Medicina cannabinoide en el territorio orofacial: estado actual y perspectivas a futuro / Cannabinoid medicine in the orofacial region: status and prospects

Introducción: El interés por emplear cannabis y cannabinoides como herramienta terapéutica ha tomado relevancia en la medicina en los últimos años. En sintonía con ello en odontología se ha incrementado el interés por su estudio. El objetivo de la presente revisión narrativa fue analizar y sintetizar la información disponible acerca de las posibilidades terapéuticas actuales del cannabis en odontología y sus perspectivas futuras. Materiales y métodos: Se realizó una búsqueda electrónica que abarcó artículos hasta diciembre del 2022, en las bases de datos MEDLINE, Scopus, Scielo y Google Académico. Se utilizaron las siguientes palabras claves principales: "dental", "dentistry", "cannabis", "cannabinoids", "benefits", "therapeutics", "treatment", "potential". En las búsquedas iniciales se encontraron un total de 834 registros. Se evaluó la elegibilidad de 45 artículos de texto completo. Se incluyeron 35 estudios para el análisis cualitativo de la presente revisión. Resultados: Los estudios muestran gran variedad de cannabinoides y derivados empleados, preparados comerciales, así como preparados experimentales. Se han llevado adelante estudios in vitro, in vivo y clínicos que evalúan la acción de los cannabinoides en el control del dolor orofacial, de la inflamación, como cicatrizante, en la regeneración del tejido óseo, como antimicrobiano y su capacidad anticancerígena. Conclusiones: Los cannabinoides han demostrado potencial en el tratamiento de diversas condiciones y/o alteraciones bucales. Aún la estandarización de los productos y protocolos de tratamiento es insuficiente por los que son necesarios más estudios que evalúen presentaciones, derivados, métodos de extracción, concentraciones y vías de administración.

Introduction: The interest in using cannabis and cannabinoids as a therapeutic tool has gained relevance in medicine in recent years. In line with this, interest in its study has increased in dentistry. The aim of the present narrative review was to analyze and synthesize the available information about the current therapeutic possibilities of cannabis in dentistry and its future perspectives. Materials and methods: an electronic search conducted that included articles until December 2022, in the MEDLINE, Scopus, Scielo and Google Scholar databases. The following main keywords used: "dental," "dentistry," "cannabis," "cannabinoids," "benefits," "therapeutics," "treatment," "potential." A total of 834 records founded in the first searches. Forty-five full-text articles assessed for eligibility. Thirty-five studies included for the qualitative analysis of the present review. Results: Studies show a great variability of cannabinoids and derivatives used, including commercial preparations, as well as experimental preparations. In vitro, in vivo, and clinical studies had conducted evaluating the action of cannabinoids in the control of orofacial pain, as anti-inflammatory and healing, in bone tissue regeneration, as antimicrobial and evaluating their anti-cancer ability. Conclusions: Cannabinoids have shown potential in the treatment of various oral conditions and/or disorders. Even the standardization of products and treatment protocols is insufficient, which is why more studies are necessary to evaluate presentations, derivatives, extraction methods, concentrations, and routes of administration for their best use.

A promising alternative for mature skin: the effects of phytoestrogens on human skin and its topical use / Alternativa promissora para peles maduras: os efeitos dos fitoestrógenos na pele humana e seu uso tópico

Skin quality deteriorates with age for various reasons, including hormone deficiencies. In women, the decline in estrogen levels during menopause plays an important role in skin degeneration, with consequent atrophy, collagen reduction, loss of elasticity, and impaired wound healing. Research has demonstrated the beneficial effects of topical phytoestrogen in preventing and repairing skin aging, with localized action and without side effects. The objective of this study was to review the relevant literature, demonstrating that this can be a safe and effective alternative for treating the skin of perimenopausal women.

A qualidade da pele deteriora-se com a idade por vários motivos, incluindo as deficiências hormonais. Nas mulheres, o declínio dos níveis de estrógeno, durante a menopausa, tem papel importante na degeneração cutânea, com consequente atrofia, redução do colágeno, perda de elasticidade e deficiência da cicatrização de feridas. Pesquisas têm demonstrado efeitos benéficos do fitoestrogênio tópico na prevenção e reparação do envelhecimento cutâneo, com ação localizada e sem efeitos colaterais. O objetivo deste estudo foi revisar a literatura pertinente ao assunto, demonstrando que esta pode ser uma alternativa segura e eficaz para o tratamento da pele de mulheres na perimenopausa.

Revisão sistemática do benefício cosmético da aplicação tópica do filtrado de fermentação / Systematic review of cosmetic benefit of topical application of ferment filtrate

O filtrado de fermentação, (FF), um subproduto de leveduras rico em nutrientes, é usado cosmeticamente no leste da Ásia desde a década de 1970. Revisamos sistematicamente os efeitos deste ativo tópico na saúde da pele e determinamos as limitações nos estudos disponíveis. A literatura recente mostrou evidências na redução do tamanho dos poros, e tambem da aspereza, hiperpigmentação e vermelhidão. No entanto, esses estudos são limitados em eficácia devido ao pequeno tamanho da amostra, muitas variáveis e capacidade limitada de validação externa. Devido ao aumento de produtos cosméticos contendo esse ingrediente, é necessária uma análise crítica da literatura disponível e futura para evitar a desinformação do consumidor

Ferment filtrate (FF), a by-product of nutrient-rich yeast, is believed to be used cosmetically in East Asia since the 1970s. We systematically reviewed the topical effects of ferment filtrate on skin health and determined limitations in the available studies. Recent literature has shown evidence in reducing the baseline fluctuation of pore size, roughness, hyperpigmentation, and redness. However, these studies are limited in efficacy due to their small sample size, their confounding variables, and their limited generalizability. Because of the increase of cosmetic products containing this ingredient, critical analysis of the available and future literature is necessary to prevent consumer misinformation.

