-19, medidas antiedema cerebral y uso del péptido CIGB-258. Tuvo una evolución favorable hacia la recuperación. Conclusiones: En pacientes con encefalopatía de causa desconocida, en el contexto de la pandemia por la COVID-19, debe considerarse la infección por SARS-CoV-2. La evolución puede ser favorable con el uso de medidas generales y antiedema cerebral.

ABSTRACT Introduction: SARS-CoV-2 virus, responsible for COVID-19, has a high contagion rate and is capable of producing conditions at different levels in the body, and includes the central nervous system, with manifestations such as febrile and afebrile seizures, status epilepticus, encephalopathies and encephalitis. Objective: To describe a patient with encephalopathy, as a form of presentation of COVID-19. Clinical case: A 25-year-old patient with a history of post-traumatic obstructive hydrocephalus, with ventricular peritoneal shunt, positive for COVID-19, who developed neurological manifestations, in the absence of respiratory manifestations. He was treated according to the protocol for patients with COVID-19, anti-cerebral edema measures and use of the CIGB-258 peptide. The patient had a favorable evolution towards recovery Conclusions: In patients with encephalopathy of unknown cause, in the context of the COVID-19 pandemic, SARS-CoV-2 infection should be considered. The evolution can be favorable with the use of general measures and anti-cerebral edema.

Aciclovir endovenoso como tratamiento en la parálisis facial periférica e idiopática en un recién nacido. Reporte de caso

Introducción: la parálisis facial neonatal debida a la parálisis de Bell es rara. El mecanismo de parto traumático representa una etiología más común. Caso clínico: neonato, previamente sano, con parto espontáneo no instrumentalizado y sin complicaciones obstétricas, que cursó con parálisis facial derecha aguda. La imagen cerebral fue normal y los hallazgos clínicos compatibles con parálisis de Bell, con buena respuesta al manejo antirretroviral y fisioterapia. Discusión: la mayoría de infantes con parálisis de Bell mejora con o sin tratamiento y sin secuelas graves. No hay evidencia concluyente en la población pediátrica sobre el beneficio de usar esteroides, solos o con antirretrovirales. Actualmente, tampoco existe un consenso sobre la seguridad de usar esteroides posnatales tardíos, que se deben reservar para neonatos sin otra opción. El aciclovir a dosis de 60 mg/Kg/día es seguro en neonatos. Conclusiones: la parálisis de Bell neonatal puede presentar una respuesta favorable a la terapia antirretroviral y fisioterapia, prescindiendo del uso de esteroides.

SUMMARY Introduction: Neonatal facial palsy due to Bell's palsy is rare. A traumatic delivery mechanism represents a common etiology. Clinical case: Neonate, without previous illnesses, born by spontaneous non-instrumentalized delivery and without any obstetric complications; who presented acute right facial palsy, with normal brain imaging and clinical findings compatible with Bell's palsy, who had a good response to antiretroviral management and physical therapy. Discussion: Most infants with Bell's palsy improve with or without treatment, with no serious sequelae. In pediatric population, evidence on benefits of steroids use, alone or with antiretrovirals, has not been conclusive. There is not a current consensus on the safety of late postnatal steroid use, and they should be reserved for neonates who have no other treatment choice. Acyclovir use at 60/mg/Kg/day it's safe in neonates. Conclusions: Neonatal Bell's palsy may present a favorable response to antiretroviral therapy and an adherent physical rehabilitation program, irrespective of steroids use.

Necrosis retiniana aguda por virus varicela zoster en un paciente inmunocompetente con seguimiento de la respuesta terapéutica mediante reacción de polimerasa en cadena / Acute retinal necrosis by varicella zoster virus in an immunocompetent patient with therapeutic follow up by PCR

Resumen Presentamos el caso de un varón de 63 años, inmunocompetente, con una necrosis retinal aguda (NRA) unilateral. Consultó por visión borrosa, dolor ocular, fotofobia y cefalea. Se confirmó una papilitis y coriorretinitis periférica asociada a vasculitis e isquemia retinal periférica. El estudio molecular por RPC de humor acuoso detectó la presencia de virus varicela zoster. El paciente fue tratado con terapia combinada con corticoesteroides orales, aciclovir oral/intravenoso, ganciclovir intravítreo semanal y luego valaciclovir oral por tres meses. Se demostró una disminución progresiva de la carga viral en el humor acuoso durante el tratamiento. El seguimiento mostró una mejoría del cuadro inflamatorio y una leve recuperación de la agudeza visual, sin embargo, finalmente presentó un desprendimiento de retina con pérdida casi total de la visión unilateral. La NRA es una complicación infrecuente provocada por algunos virus herpes con mal pronóstico visual, desenlace que puede ser mejorado con un diagnóstico y tratamiento precoz con antivirales. El tratamiento prolongado permite evitar la recaída y el compromiso contralateral.