Tratamento da hipomelanose gutata idiopática com laser Er:YAG 2940nm isolado ou combinado ao drug delivery de piperina: um estudo-piloto comparativo / Treatment of idiopathic guttate hypomelanosis with Er:YAG 2940nm laser alone or combined to piperine drug delivery: a pilot and comparative study

Introdução: Introdução: A hipomelanose gutata idiopática constitui uma leucodermia adquirida, cujas opções terapêuticas disponíveis apresentam resultados inconsistentes. Objetivos: Avaliar o efeito do laser fracionado ablativo isolado ou combinado ao drug delivery de piperina para tratamento de hipomelanose gutata idiopática. Materiais e métodos: Em um estudo prospectivo e comparativo, sete pacientes apresentando HGI nas pernas foram selecionadas, sendo escolhidas cinco lesões em cada perna de cada uma. Ambas as pernas de cada paciente foram submetidas a duas sessões de laser Er:- YAG 2940nm, seguido de drug delivery de piperina 20% somente na perna direita. A avaliação foi feita por avaliadores cegos por meio de fotografias e medidas comparativas das lesões. Resultados: O tamanho das lesões variou de 0,2cm a 1,5cm. Ambos os tratamentos reduziram significativamente o tamanho das lesões (p<0,00008 perna direita e p<0,002 perna esquerda). O método de equações de estimativas generalizadas demonstrou que não houve diferença estatística entre os grupos em relação à redução do tamanho das lesões. A avaliação atingiu melhores escores para a perna direita (laser + piperina) (p=0,126). Conclusão: Embora diferenças estatisticamente significativas não tenham sido encontradas entre o lado tratado com laser e drug delivery versus o lado tratado somente com laser, acreditamos que a técnica possa representar uma opção no arsenal terapêutico.

Introduction: Idiopathic guttate hypomelanosis is an acquired leukoderma, whose available therapeutic options have inconsistent results. Objectives: To evaluate the effect of isolated or combined ablative fractionated laser to drug delivery of piperine for treatment of idiopathic guttate hypomelanosis. Materials and methods: In a prospective and comparative study, seven patients with idiopathic guttate hypomelanosis in the legs were elected, and five lesions were selected on each leg of each. Both legs of each patient were submitted to two Er:YAG 2940nm laser sessions, followed by drug delivery of piperine 20% only in the right leg. Blind evaluators conducted the assessment through photographs and comparative measurements of the lesions. Results: The lesion size ranged from 0.2cm to 1.5 cm. Both treatments significantly reduced lesion size (p< 0.00008, right leg; p< 0.002, left leg). The generalized estimating equation method showed that there was no statistical difference between the groups regarding the reduction of lesion size. The evaluation achieved better scores for the right leg (laser + piperine) (p=0.126). Conclusion: Although statistically significant differences were not found between the side treated with laser and drug delivery versus the side treated only with laser, we believe that the technique may represent an option in the therapeutic arsenal.

Clinical research of Chinese medicine acupoint sticking at Shenque and Yongquan in adjuvant treatment of pregnancy resistance / 中国基层医药

Objective To obsOrvO thO clinical OffOct of ChinOsO mOdicinO acupoint sticking at ShOnquO and Yongquan in adjuvant trOatmOnt of prOgnancy rOsistancO.Methods From January 2015 to January 2018, 210 patiOnts with prOOclampsia wOrO sOlOctOd in thO Traditional ChinOsO MOdicinO Hospital of Pinghu. According to thO random numbOr tablO mOthod, thO patiOnts wOrO dividOd into control group(n=105) and obsOrvation group (n=105). ThO control group was trOatOd with routinO infusions. In thO obsOrvation group, ShOnquO Yongquan two-acupoint tradi-tional ChinOsO mOdicinO was appliOd as an adjuvant thOrapy on thO basis of thO control group. ThO trOatmOnt OffOcts of thO two groups aftOr 5 days and 10 days trOatmOnt wOrO obsOrvOd, and thO disappOarancO ratO of thO main symptoms and thO rOcurrOncO ratO within 2 wOOks aftOr trOatmOnt wOrO obsOrvOd. Results ThO total OffOctivO ratOs of thO obsOr-vation group aftOr trOatmOnt for 5 days and trOatmOnt for 10 days wOrO 68.57% (72/105) and 98.10% (103/105), rOspOctivOly, which wOrO significantly highOr than thosO of thO control group [51.43% (54/105) and 71.43% (75/105)],thO diffOrOncOs wOrO statistically significant(χ2 =6.429,28.905,all P<0.05). ThO disappOarancO ratOs of vomiting, dizzinOss and burnout in thO obsOrvation group wOrO 50.48% ,44.57% and 34.12% ,rOspOctivOly, which wOrO significantly lowOr than thosO in thO control group (70.48% ,71.28% and 80.90% ) (χ2 =8.786,13.624, 39.071,all P<0.05).ThO rOcurrOncO ratO of thO obsOrvation group (2.86% ) with in 2 wOOks was significantly lowOr than 22. 86% of thO control group, and thO diffOrOncO was statistically significant ( χ2 =18. 743, P <0. 05 ). Conclusion ShOnquO Yongquan two -acupoint ChinOsO traditional mOdicinO sticking combinOd with convOntional infusion thOrapy has significant clinical OffOct in thO trOatmOnt of prOgnancy rOsistancO.