Abstract We present the case of a 63-year-old immunocompetent man with unilateral acute retinal necrosis (ARN). He consulted for blurred vision, eye pain, photophobia, and headache. Papillitis and peripheal chorioretinitis associated with vasculitis and peripheral retinal ischemia was confirmed. PCR from aqueous humor sample detected varicella zoster virus. The patient was treated with a combined therapy of oral corticosteroids, oral / intravenous acyclovir along with weekly intravitreous ganciclovir doses followed by oral valaciclovir for three months. A progressive decrease in viral load in aqueous humor was demonstrated during treatment. Follow-up showed improvement in the inflammatory condition and a slight recovery of visual acuity, however, finally he presented a retinal detachment with total loss of one-sided vision. ARN is an uncommon complication caused by some herpesviruses with a poor visual prognosis, an outcome that can be improved with early diagnosis and treatment using appropriate antivirals. Prolonged treatment reduces relapse frequency and fellow eye compromise.

Improvement of Transdermal Delivery of Aciclovir Aliphatic Ester Prodrugs by Using Supersaturated System / 中国药房

OBJECTIVE：To prepare supersaturated system of lip ophilic aci clovir（ACV）prodrug，and to increase the cutaneous bioavailability of ACV. METHODS ：Three prodrugs of ACV were synthesized by anhydride acylation ，i.e. aciclovir acetate （ACV-Ace），butyrate（ACV-But）and hexanoate （ACV-Hex）. The structures of ACV and three ACV prodrugs were confirmed by 1H-NMR and HRESI-MS ；the concentrations of ACV and three ACV prodrugs were determined by UPLC-triple quadrupole tandem mass spectrometry ，and saturated solubility of them in different volume fractions of propylene glycol-water solution was calculated. The compound with the greatest potential of form supersaturated system was screened out. The supersaturated system of that compound was prepared by co-solvent method. The effect of hydroxypropyl methylcellulose E 3 （HPMC E 3） on its physical stability was observed by light microscope. Vertical Franz diffusion cells were used to study the effects of degree of supersaturation （DS）and HPMC E 3 on the deposited amount of drug in the excised porcine skin after using the supersaturated system for 1 h. The distribution of ACV in the excised porcine skin was determined by frozen slicing stratified quantitative method after using the supersaturated system and marketed aciclovir cream for 1 h. RESULTS ：Three ACV prodrugs were successfully synthesized. The established quantification methods met the requirements of biological sample analysis. Among all of the three ACV prodrugs ， ACV-Hex showed the lowest saturated solubility in water [ （0.5±0.0）mmol/L] a nd the highest saturated solubility in propylene glycol [（53.4 ± 14.2）mmol/L]，which made it potentially feasible to form supersaturated system with high DS. In 10％propylene glycol-water system ，the addition of HPMC E 3 163.com enabled ACV-Hex supersaturated systems ，with DS no morethan 4，to maintain physical stability within 1 h. The total deposited amount （ACV + ACV-Hex ） in skin after the application of ACV-Hex supersaturated system with DS of 4 for 1 h was higher than that after the application of ACV-Hex supersaturated system with DS less than 4 or without HPMC E 3. In addition ，the concentration of ACV in the basal epidermis （skin thickness was 100-160 mm）by supersaturated system was significantly higher than that of the marketed aciclovir cream （P＜0.05）. CONCLUSIONS：ACV-Hex，the lipophilic prodrug of ACV ，can form stable supersaturated system with DS of 4 in 10％ propylene glycol-water system in the presence of HPMC E 3. High concentration of ACV could be accumulated in the basal epidermis after the skin was exposed to supersaturated system for 1 h，which may be valuable for local treatment skin infection of herpes simplex virus .

Comparative Efficacy of Different Chemotherapeutic Regimens in the Treatment of Peste des Petits Ruminants in West African Dwarf Goats / Eficacia comparativa de diferentes regímenes quimioterapéuticos en el tratamiento de la Peste des petits ruminants (PPR) en cabras enanas de África occidental

Abstract The comparative efficacy of different chemotherapeutic regimes in the treatment of natural clinical infection of Peste des petits ruminants (PPR) infection in West African Dwarf (WAD) goats were determined. Twenty WAD male goats divided into five groups, of four each were used. Group 1 was the combined therapy group treated with Acyclovir, Oxytetracycline and Ivermectin, Group 2 was treated with Acyclovir only, Group 3 was treated with Ivermectin only, Group 4 was treated with Oxytetracycline only and Group 5 was left untreated. Clinical signs such as nasal and ocular discharges, emaciation, anorexia, pyrexia, ulcerative oral lesions, respiratory distress and diarrhoea were observed in these goats during the period of their acclimatization. The prominent post-mortem lesion observed was discontinuous streaks of congestion (Zebra markings) in the mucosa of the colon and rectum. The physiologic parameters (temperature, pulse rate, heart rate, and respiratory rate) were taken daily. It was observed that there was a significant increase in the temperature above normal in the untreated group, suggesting pyrexia. It was also observed that the combined therapy group showed a smaller number of mortality and thus, had a better efficacy when compared to the other chemotherapeutic agents used singly.

Resumen Se determinó la eficacia comparativa de diferentes regímenes quimioterapéuticos en el tratamiento de la infección clínica natural con la Peste de los pequeños rumiantes (PPR) en cabras enanas de África occidental (WAD). Se usaron veinte cabras WAD machos, distribuidas en cinco grupos, de cuatro cabras cada uno. El grupo 1 fue el grupo de terapia combinada, tratado con aciclovir, oxitetraciclina e ivermectina. El grupo 2 fue tratado solo con aciclovir. El grupo 3 fue tratado con ivermectina solamente. El Grupo 4 fue tratado con oxitetraciclina y el grupo 5 no recibió tratamiento. Se observaron signos clínicos como secreciones nasales y oculares, emaciación, anorexia, pirexia, lesiones orales ulcerativas, dificultad respiratoria y diarrea en estas cabras durante su periodo de aclimatación. La lesión post-mórtem más notable que se observó fueron las manchas descontinuas de congestión (como las rayas de la cebra) en la mucosa del colon y del recto. Los parámetros fisiológicos (temperatura, frecuencia del pulso, ritmo cardiaco y frecuencia respiratoria) se midieron diariamente. Se observó que había un aumento significativo en la temperatura por encima de lo normal en el grupo sin tratamiento, lo que sugirió pirexia. También se observó que el grupo de terapia combinada mostró una cifra de mortalidad menor y, por ende, allí hubo una mejor eficacia en comparación con los otros agentes quimioterapéuticos usados solos.

Meningoencefalitis por herpes simple: una visión de la infección viral que causa el mayor compromiso cerebral / Herpes simplex virus encephalitis: an overview of the viral infection causing the greatest brain compromise

La inflamación del sistema nervioso central secundaria a la infección por la familia herpesviridae puede generar un compromiso difuso del parénquima encefálico, la cual puede ser fatal en ausencia de un rápido diagnóstico y tratamiento. Objetivo: revisar las diferentes características biológicas, fisiopatológicas, clínicas, terapéuticas y pronóstico del meningoencefalitis causada por VHS-1 y 2. Materiales y métodos: revisión de la literatura científica (revisión crítica), llevada a cabo mediante las bases de datos Medline y buscadores específicos IMBIOMED, PUBMEDE, SCIENCEDIRECT, SCIELO, con un total de 150 artículos, se priorizaron 67 los cuales fueron leídos a profundidad. Resultados y discusión: debido el neurotropismo del herpes virus simple puede causar neuroinvasividad, neurotoxicidad y latencia en el SNC. Por sus características semiológicas inespecíficas se requiere un estudio exhaustivo para lograr el diagnóstico acertado. Los métodos actuales tales como neuroimágenes y PCR han aportado al esclarecimiento del diagnóstico etiológico de esta patología. La detección temprana de la entidad y la instauración precoz del tratamiento, se asocian con un aumento en la tasa de supervivencia y a una disminución de las secuelas neurológicas. Conclusión: conocer la biología del virus, su comportamiento, las características clínicas y el tratamiento de la entidad es una estrategia eficaz para disminuir secuelas y desenlaces fatales.

Central nervous system (CNS) inflammation secondary to an infection by the Herpesviridae family may generate a diffuse compromise of the encephalic parenchyma which may be fatal in the absence of a rapid diagnosis and prompt institution of treatment. Objective: to review the biological, physiopathology, clinical and therapeutic characteristics and prognosis of encephalitis caused by HSV-1 and HSV-2 viruses. Materials and Methods: a scientific literature review (critical review), in the Medline scientific database and IMBIOMED, PUBMEDE, SCIENCEDIRECT, SCIELO search engines, obtaining 150 results limited to 67 articles read in detail. Results and Discussion: herpes simplex virus is neurotropic and may cause invasion, toxicity and latent infection of the CNS. Due to its unspecific symptoms a thorough diagnostic workup is required to achieve a correct diagnosis. Current methods such as neuroimaging studies and polymerase chain reaction (PCR) examination have contributed to elucidate the etiologic virus. A rapid detection and prompt treatment is associated with an increase in the survival rate and decrease in neurologic sequelae. Conclusion: understanding the biology, behavior, clinical manifestations and treatment of this viral infection is an efficient strategy to prevent sequelae and reduce fatal outcomes.