The progress of topical drug delivery to the inner ear for the inhibition of inflammation and fibrosis following cochlear implantation / 中华耳鼻咽喉头颈外科杂志

Nowadays, more than 300 000 deaf people around the world benefit from cochlea implantation. With the extension of cochlear implantation indications, it has become a research focus for how to apply the anti-inflammatory and anti-fibrotic drugs safely and effectively to better retain residual hearing, as well as to protect hair cells and the spiral ganglion cells from apoptosis. Due to the blood-labyrinth barrier, perioperative systemic steroids are often unable to achieve satisfactory drug concentration in the inner ear. Also, given that higher doses of steroids will cause more serious side effects and sometimes steroids are strictly limited to apply on some patients with certain diseases, the attention has been attracted on topical drug delivery to the inner ear. In this review, the methods of topical drug delivery to the inner ear are divided into four categories: transtympanic injection of liquid solutions, tympanic implantation of drug delivery systems, intracochlear injection and modified implant electrode. The results in each category and up to date progress are reviewed.

Metronidazole concentration in the bloodstream following its topical application, at different concentration levels, on experimental skin wounds during healing by secondary intention

Abstract Purpose: To characterize qualitatively and quantitatively the absorption of metronidazole solution, in greater concentrations and for longer periods, when applied topically to an experimental open skin wound model. Methods: An open skin wound, 2 cm in diameter and total skin thickness was prepared, under anesthetic, in the dorsal region of 108 Wistar rats weighing between 300 and 350 grams. The animals were allocated to groups of 18 animals in accordance with the concentration of metronidazole in the solution to be applied daily to the wound. In the control group (CG), 0.9% sodium chloride solution was used for application, and in the experimental groups (GI, GII, GIII, GIV and GV) metronidazole solution at 4%, 6%, 8%, 10% and 12%, respectively, was applied. After 3, 7 and 14 days of treatment. Blood samples collected through cardiac puncture were examined for the existence or non-existence of metronidazole, using high performance liquid chromatography (HPLC). Detected metronidazole values were compared statistically within each group (temporal analysis 3 days X 7 days X 14 days) and between the groups that used topical metronidazole (4% X 6% X 8% X 10% and 12%) using the Kruskal-Wallis test, considering a statistical significance of 95% (p<0.05). Results: Metronidazole was detected in all the samples at all times in all the groups in which topical metronidazole was applied to the wounds. Characteristically, there was no significant difference between the doses obtained within each group over time (3 days X 7 days X 14 days) GI=0.461; GII=0.154; GIII=0.888; GIV= 0.264 and GV=0.152. In the evaluation between groups, a similar degree of absorption was found after 3 days (p=0.829) and 14 days (p=0.751). Conclusion: The serum concentration of metronidazole that was achieved was not influenced by the concentration of the solution applied to the skin wound, with similar extend, or by the duration of the application.

Diferenciação de miofibroblastos em feridas após uso tópico do metronidazol: estudo experimental / Differentiation of myofibroblasts in wounds after topical use of metronidazole: an experimental study

RESUMO Objetivo: avaliar os efeitos da administração tópica do metronidazol na diferenciação de fibroblastos e na contração da ferida durante cicatrização experimental por segunda intenção em ratos. Métodos: cento e oito animais foram submetidos a uma ferida circular no dorso, com 2cm de diâmetro e divididos em seis grupos: grupo controle, com aplicação de solução salina sobre a ferida e cinco grupos experimentais divididos de acordo com a concentração da solução do metronidazol utilizada (4%, 6%, 8%,10% e 12%). Curativos foram realizados diariamente durante todo o período do experimento, que foi subdividido em três momentos de análise: três, sete e 14 dias. A contração da ferida foi avaliada por planimetria digital e os miofibroblastos e protomiofibroblastos foram identificados usando técnicas de imuno-histoquímica CD34 e a-SMA. Resultados: a contração da ferida não apresentou diferença entre os grupos e o controle. Os protomiofibroblastos foram significativamente mais numerosos aos sete dias (p=0,022) nos grupos metronidazol de 4%, 6% e 8%. Após 14 dias, nos mesmos grupos, os miofibroblastos predominaram significativamente (p=0,01). Conclusão: a administração tópica de solução de metronidazol em feridas de pele com cicatrização por segunda intenção foi capaz de melhorar a diferenciação de fibroblastos. A fase de contração da cicatrização de feridas permaneceu inalterada, sem redução significativa da contração avaliada pela planimetria digital. Estes resultados podem ser utilizados em favor do processo de cicatrização de feridas.

ABSTRACT Objective: to assess the effects of topical administration of metronidazole on fibroblast differentiation and on wound contraction during experimental secondary intention wound healing in rats. Methods: we submitted 108 rats to a circular wound on the back, 2cm in diameter, and divided them into six groups: control group, with application of saline solution on the wound and five experimental groups, divided according to the concentration of metronidazole solution used (4%, 6%, 8%, 10% and 12%). We changed the dressings daily throughout the trial period, which comprised three stages of analysis: three, seven and 14 days. We evaluated wound contraction by digital planimetry, and identified myofibroblasts and protomyofibroblasts using CD34 and α-SMA immunohistochemistry techniques. Results: wound contraction was not different between the experimental and the control groups. Protomyofibroblasts were significantly more numerous at seven days (p=0.022) in the 4%, 6% and 8% metronidazole groups. After 14 days, in the same groups, myofibroblasts predominated significantly (p=0.01). Conclusion: the topical administration of metronidazole solution in skin wounds healing by secondary intention was able to improve the differentiation of fibroblasts. The contraction phase of wound healing remained unchanged, without significant reduction of the contraction evaluated by digital planimetry. These results can be used in favor of the wound healing process.

Wet wrap dressings as a rescue therapy option for erythrodermic psoriasis

Abstract: Wet wrap dressings provide an ancillary treatment option for erythrodermic patients. Wet wrap therapy consists of the application of topical corticosteroids on all affected surfaces, followed by the application of a warm moist cotton cloth with a dry cotton cloth on top. The advantages of this procedure include its safety, as well as the prompt and marked improvement of the erythroderma. For erythrodermic psoriasis, wet wrap dressings can serve as an important rescue therapy option. The purpose of this study is to report a case series of seven patients with erythrodermic psoriasis that responded promptly to wet wrap therapy prior to the initiation of systemic treatment.

Comparison of topical and retrobulbar anesthesia in terms of pain experience during silicone oil extraction / Comparação da sensação de dor durante a extração de óleo de silicone sob anestesia tópica e retrobulbar

ABSTRACT Purpose: To compare the use of topical anesthesia and retrobulbar anesthesia during silicone oil removal with a mixed pars plana technique, through evaluating the pain experience of patients. Methods: We selected patients according to their behavior during previous vitreoretinal surgery and ophthalmologic examinations and divided them into two anesthesia groups: topical (n=36) and retrobulbar (n=33). We used a mixed technique for the passive removal of silicone oil in both groups. During each step of the surgery, the patients' pain experience and the surgeon's comfort were scored according to a pain scale. Results: The pain experienced during the application of the anesthesia was significantly greater in the retrobulbar group (p<0.001). The topical group experienced greater pain during trocar insertion (p<0.001). There was no significant difference between the groups regarding the overall pain experience or complications. Conclusions: The pain experience of the selected patients during silicone oil removal was comparable between the topical and the retrobulbar anesthesia. Topical anesthesia with the mixed pars plana technique is an effective and safe alternative option for silicone oil removal surgery.

RESUMO Objetivo: Comparar a sensação de dor de pacientes durante a remoção do óleo de silicone sob anestesia tópica e retrobulbar, usando uma técnica via pars plana combinada. Métodos: Os pacientes foram selecionados, de acordo com suas atitudes durante cirurgia vitreorretiniana prévia e exames oftalmológicos, e divididos em dois grupos: anestesia tópica e retrobulbar. Para a remoção passiva do óleo de silicone, utilizou-se uma técnica combinada em ambos os grupos. A sensação de dor dos pacientes e o conforto do cirurgião foram classificados através de uma escala de dor durante cada etapa da cirurgia. Resultados: Os grupos anestesia tópica e retrobulbar incluíram 36 e 33 pacientes, respectivamente. A sensação de dor durante a aplicação da anestesia foi significativamente maior no grupo retrobulbar (p<0,001). O grupo anestesia tópica sentiu mais dor durante a inserção do trocarte (p<0,001). Não houve diferença significativa entre os grupos em relação à sensação geral de dor e a complicações. Conclusões: A sensação de dor é comparável entre a anestesia tópica e a retrobulbar durante a remoção de óleo de silicone. A combinação de anestesia tópica e uma técnica via pars plana é uma opção alternativa eficaz e segura para a cirurgia de remoção de óleo de silicone.

Curativos de prata iônica como substitutos da sulfadiazina para feridas de queimaduras profundas: relato de caso / Ionic silver dressings as substitute for sulfadiazine for deep burn wounds: case report / Apósitos de plata iónica como sustitutos de sulfadiazina en las heridas por quemaduras profundas: reporte de caso

OBJETIVO: Este artigo tem por objetivo relatar as possíveis vantagens de curativos na forma de lâminas impregnadas com prata iônica (Atrauman®, Mepilex border Ag®, Mepilex-Ag® e Silvercel não aderente®) como agentes tópicos substitutos do creme de sulfadiazina de prata 1% nas queimaduras profundas. RELATO DOS CASOS: Foram tratados 31 pacientes. O Atrauman-Ag® foi empregado em 15 pacientes, o Mepilex border Ag® em três, Mepilex-Ag® em quatro e o Silvercel não aderente® em nove pacientes. Do total, relatamos a utilização destes novos curativos em dois pacientes do estudo com diagnóstico inicial de queimadura profunda. Em nenhum caso foram observados sinais de infecção nas feridas, apesar das trocas de curativos terem sido realizadas entre 4 a 7 dias, mesmo nas queimaduras de espessura total. O conforto propiciado por estes curativos foi evidente, minimizando o estresse e dor e as feridas de espessura parcial se apresentaram com sinais evidentes de rápida epitelização. CONCLUSÃO: Neste estudo preliminar, notamos que todos pacientes se beneficiaram de modo significativo do uso de curativos modernos com lâminas impregnadas por prata iônica quando comparados ao curativo convencional de sulfadiazina. Além da proteção contra infecção, mesmo nas queimaduras de espessura total, eles oferecem a enorme vantagem de as trocas serem espaçadas entre 4 a 7 dias, quando comparados à sulfadiazina, que exige a troca diária dos curativos, minimizando dor e desconforto aos pacientes e também o estresse da equipe de saúde envolvida nos Centros de Tratamento de Queimados.(AU)