Retinal vasculitis associated with epstein-barr virus infection in a young immunocompetent patient. first colombian case report

RESUMEN Introducción. La infección por virus de Epstein-Barr (VEB) suele ser asintomática y persiste durante toda la vida. La afectación ocular es infrecuente, y aunque existen informes de casos, ninguno de ellos proviene de Colombia o Latinoamérica. Presentación del caso. Paciente masculino inmunocompetente con vasculitis retiniana unilateral generalizada, con vasos sin sangre temporales e inferonasales en la periferia, hemorragias intrarretinianas, vitritis intensa y desprendimiento de retina. La presencia de VEB se definió con una técnica de reacción en cadena de la poli-merasa en humor vítreo. El paciente recuperó la agudeza visual con el tratamiento oral antiviral convencional. Discusión. La afectación ocular asociada con el VEB se describe en pacientes inmunocomprometidos, en especial con infección por virus de inmunodeficiencia humana donde puede haber afectación retiniana. En este caso particular se discute la presencia de esta patología en pacientes inmunocompetentes. Conclusiones. La vasculitis retiniana es una entidad rara con mayor asociación a la inmuno-depresión. No existe un algoritmo de diagnóstico de esta enfermedad y la afectación ocular puede ser variable; tampoco existen líneas estándar de tratamiento. La evidencia reportada en el presente caso podría justificar estudios en pacientes seleccionados que muestran un compromiso de la agudeza visual sin una etiología establecida.

ABSTRACT Introduction: Epstein - Barr virus (EBV) infection is usually asymptomatic and persists throughout life. Eye involvement is rare, and even though there are some case reports, none of them comes from Colombia or Latin America. Case presentation: Immunocompetent young man with generalized unilateral retinal vasculitis, temporal and inferonasal bloodless vessels in the periphery, intraretinal hemorrhages, intense vitritis and retinal detachment. Epstein-Barr virus presence was determined using a polymerase chain reaction technique in vitreous humor. The patient recovered visual acuity with conventional antiviral oral treatment. Discussion: Eye involvement associated with Epstein-Barr virus is observed in immunocompromised patients, especially with HIV infection, where retinal involvement may occur. This case reports the presence of this pathology in an immunocompetent patient. Conclusions: Retinal vasculitis is a rare entity, frequently associated with immunocompromise. There is no diagnostic algorithm for this disease and eye involvement may be variable; there are no standard lines of treatment either. The evidence reported here explains the need for studies in selected patients showing visual acuity involvement without an established etiology.

Meningitis linfocítica recurrente por virus herpes simple tipo 2 / Recurrent lymphocytic meningitis by herpes simplex virus type 2

La meningitis linfocítica recurrente o meningitis de Mollaret es una entidad asociada a un gran número de etiologías infecciosas, autoinmunes, toxicológicas y neoplásicas. En la actualidad el virus herpes simple tipo 2 (HSV-2) es el agente más frecuentemente aislado. Afecta frecuentemente a mujeres de mediana edad y tiende a autolimitarse sin secuelas dentro de la primera semana de inicio de síntomas. El diagnóstico se basa en la detección de ácidos nucleicos virales en el líquido cefalorraquídeo. Al momento no se ha demostrado beneficio en el uso de tratamiento antiviral en la prevención de recurrencias.

Recurrent lymphocytic meningitis or Mollaret´s meningitis is a rare condition caused by a number of infectious, autoimmune, toxic and neoplastic diseases. Herpes simplex type 2 is the most commonly isolated agent. It usually compromises middle aged women, with a self-limited clinical presentation that resolves within a week leaving no sequelae. Its diagnosis is mainly based on nucleic acid detection on cerebrospinal fluid. Antiviral prophylaxis has not shown conclusive to avoid recurrences.

Encefalitis por herpes simple resistente al aciclovir en un niño tratado satisfactoriamente con el agregado de foscarnet: A propósito de un caso / Acyclovir Unresponsive Herpes Simplex Encephalitis in a child successfully treated with the addition of Foscarnet: Case report

La encefalitis por herpes simple (EHS) es la causa más frecuente de encefalitis focal esporádica en todo el mundo. El aciclovir es el tratamiento preferido para la EHS desde la década de 1980. Después del uso generalizado del aciclovir, se redujo la tasa de mortalidad relacionada con la EHS pero surgieron cepas resistentes. Se ha informado que la incidencia de virus del herpes simple (VHS) resistente al aciclovir es del 0,5 % y del 3,5 %-10 % aproximadamente en los pacientes inmunocompetentes e inmunocomprometidos, respectivamente. En este artículo, describimos el caso de un paciente inmunocompetente de 12 años de edad con encefalitis por VHS-1 tratado satisfactoriamente con aciclovir y foscarnet. En el caso de una condición clínica que desmejora con el tratamiento con aciclovir, incluso si no se demuestra un aumento de la carga viral del VHS en el líquido cefalorraquídeo, se podría considerar la posibilidad de EHS resistente al aciclovir y el agregado de foscarnet al tratamiento con aciclovir.

Herpes simplex encephalitis (HSE) is the most common cause of sporadic focal encephalitis worldwide. Acyclovir is the treatment of choice of HSE since the 1980s. After the widespread use of acyclovir, HSE related mortality rate had reduced but resistant strains emerged. Acyclovir resistant HSV incidence was reported as about 0.5 % and 3.5 %-10 % in immunocompetent and immunocompromised patients, respectively. Herein, a 12-year-old immunocompetent patient with HSV-1 encephalitis who was successfully treated with combined acyclovir and foscarnet therapy is described. In the case of deteriorating clinical condition under acyclovir treatment even if the absence of demonstration of increased CSF HSV viral load, the possibility of acyclovir resistant HSE and the addition of foscarnet to the acyclovir treatment might be considered.