OBJECTIVES: This article aims to evaluate the efficacy, and possible advantages of dressings in the form of ionic silver impregnated sheets (Atrauman Ag®, Mepilex Border Ag®, Mepilex - Ag® and Silvercel non - adherent®) as a local substitute agents for the cream of silver sulfadiazine-1% on deep burns. CASE REPORTS: 31 patients were treated. Atrauman-Ag® was used in 15 patients, Mepilex Border Ag® in three, Mepilex-Ag® in four and Silvercel non-adherent® in nine patients. Of the total, we report the use of these new dressings in two patients. In no case were signs of wound infection, even though dressing changes were performed between 4 and 7 days, also in total thickness burns. The comfort provided by these dressings was evident, minimizing stress and pain and partial thickness wounds presented with clear signs of rapid epithelization. CONCLUSION: In this preliminary study, we noticed that all patients benefited significantly from the use of new dressings with ionic silver impregnated sheets when compared to the conventional dressing of sulfadiazine cream. In addition to protection against infection, even in full-thickness burns, they offer the significant advantage that the changes of dressings are spaced between 4 and 7 days. Compared to sulfadiazine, which requires the daily exchange of dressings, they minimize pain and discomfort to patients, and also the stress to the health team involved in the treatment of the Burn Treatment Centers.(AU)

Objetivos: Este artículo tiene como objetivo evaluar la eficacia preliminar y los beneficios potenciales de la curación en forma de láminas impregnadas con plata iónica (Atrauman®, Mepilex Border Ag®, Mepilex-Ag® y Silvercel no aderente®) como sustitutos de crema de sulfadiazina de plata al 1% en quemaduras profundas. Casos Clínicos: Se han tratado 31 pacientes. El Atrauman-Ag® se utilizó en 15 pacientes, Mepilex Border Ag® en tres, Mepilex Ag® en cuatro y Silvercel no adherente® en nueve pacientes. Del total, se presenta la utilización de estos nuevos apósitos en dos pacientes. En ningún caso se observaron signos de infección en las heridas, a pesar de los cambios de apósito se llevaron a cabo entre los 4 y 7 días, incluso en quemaduras de espesor total. La comodidad ofrecida por éstos curación era evidente, lo que minimiza el estrés y el dolor y las heridas de espesor parcial se presentan con signos claros de una rápida epitelización. Conclusión: En este estudio preliminar, se observó que todos los pacientes se beneficiaron significativamente del uso de apósitos impregnados con plata iónica en comparación con sulfadiazina. Además de la protección contra la infección, incluso en quemaduras de espesor total, ofrecen la gran ventaja de las cambios están separadas de 4 a 7 días en comparación con sulfadiazina, que requiere el cambio diario de vendajes, minimizando dolor y malestar a los pacientes, e también el estrés del personal de salud de los centros de tratamiento de Queimados.(AU)

Efeito midriático da fenilefrina a 10% na comparação entre a autoinstilação de gota em olhos abertos e a vaporização em olhos fechados / Phenylephrine 10% mydriatic effect: comparison between self instillation of eye drop in open eyes and spray in closed eyes

RESUMO Objetivo: Comparar a eficácia fenilefrina a 10% aplicada pelo próprio paciente por vaporização em olho fechado em relação à instilação de gota em olho aberto em indivíduos que irão realizar exame de fundoscopia e avaliar o nível de dificuldade e a adequação técnica entre os métodos de administração. Métodos: Ensaio clínico controlado, randomizado e pareado realizado em 2014 envolvendo 100 olhos de 50 pacientes na Policlínica Ronaldo Gazolla - RJ, sem doenças oculares ou sistêmicas que comprometiam a dilatação pupilar. Os pacientes foram submetidos à instilação de 1 gota de fenilefrina a 10% e aplicação de vaporizador do mesmo midriático no olho contralateral. O olho em que se instilou o colírio permaneceu aberto, enquanto o olho vaporizado ficou fechado durante as aplicações da medicação. O diâmetro pupilar foi medido antes da aplicação, 10, 20 e 30 minutos após. O processo de instilação ou vaporização foi observado quanto a sua adequação técnica por um dos autores. Após o processo foi perguntado ao paciente questões pré-formuladas sobre a praticidade de ambos os métodos. Resultados: A diferença de midríase média entre os grupos de olhos avaliados em um determinado tempo foi no máximo 0,3 mm , o que não foi clinicamente ou estatisticamente significativo (ANOVA: F = 1,97 e p = 0,163609) . Porém, ao longo do tempo, a diferença entre o diâmetro da pupila no tempo inicial e no tempo de 30 minutos foi 1,15 mm para os olhos vaporizados e 1,58 mm para os olhos instilados com gotas (ANOVA: F = 129,22 e p ≤ 0,0001). Percentual de 60% dos pacientes tocaram a ponta do frasco de colírio nos olhos, enquanto que 12% tocaram o orifício na ponta do vaporizador com os dedos (p < 0,000001). Setenta de dois por cento (72%) consideraram a instilação de gotas fácil ou muito fácil enquanto 62% consideraram a vaporização em olho fechado fácil ou muito fácil (p = 0,238). Conclusão: A instilação de gotas em olhos abertos e a vaporização de olhos fechados da fenilefrina a 10% apresentou eficácia clínica semelhante. A vaporização foi mais segura e apresentou nível de dificuldade um pouco maior do que a instilação, apesar dos pacientes serem experientes para instilar gotas e inexperientes para vaporizar a medicação em olho fechado.