In vitro activity of six antiviral drugs against equid alphaherpesvirus type 1 indicates ganciclovir as promising drug for in vivo studies / A atividade in vitro de seis drogas antivirais contra o alfaherpesvírus equino tipo 1 indica que o ganciclovir é uma droga promissora para estudos in vivo

ABSTRACT: Equid alphaherpesvirus type 1 (EHV-1) is distributed worldwide and is a major agent of abortion, respiratory and neurological disease in horses. No specific treatment is available for EHV-1 infection, yet the potential of antiviral therapy has been explored. In this study we investigated the in vitro activity of Acyclovir, Ganciclovir, Foscarnet, Famciclovir, Vidarabina and Cidofovir against EHV-1. For this, the MTT test was performed, in which all the tested drugs showed no toxicity up to 200μg/mL. Subsequently, different drug concentrations were submitted to viral plaque reduction assays in cell culture. The selectivity index (SI) of the compounds was determined using the cytotoxic concentration for 50% of cells (CC50), obtained by MTT, and effective drug concentration to inhibit by 50% the number of viral plaques (EC50). Ganciclovir (SI: 490; EC50: 1.9 μg/mL) was the most efficient and safest drug against EHV-1, followed by Cidofovir (SI: 150, EC50: 5.7μg/mL), Acyclovir (SI: 37.4, EC50: 22.2μg/mL), Famciclovir (SI: 25.1, EC50: 24.5μg/mL), Vidarabine (SI: 12.2, EC50: 40.9μg/mL) and Foscarnet (SI: 6.9, EC50: 49.5 μg/mL), respectively. These results indicated that Ganciclovir (followed by Cidofovir), is a promising candidate for use in in vivo experiments.

RESUMO: O alfaherpesvírus equino tipo 1 (EHV-1) está amplamente distribuído nos rebanhos equinos de todo o mundo e é um dos principais agentes causadores de abortos, doença respiratória e neurológica em equinos. Ainda não há tratamento específico para a infecção pelo EHV-1 em equinos, mas o potencial da terapia antiviral tem sido investigado. Neste trabalho, foi investigada a atividade anti-herpética in vitro dos fármacos Aciclovir, Ganciclovir, Foscanet, Famciclovir, Vidarabina e Cidofovir frente ao EHV-1. Para isso, foi realizado o teste de MTT, em que todas as drogas não apresentaram citotoxicidade até a dose de 200μg/mL. A seguir, diferentes concentrações dos fármacos foram submetidas ao teste de redução de placas virais em cultivo celular. O índice de seletividade (IS) dos compostos foi determinado usando a concentração citotóxica para 50% dos cultivos celulares (CC50), obtida pelo MTT, e pela concentração dos fármacos efetiva para inibir em 50% o número de placas virais (EC50). O Ganciclovir (IS: 490; EC50: 1,9μg/mL) foi o mais eficiente e seguro frente ao EHV-1, seguido pelo Cidofovir (IS: 150; EC50: 5,7 μg/mL), Aciclovir (IS: 37,4; EC50: 22,2μg/mL), Famciclovir (IS: 25,1; EC50: 24,5μg/mL), Vidarabina (IS: 12,2; EC50: 40,9μg/mL) e Foscarnet (IS: 6,9; EC50: 49,5μg/mL). Estes resultados indicam que o Ganciclovir constitui-se em um candidato para uso em experimentos in vivo.

The outcome of penetrating keratoplasty for corneal scarring due to herpes simplex keratitis / O resultado da ceratoplastia penetrante para cicatriz de córnea consequente à ceratite por herpes simplex

ABSTRACT Purpose: To determine the outcomes of penetrating keratoplasty (PK) for treatment of corneal scarring caused by Herpes simplex virus (HSV) keratitis, and whether the corneal scar type affects treatment outcome. Methods: A retrospective analysis of patients who underwent PK for HSV-related corneal scarring between January 2008 and July 2011 was performed. The patients were categorized into two groups. Group 1 consisted of patients with a quiescent herpetic corneal scar and group 2 consisted of patients who developed a corneal descemetocele or perforation secondary to persistent epithelial defects with no active stromal inflammation. The mean follow-up was 21.30 ± 14.59 months. The main parameters evaluated were recurrence of herpetic keratitis, graft rejection, graft failure, visual acuity, and graft survival rate. Results: There were 42 patients in group 1 and 13 in group 2. Preoperative BCVA varied from hand movements to 0.7 logMAR. Postoperatively, 34 patients (61.8%) achieved visual acuity of 0.6 logMAR or more. Recurrence of HSV keratitis was noted in 12 (28.57%) eyes in group 1 and 4 (30.76%) eyes in group 2 (p=0.40). Graft rejection occurred in 4 eyes (9.52%) in group 1 and in 3 (23.07%) eyes in group 2 (p=0.58). The 1-, 2-, and 3-year graft survival rates were 91.9%, 76.0%, and 65.1% in group 1, and 89.5%, 76.0%, and 63.6% in group 2 (p=0.91), respectively. Conclusions: Although there were different recurrence and graft rejection rates for two groups, the graft survival rates at 3 years were similar. According to our results, without inflammation, corneal herpetic scarring with a descemetocele or perforation achieved similar graft survival rates with quiescent herpetic corneal scars.

RESUMO Objetivo: Determinar os resultados da ceratoplastia penetrante (PK) para o tratamento da cicatriz da córnea consequente à ceratite por Herpes simplex vírus (HSV), e se o tipo de cicatriz na córnea afeta o resultado cirúrgico. Métodos: Foi realizada análise retrospectiva dos pacientes, submetidos à PK para a cicatriz da córnea relacionados com o HSV entre janeiro de 2008 e julho de 2011. Os pacientes foram divididos em dois grupos. Grupo 1 consistiu de pacientes que tiveram cicatriz corneana herpética quiescente e grupo 2 consistiu de pacientes que desenvolveram descemetocele ou perfuração córnea secundária a defeitos epiteliais persistentes sem inflamação estromal ativa. O seguimento médio foi de 21,30 ± 14,59 meses. Os principais parâmetros avaliados foram recorrência de ceratite herpética, rejeição de enxerto, falência do enxerto, acuidade visual e taxa de sobrevida do enxerto. Resultados: Foram avaliados 42 pacientes do grupo 1 e 13 doentes do grupo 2. Acuidade visual pré-operatória variou de movimentos das mãos (HM) para 0,7 logMAR. No pós-operatório, 34 pacientes (61,8%) atingiram acuidade visual de 0,6 logMAR ou melhor. Doze olhos (28,57%) tiveram recorrência de HSV ceratite no grupo 1, e quatro olhos (30,76%) tiveram recorrência no grupo 2 (p=0,40). A rejeição do enxerto ocorreu em 4 olhos (9,52%) no grupo 1, e em 3 olhos do grupo 2 (23,07%; p=0,58), taxa de sobrevivência do enxerto foi de 91,9% a 1 ano, 76,0% aos 2 anos e 65,1% aos 3 anos no grupo 1, e 89,5% a 1 ano, 76,0% aos 2 anos e 63,6% aos 3 anos no grupo 2 (p=0,91). Conclusões: Embora diferentes taxas de recorrência e de rejeição do enxerto foram encontradas nos dois grupos, a taxa de sobrevida do enxerto em 3 anos foi semelhantes nos dois grupos. De acordo com nossos resultados, em casos sem inflamação, a cicatriz herpética da córnea com descemetocele ou perfuração demonstra as taxas de sobrevivência do enxerto semelhantes às da cicatriz corneana herpética quiescente.

Analysis on curative effect of the combined therapy of ReDuNing injection and acyclovir on children with infectious mononucleosis / 实用医学杂志

Objective To evaluate the efficacy of the combined therapy of ReDuNing injection and acyclo-vir on children with infectious mononueleosis(IM). Methods From October 2012 to July 2015 in the emergency ward of Children′s Hospital of Nanjing Medical University ,167 cases diagnosised with infectious mononucleosis were enrolled in this study. Ninety-five cases received acyclovir treatment were recruited in the conventional treat-ment group,72 cases received the combined thrapy of ReDuNing injection and acyclovir of children were recruited in the observation group. The clinical symptoms ,clinical manifestation and blood routine ,liver and kidney func-tion,myocardial enzymes,temperature recovery time,reduce lymph node,liver function recovery time and hospi-talization time of patients were recorded and compared between the two groups. Results No significant differences were observed in the clinical course and general fever,pharyngitis,lymphadenopathy,hepatosplenomegaly,rash and eyelid edema in children of the observation group (ReDuNing + Acyclovir) and routine treatment group (Acyclovir). No significant differences were found in blood routine ,blood biochemical indexes of liver ,kidney function and myocardial enzymes in patients of the two groups before and after treatment. The white blood cells , ALT and LDH were significantly reduced in patients of the two groups after treatment(P<0.05). However,LDH was still high in patients of the two groups before discharge ,with the level of(355.63 ± 116.89)U/L and(347.79 ± 106.74)U/L,respectively. The pyretolysis time(2.97 ± 2.56)d,lymph node reduced time(9.08 ± 1.54)d,liver function recovery time(8.67 ± 2.35)d,white blood cell recovery time(6.76 ± 2.96)d,hospitalization time (11.10 ± 3)d in the observation group were significantly shortened than those in the conventional treatment group ((4.38 ± 2.70)d,(10.48 ± 3.62)d,(11.50 ± 3.71)d,(9.15 ± 3.24)d,12.32 ± 3.62)d,respectively)(P<0.05, respectively). Conclusions The fever,lymphadenopathy,leukocytosis,liver damage and LDH were relieved and reduced at different degrees in patients of both the observation group and the routine treatment group after treat-ments. Reduning combined with acyclovir treatments lead to better clinical efficacy in children ,with shortening the duration of fever,Lymph node reduction time,and white blood cell recovery time. In particularly,the combined therapy can shorten the recovery time of patients with liver function damage ,which is a safe clinical application and can be used as one of the effective treatment measures for children with infectious mononucleosis.