ABSTRACT Objective: To compare the effectiveness of phenylephrine 10% applied by a spray onto the eye closed over drop instillation onto an open eye on patients who will perform ophthalmoscopy and assess the level of difficulty and technical adequacy of the administration methods. Methods: The study was a clinical trial, controlled, randomized and paired, performed in 2014, involving 100 eyes of 50 patients in the Polyclinic Ronaldo Gazolla - RJ, with no ocular or systemic diseases that compromised the pupillary dilation. Patients underwent 10% phenylephrine eye drop instillation onto one open eye and spray application onto the other eye, which was closed. Pupillary diameter was measured before application and 10, 20, 30 minutes after. The process of instillation or vaporization was observed for its technical correctness by one of the authors. A questionnaire was asked to the patient about the difficulty of both methods after topical administration. Results: The average mydriasis difference between the eye groups assessed at a given time was at most 0.3 mm, which was not clinically or statistically significant (ANOVA: F = 1.97 and p = 0.163609). However, over time, the difference between the average pupil diameter before application and after 30 minutes was 1.15 mm to vaporized eyes and to 1.58 mm in eyes instilled with drops (ANOVA: F = 129, 22 and p ≤ 0.0001). Sixty per cent of patients touched the tip of the eye drop bottle onto the eye, while 12% touched the tip of the vaporizer with their fingers (p <0.000001). Seventy two percent (72%) considered the drops instillation easy or very easy, while 62% considered vaporization in a closed eye easy or very easy (p = 0.238). Conclusion: The instillation of drops phenylephrine 10% in open eyes and the vaporization onto closed eyes showed similar clinical efficacy. Vaporization was safer and a little more difficult than instillation, despite the patients being experienced for instilling drops and inexperienced to vaporize the medication in a closed eye.

Analysis of the effect of traditional Chinese medicine fumigation and washing for hemorrhoids / 中国基层医药

Objective To observe the application effect of traditional Chinese medicine fumigation in the treatment of hemorrhoids.Methods 80 patients with hemorrhoids were chosen as the research subjects,they were randomly divided into two groups.40 cases in the control group received conventional western medicine treatment,40 cases in the observation group were treated by traditional Chinese medicine fumigation.The symptom scores before and after treatment,the symptoms disappear time and clinical effect were compared between the two groups.Results The total effective rate of the observation group was 90％,which was significantly higher than 75％ of the control group (x2 =4.12,P ＜ 0.05).After treatment,the anal pain,anal edema,anal pruritus,bloody symptom scores of the two groups were lower than before treatment,the symptom scores after treatment between the two groups had statistically significant differences (t =12.11,13.02,14.19,12.09,all P ＜ 0.05).The disappearance time of anal pain,anal edema,anal urticant,bloody of the observation group were (4.1 ± 0.2) d,(3.4 ± 0.1) d,(4.0 ± 0.2) d,(5.0 ± 1.1) d,respectively,which were shorter than those of the control group [(6.9 ± 0.5) d,(6.0 ± 1.1) d,(6.8 ± 1.1)d,(8.0 ± 0.2)d],the differences between the two groups were statistically significant (t =13.10,13.09,14.18,11.29,all P ＜ 0.05).Conclusion Chinese medicine fumigation in the treatment of patients with hemorrhoids,anal pain,anal edema,can significantly improve the patients’ symptoms such as anal urticant,bloody,the clinical effect is superior to conventional western medicine treatment.

Percepção de autoinstilação de gotas oculares em idosos com ou sem dispositivo de apoio facial / Self instillation perception of eye drops in elderly patients with and without facial support device

RESUMO Objetivo: Determinar o grau de dificuldade para instilação tópica ocular em idosos, com ou sem o auxílio de dispositivo de apoio facial, por meio de questionário. Observar qual método foi tecnicamente melhor para aplicação tópica ocular de gotas. Métodos: O estudo foi um ensaio clínico, controlado, randomizado e pareado, realizado em 50 pacientes idosos de setembro de 2015 a junho de 2016 na Policlínica Ronaldo Gazolla, Lapa-Rio de Janeiro. Um frasco de colírio Optive® foi acoplado ao dispositivo de apoio facial denominado Eyedrop®. Cada participante instilou o colírio com ou sem o auxílio do dispositivo em cada um dos olhos, sendo que a seleção ocular foi feita aleatoriamente. Foi perguntado ao paciente questões pré-formuladas sobre a dificuldade de ambos os métodos e a técnica de administração tópica ocular foi avaliada. Resultados: A instilação de gotas foi considerada difícil ou muito difícil por 10% dos idosos com o auxílio do dispositivo e por 36% sem o auxílio (p = 0,0047). Houve toque da ponta do colírio com os tecidos oculares em 64% dos pacientes que não usaram o Eyedrop® e em 4% dos que o utilizaram (p=0,000001). A maior dificuldade descrita na instilação tradicional foi acertar o olho com a gota (32%) e com o dispositivo de apoio foi entender seu uso(4%). Conclusão: A maioria dos idosos instila colírios erroneamente, tocando a ponta do frasco em tecidos oculares, o que favorece sua contaminação. O dispositivo de apoio facial tornou mais segura e fácil a instilação.

ABSTRACT Objective: To determine the degree of difficulty for topical ocular instillation in the elderly, through a questionnaire, with or without the aid of facial support device. Observe which method was technically better to topical ocular application of drops. Methods: The study was a clinical trial, controlled, randomized and paired, which was conducted in 50 elderly patients from September 2015 to June 2016 at the Polyclinic Ronaldo Gazolla, Lapa, Rio de Janeiro. A Optive® eyedrop bottle was attached to a facial support device called Eyedrop®. Each participant instilled an eye drop with or without the device help in each of both eyes, wherein the eye selection was made randomly. He was asked to answer pre-formulated questions about the difficulty of both methods and the topical ocular administration technique was evaluated. Results: Eye drop instillation was difficult or very difficult for 10% of the elderly with the device aid and for 36% without it (p = 0.0047). There were bottle tip touch onto the ocular tissues in 64% of patients who did not use Eyedrop® and 4% who used it (p = 0.000001). The greatest difficulty described in traditional instillation was to head properly the eye drop (32%) and when the support device was used, it was to understand how to use it (4%). Conclusion: Most elderly instills eye drops mistakenly, touching the tip of the bottle onto ocular tissues, which favors contamination. The facial support device increased security and facility in instillation.

TopicalJinhuang unction combined with oralSangqin mixture for the patients with moderate to severe acnevulgaris / 国际中医中药杂志

Objective To evaluate the efficacy of topicalJinhuang unction combined with oralSangqin mixture forthe patients with moderate to severe acnevulgaris.Methods A total of 72 patients with moderate to severe acne (Pills bury grade 2 or grade 3) were included and divided into a study group and a control group by random number table method, 36 in each group. The patients were treated for 2 months in the study group with topicalJinhuang unction combined with oralSangqin mixture, and in the control group with topical fusidic acid combined with oralSangqin mixture. The number of lesions and the Global Acne GradingSystem (GAGS) score for each patient were obtained and evaluated. The number offollicularPropionibacterium acnes was determined with real-time fluorescence quantitative polymerase chain reaction.Results After treatment, the number of papule (28.69 ± 10.50vs. 36.61 ± 10.10;t=3.262,P=0.002) was significantly less than that in the control group. The pustules was 1(0, 3) and the nodules was 0 (0, 1) in the study group, which were significantly less than those of 3(0, 15) and 0 (0, 4) in the control group (P<0.01). The GAGS scores was 13(6, 24), which was significantly less than those of 20(17, 32) in the control group significantly lower (Z=-6.482,P<0.01). The number reduction rate of follicular Propionibacterium acnes per unit area in the study group were 43.07% (-57.14%, 86.23%), which was significantly higher than that of 12.68% (-34.52%, 51.11%) in the control group (Z=-2.705,P=0.007). Conclusions TopicalJinhuang unction combined with oralSangqin mixture may reduce the damage of the skin, decrease the numbers of papule, pustules and nodules, depressPropionibacterium acnes in patients with moderate to severe acne vulgaris. TopicalJinhuang unction combined with oralSangqin mixture is superior to topical fusidic acid combined with oralSangqin mixture for the treatment of moderate to severe acne vulgaris.

Effects of Hubai powder navel on prevention of cisplatin -induced nausea and vomiting / 中国基层医药

Objective To observe the prevention effect of Hubai powder applied on navel for nausea and vomiting induced by chemotherapy with cisplatin.Methods 97 patients who received chemotherapy with cisplatin (75mg/m2 )were randomly divided into observation group(n =49)and control group(n =48).In the control group, 30min before chemotherapy,the patients were treated with intravenous granisetron 3mg as antiemetic;Based on the control group,the observation group were treated with Hubai powder 10g applied on Shenque point in the night before the chemotherapy until the end of the next morning after chemotherapy.The curative effect of the two groups were observed.Results The acute vomiting rate of the observation group was 83.7%,which was significantly higher than that of the control group(60.4%)(χ2 =5.423,P =0.019);The delayed vomiting rate of the observation group was 85.7%,which was significantly higher than that of the control group(56.3%)(χ2 =8.867,P =0.003);The patient appetite of the observation group was obviously better than that of the control group,0 -Ⅰ degree occurrence rate of the two groups had statistical significance(χ2 =6.469,4.552,P =0.011,0.033);Ⅱ -Ⅲ degree occurrence rate of the two groups did't have statistical significance.Conclusion Hu Bai powder umbilicus can effectively prevent nausea and vomiting induced by chemotherapy with cisplatin.

Efficacy of topical glucocorticoids combined with a moisturizer containing antimicrobial peptides in the treatment of eczema:a clinical observation / 中华皮肤科杂志

Objective To evaluate the clinical efficacy and safety of topical glucocorticoids combined with a moisturizer containing antimicrobial peptides in the treatment of persistent localized eczema. Methods A total of 60 patients with localized eczema were divided into 2 groups. Group 1 topically applied Fuqing gel (an antimicrobial dressing) and hydrocortisone butyrate cream twice a day for 2 weeks, and group 2 topically applied the vehicle of Fuqing gel and hydrocortisone butyrate cream twice a day for 2 weeks. Recovered patients were followed up once every 4 weeks for 12 weeks. Bacterial culture was performed for 5 patients with suspected local Staphylococcus. aureus infection, including 3 patients in group 1 and 2 in group 2, before and after the 2?week treatment. Therapeutic effects were evaluated and compared between the two groups. Results Compared with group 2, group 1 showed a signifi?cantly higher response rate after 1?week treatment(χ2 = 5.455, P < 0.05), but significantly lower eczema area and severity index(EASI)scores after 1? and 2?week treatment(both P < 0.05). Before the treatment, S. aureus was detected in all the 5 patients. After 2?week treatment, S. aureus was undetected in all the 3 patients in group 1, but was still detected in the other 2 patients in group 2. The treatment was rated as ineffective in none of 7 recovered patients in group 1 during the 12?week follow up, but in 2 of 5 recovered patients in group 2 at week 10. Conclusion Fuqing gel combined with glucocorticoid ointment is safe and effective for the treatment of localized eczema, and can be applied in clinic.