Analysis on curative effect of the combined therapy of ReDuNing injection and acyclovir on children with infectious mononucleosis / 实用医学杂志

Objective To evaluate the efficacy of the combined therapy of ReDuNing injection and acyclo-vir on children with infectious mononueleosis(IM). Methods From October 2012 to July 2015 in the emergency ward of Children′s Hospital of Nanjing Medical University ,167 cases diagnosised with infectious mononucleosis were enrolled in this study. Ninety-five cases received acyclovir treatment were recruited in the conventional treat-ment group,72 cases received the combined thrapy of ReDuNing injection and acyclovir of children were recruited in the observation group. The clinical symptoms ,clinical manifestation and blood routine ,liver and kidney func-tion,myocardial enzymes,temperature recovery time,reduce lymph node,liver function recovery time and hospi-talization time of patients were recorded and compared between the two groups. Results No significant differences were observed in the clinical course and general fever,pharyngitis,lymphadenopathy,hepatosplenomegaly,rash and eyelid edema in children of the observation group (ReDuNing + Acyclovir) and routine treatment group (Acyclovir). No significant differences were found in blood routine ,blood biochemical indexes of liver ,kidney function and myocardial enzymes in patients of the two groups before and after treatment. The white blood cells , ALT and LDH were significantly reduced in patients of the two groups after treatment(P<0.05). However,LDH was still high in patients of the two groups before discharge ,with the level of(355.63 ± 116.89)U/L and(347.79 ± 106.74)U/L,respectively. The pyretolysis time(2.97 ± 2.56)d,lymph node reduced time(9.08 ± 1.54)d,liver function recovery time(8.67 ± 2.35)d,white blood cell recovery time(6.76 ± 2.96)d,hospitalization time (11.10 ± 3)d in the observation group were significantly shortened than those in the conventional treatment group ((4.38 ± 2.70)d,(10.48 ± 3.62)d,(11.50 ± 3.71)d,(9.15 ± 3.24)d,12.32 ± 3.62)d,respectively)(P<0.05, respectively). Conclusions The fever,lymphadenopathy,leukocytosis,liver damage and LDH were relieved and reduced at different degrees in patients of both the observation group and the routine treatment group after treat-ments. Reduning combined with acyclovir treatments lead to better clinical efficacy in children ,with shortening the duration of fever,Lymph node reduction time,and white blood cell recovery time. In particularly,the combined therapy can shorten the recovery time of patients with liver function damage ,which is a safe clinical application and can be used as one of the effective treatment measures for children with infectious mononucleosis.

Calcificaciones intracraneales por herpes virus tipo I / Intracranial calcifications for herpes virus type I

Las enfermedades intrauterinas representan una carga importante de morbilidad para el recién nacido como es la infección por Herpes simple, al adquirir este tipo de infección puede traer diversas afecciones del sistema nervioso central. El diagnóstico diferencial de las calcificaciones en el cerebro no siempre es fácil, existen múltiples causas que pueden originar calcificaciones intracraneales, dentro de ellas causas fisiológicas congénitas, infecciosas, metabólica, vasculares y por neoplasias. Con alta mortalidad y morbilidad, la incidencia varia de 1/3.000 a 1/20.000 nacimientos. Se requiere de una sospecha clínica precoz para establecer un tratamiento adecuado, presentamos un caso de una recién nacida de 21 días de vida que presenta un cuadro febril cuyo diagnóstico fue confirmado por la técnica de reacción de la polimerasa en cadena, la misma certifico la presencia del virus del herpes simple tipo 1 en liquido céfalo raquídeo, además evidencia de calcificaciones intracraneales en tomografía axial computarizada.

Intrauterina diseases represent an important burden of morbidity for the newborn as is the infection with Herpes simplex, when aquiring this type of infeccion can bring diverse affections of the central nervous system.The differential diagnosis of calcifications in the brain is not always easy, there are multiple causes that can causse intracranial calcifications,within them congenital,infectious,metabolic,vascular and neoplastic,vascular and neoplastic causes,with high mortality and morbidity, the incidence varies from 1/3000 to 1 /20.000 briths,Early clinical suspicion is required to establish an adequate treatment,we present a case of a newborn of 21 days of life that presents a febrile condition whose diagnosis was confirmed by the polymerase chain reaction technique,it certifies the presence of herpes simplex virus type 1 in cerebrospinal fluid,in addition to evidence of intracranial calcifications in computed tomography.

Varicela perinatal en el Hospital Puerto Lempira: reporte de un caso / Perinatal Varicella at Puerto Lempira Hospital. Case report

Antecedentes: La varicela es una enfermedad exantemática que se presenta predominantemente en la infancia, siendo muy contagiosa por lo que su presencia durante el embarazo, en el feto y el recién nacido pueden representar un verdadero problema. El primer caso de varicela congénita se informó ́ en 1878; ocurrió ́ en un recién nacido de un día de vida por lo que hizo pensar que la infección había sido adquirida in utero. Caso clínico: Se expone el caso de un neonato de 14 días de vida el cual es llevado a emer - gencias por presentar lesiones vesiculosas generalizadas acompañado de irritabilidad, sin ningún otro síntoma acompañante, con an - tecedente de su madre y su hermano mayor de presentar las mismas lesiones una semana antes del nacimiento, por lo cual se ingresó con el diagnóstico y tratamiento de varicela perinatal, con evolución satisfactoria a las dos semanas de tratamiento, sin complicaciones. Conclusión: El empleo temprano de Aciclovir oral contribuyo a la remisión satisfactoria del cuadro, aunado a la protección parcial por las IgG de la madre adquirida vía transplacentaria. La infección por VVZ en la embarazada se ha demostrado como un agente terató - geno reconocido y la varicela perinatal puede ser muy grave, pero aquí radica la importancia del periodo de gestación en la cual ocurre la transmisión, siendo la falta de control prenatal un detonante que contribuye al aumento de morbimortalidad perinatal...(AU)

Infección por varicela con compromiso multisistémico en adulto previamente sano / Varicella infection with multisystem involvement in previously healthy adult

Resumen La varicela en adultos inmunocompetentes es infrecuente, pero se relaciona con alta mortalidad por las múltiples complicaciones. Se describe el caso de un adulto previamente sano que presenta varicela con hepatitis, coagulación intravascular diseminada (CID), insuficiencia renal y SDRA (síndrome de dificultad respiratoria agudo). Hubo respuesta satisfactoria al manejo antiviral temprano y uso de esteroides en infusión continua. (Acta Med Colomb 2016; 42: 144-147).

Abstract Chickenpox in immunocompetent adults is rare but is associated with high mortality due to multiple complications. The case of a previously healthy adult patient who presented chickenpox with hepatitis, disseminated intravascular coagulation (DIC), renal failure and ARDS (acute respiratory distress syndrome) is described. There was satisfactory response to early antiviral therapy and continuous infusion of steroids. (Acta Med Colomb 2016; 42: 144-147).

Compatible Stability of Vidarabine Monophosphate for Injection and Aciclovir Injection / 中国药房

OBJECTIVE:To investigate the stability of Vidarabine monophosphate for injection combined with Aciclovir injec-tion. METHODS:HPLC method was adopted. The content variations of two drugs in mixture were determined within 8 h at 5 ℃, 25℃,35℃under dark and light. The changes in appearance,property,pH value and insoluble particles(within 24 h)were inves-tigated before and after compatibility. RESULTS:There were no significant changes in appearance and pH value at 5 ℃,25 ℃, 35 ℃ under dark,and insoluble particles were in line with Chinese Pharmacopoeia(2010 edition),and the relative content of vida-rabine monophosphate and aciclovir were above 99%(compared with 0 h)within 8 h. Under the light conditions,as the tempera-ture raised and the extension of storage time,the content of vidarabine monophosphate did not significantly decrease,but that of aciclovir had declined significantly(4 h and after 4 h),while pH value also had a certain degree of rise;the insoluble particles had no obvious change. CONCLUSIONS:The mixture of vidarabine monophosphate and aciclovir in 0.9% Sodium chloride injections is stable under dark conditions within 8 h;it is suggested that the mixture should be used up within 4 h after mixing and protect from light to guarantee the safety of drug use in the clinic.

Insuficiencia renal aguda secundaria a aciclovir: Reporte de caso y revisión de la literatura / Acute renal failure secondary to acyclovir. Case report and literature review

La excreción renal es uno de los principales mecanismos para la eliminación de medicamentos, lo cual convierte a los riñones en blanco frecuente de lesión. Distintos medicamentos han sido asociados a desarrollo de insuficiencia renal aguda. El aciclovir es un antiviral altamente efectivo en el tratamiento de infecciones por virus del complejo Herpesviridae y puede causar daño renal agudo por depósito de cristales en los túbulos contorneados distales. Se presenta el caso de un paciente, quien desarrolla insuficiencia renal aguda secundaria probablemente a tratamiento con aciclovir intravenoso administrado para manejo de herpes zóster facial.

Renal excretion is one of the main mechanisms for the elimination of drugs, which makes the kidneys a frequent target of injury. Various drugs have been associated with development of acute renal failure. Acyclovir is an antiviral highly effective in the treatment of herpes virus infections and can cause acute kidney damage for crystal deposition in the distal convo-luted tubules. Here we present a case report on a patient who developed acute renal failure likely due to intravenous acyclovir administered for the treatment of facial herpes zoster.