Sodium aescinate gel alleviates hand swelling in elderly patients with distal radius fracture / 中华全科医师杂志

Sixty-two elderly patients with distal radius fractures after fixation with small splints were enrolled in the study from January to December 2014.Patients were randomly divided into intervention and control groups with 31 cases in each group.Patients in both groups received comprehensive prevention for hand swelling, those in intervention group were given additional external administration of sodium aescinate gel (SAG), 1 g, t.i.d for 7 d.Swelling score and visual analogue scale (VAS) were documented before and 3, 7 d after intervention.At the time of fracture healing, the wrist functions, including motions of flexion-extension, motions of radial-ulnar and motions of pronation-supination were examined.At 3 and 7 d after intervention, the swelling score(1.22 ±0.69 vs.1.65 ±0.75 and 0.64 ±0.42 vs.0.96 ±0.71) and VAS(1.96 ±1.27 vs.2.85 ±1.40 and 1.11 ±0.65 vs.1.86 ±1.09)of intervention group were lower than those of control group (all P<0.05).At the time of fracture healing, the wrist motions of flexion-extension [(83.7 ±8.6) vs.(77.6 ±7.1)%], motions of radial-ulnar [(83.0 ±7.6) vs.(78.2 ±8.7)%] and motions of pronation-supination [(81.0 ±7.0) vs.(76.2 ±7.5)%] of intervention group were higher than those of control group ( P <0.05 ) .The results indicate that SAG can reduce swelling, relief pain and promote the recovery of wrist function in elderly patients with distal radius fractures.

Recent advances in topical anesthesia

Topical anesthetics act on the peripheral nerves and reduce the sensation of pain at the site of application. In dentistry, they are used to control local pain caused by needling, placement of orthodontic bands, the vomiting reflex, oral mucositis, and rubber-dam clamp placement. Traditional topical anesthetics contain lidocaine or benzocaine as active ingredients and are used in the form of solutions, creams, gels, and sprays. Eutectic mixtures of local anesthesia cream, a mixture of various topical anesthetics, has been reported to be more potent than other anesthetics. Recently, new products with modified ingredients and application methods have been introduced into the market. These products may be used for mild pain during periodontal treatment, such as scaling. Dentists should be aware that topical anesthetics, although rare, might induce allergic reactions or side effects as a result of an overdose. Topical anesthetics are useful aids during dental treatment, as they reduce dental phobia, especially in children, by mitigating discomfort and pain.

Toxic effects of manganese ion eyedrops to ocular anterior segment / 中华实验眼科杂志

Background A preliminary study determined an application of manganese ion eyedrops in tracing observation of visual system in vivo,but whether manganese ion has toxic effects on ocular anterior segment tissues is still unclear.Objective This study was to investigate the toxic effects of different concentrations of manganese ion eyedrops on ocular anterior segment tissues.Methods Thirty-two clean New-Zealand white rabbits were divided into 1.00 mol/L MnCl2 group,0.50 mol/L MnCl2 group,0.25 mol/L MnCl2 group and normal control group according to random number table.The experimental eye was randomly chosen from each rabbit for eyedrops application.The manganese ion eyedrops at concentration of 1.00 mol/L,0.50 mol/L or 0.25 mol/L was topically administered in any lateral eye of each rabbit in the 1.00 mol/L MnCl2 group,0.50 mol/L MnCl2 group,0.25 mol/L MnCl2 group,and normal saline solution was used in the same way in the normal control group.In 2 hours,1 day and 3,7,14,21,28 days after eyedrops application,the irritative response of ocular surface was examined under the slit lamp microscope,and corneal damage was evaluated by corneal fluorescence staining,and corneal endothelial cell density (ECD) and corneal thickness were assessed using corneal specular microscope.The eyeball samples were prepared in 3,7,14 and 28 days after eyedrops application and hematoxylin and eosin staining was performed for histopathological examination of conjunctiva,cornea,trabecular meshwork and ciliary body tissue.The use and care of experimental animals complied with the Statement of ARVO.Results Severe hyperemia and edema in palpebral conjunctiva appeared in the 1.00 mol/L MnCl2 group and 0.50 mol/L MnCl2 group,and the symptoms reached a maximum level 1 day after eyedrop application and disappeared 7 days after eyedrops application in the 1.00 mol/L MnCl2 group.These symptoms were milder in the 0.50 mol/L MnCl2 group in comparison with the 1.00 mol/L MnCl2 group.There were no ocular irritative response in the 0.25 mol/L MnCl2 group.Significant differences were found in the corneal fluorescence scores among the groups 2 hours,1 day,3 and 7 days after eyedrop application (X2 =17.350,19.200,12.200,10.140,all at P＜0.05),with the highest score in the 1.00 mol/L MnCl2 group.The ECD was not significantly different among the groups and different time points (Fgroup =0.38,P＞0.05;Ftime =1.79,P＞0.05).The corneal thickness value was significantly different among the groups and different time points (Fgroup =18.22,P＜0.05;Ftime =116.75,P ＜ 0.05).The corneal thickness value was elevated during 2 hours to 3 days after administration of eyedrops in the 1.00 mol/L MnCl2 group and closed to normal from 7 days to 28 days.The corneal thickness value was higher from 2 hours to 14 days than that in 28 days after administration of eyedrops in the 1.00 moL/L MnCl2 group,and the corneal thickness value was higher in 2 hours to 1 day than that in 28 days after administration of eyedrops in the 0.50 mol/L MnCl2 group (all at P＜0.05).Inflammatory cell infiltration and stromal edema were exhibited in conjunctival,trabecular meshwork and ciliary body tissue in the 1.00 mol/L MnCl2 group 3 days and 7 days after eyedrops application,and only inflammatory cell infiltration in conjunctival tissue in the 0.50 mol/L MnCl2 group 3 days after eyedrops application.No obvious abnormity was seen in the 0.25 mol/L MnCl2 group.Conclusions 1.00 mol/L manganese ion eyedrops has a remarkable toxic effect on ocular anterior segment tissue in rabbit.With the lowing of drug concentrations,the toxic effects were reduced.The manganese-enhanced MRI using 0.25 mol/L manganese ion eyedrops is feasibility bacause of its non-toxicity to ocular tissues.