Síndrome DRESS asociado a fenitoína: informe de caso / DRESS syndrome associated with phenytoin: case report

El síndrome DRESS es una reacción adversa dermatológica que puede presentarse debido a diversos medicamentos, y constituye uno de los diagnósticos más importantes por encima del síndrome de Stevens-Johnson. Se trata de un caso relacionado con una reacción adversa de muy baja frecuencia, que está documentada en la literatura científica, a varios medicamentos, entre ellos la fenitoína. Por lo mencionado, la publicación de estos casos resulta escasa y limitada. Las principales preocupaciones del paciente relacionadas con su cuadro clínico radicaban en el gran compromiso cutáneo que lo llevó a hospitalización, dolor e incomodidad, por el cual recurrió al manejo tópico generalizado con vaselina. Los hallazgos clínicos relevantes fueron: eosinofilia severa, ulceraciones cutáneas, hepatitis química y fiebre. Con los hallazgos del cuadro clínico y la evaluación de la escala RegiSCAR se hace el diagnóstico de síndrome DRESS inducido por fenitoína. Se suspende la fenitoína, se inicia levetiracetam y se administran corticosteroides y acetaminofén con evolución favorable. (AU)

DRESS syndrome is a dermatological adverse reaction can occur due to various medications, being one of the most important diagnoses above Steven-Johnson syndrome. This is a case related to a very low frequency adverse reaction that is documented in the scientific literature to several medicines among those, the phenytoin. Therefore, the publication of these cases is scarce and limited. The main concerns of the patients related to their clinical picture were due to the great cutaneous compromise that lead to hospitalization, pain and discomfort for which they resorted to generalized topical management with vaseline (petrolatum). Relevant clinical findings were severe eosinophilia, skin ulcerations, chemical hepatitis and fever. With clinical picture findings and evaluation of the RegiSCAR scale, the diagnosis of Phenytoin-induced DRESS syndrome is made. Phenytoin is discontinued, levetiracetam is started and corticosteroids and acetaminophen are administrated with favorable evolution. (AU)

Estudio del índice nivel/dosis de la fenitoína en pacientes epilépticos voluntarios de Mérida / Study of the level/dose index of phenytoin in volunteer epileptic patients from Mérida

INTRODUCCIÓN La fenitoína es usada con mucha frecuencia en nuestro medio, por lo que se requiere hacer estudios de monitorización terapéutica, que contribuya a minimizar los efectos adversos y optimizar la terapia farmacológica. En ese contexto, nuestro objetivo ha sido determinar el índice nivel/dosis de la fenitoína en pacientes epilépticos voluntarios de Mérida. MÉTODOS Se realizó un estudio descriptivo, observacional y por reclutamiento consecutivo concurrente, conformado por 30 pacientes voluntarios con diagnóstico de epilepsia. Las muestras de suero se obtuvieron en niveles mínimos de pacientes que estaban en tratamiento con fenitoína durante 1 mes. Los niveles del fármaco se cuantificaron por el método de Inmunoensayo de enzima donante clonada en el equipo Indiko Thermo Scientific. RESULTADOS El índice nivel/dosis fue de 1,4 y 1,6, la concentración plasmática de 4,8mg/l y 8,0mg/l, la capacidad metabólica de 388,4 y 462,9mg/día, respectivamente en mujeres y hombres. Mientras que el nivel de la concentración plasmática en el estado estacionario fue de 6,5mg/l y 5,5mg/l, la dosis de carga máxima de 237,3mg y de 395,6mg, respectivamente en mujeres y hombres con epilepsia de la ciudad de Mérida. CONCLUSIONES Nuestros resultados sugieren que se debe individualizar la dosis en base al índice nivel/dosis de cada paciente, ya que no se puede extrapolar para todos los pacientes con epilepsia, debido a diversos factores como al fenotipo metabólico y al uso de fármacos inductores e inhibidores enzimáticos.

INTRODUCTION Phenytoin is used very frequently in our environment, so it is necessary to do studies of therapeutic monitoring, which helps to minimize adverse drug reaction and optimize pharmacological therapy. In this context, our objective was to determine the level/dose index of phenytoin in volunteer epileptic patients from Mérida. METHODS A descriptive, observational and consecutive concurrent recruitment study was carried out, consisting of 30 volunteer patients with a diagnosis of epilepsy. The serum samples were obtained in minimum levels from patients who were in treatment with phenytoin for 1 month. The levels of the drug were quantified by the method of donor enzyme immunoassay cloned in the Indiko Thermo Scientific equipment. RESULTS The level/dose index was 1,4 and 1,6, the plasma concentration of 4,8mg/l and 8,0mg/l, the metabolic capacity of 388,4 and 462,9mg/day, respectively in women and men. While the level of plasma concentration at steady state was 6,5mg/l and 5,5mg/l, the maximum loading dose of 237,3mg and 395,6mg, respectively in women and men with epilepsy of the city of Mérida. CONCLUSIONS Our results suggest that the dose should be individualized based on the level/dose index of each patient, since it can not be extrapolated for all patients with epilepsy, due to various factors such as the metabolic phenotype and the use of enzyme-inducing drugs and inhibitors.

comparative assessment the efficacy of intravenous infusion of sodium valproate and phenytoin in the treatment of status epilepticus

Status epilepticus [SE] is a type of persistent lasting seizure with high mortality and morbidity. Numerous medications are suggested for the treatment of SE, two of which are sodium valproate and phenytoin. The purpose of this study is to conduct a comparison between the efficiencies of intravenous sodium valproate and phenytoin in the treatment of this type of epilepsy. This is a clinical trial study conducted on SE-suffering patients admitted to the emergency departments of Al-Zahra and Ayatollah Kashani Medical Centers of Isfahan in 2009 and 2010. The patients were randomly assigned into two groups and taken under treatment, separately by intravenous infusion sodium valproate and phenytoin. No significant difference was observed between the two groups [at P = 0.06]. In terms of incidence of the clinical complications, the incidence of clinical complications in the two groups was significantly different [at P = 0.03]. Based on the findings the efficiency of sodium valproate is larger than that of the phenytoin, and thus, the treatment by sodium valproate is preferred over the treatment by phenytoin

Comparing the effect of phenytoin syrup and triamcinolone acetonide ointment on aphthous ulcers in patients with Behcet's syndrome

Recurrent aphthous stomatitis [RAS] appears to be the most common type of oral ulcers. The lesion is usually self limited but its painful presentation results in some difficulties. Therefore, an efficient therapeutic strategy is required and currently existing therapies seem to be inadequate because of its unclear etiology. Here the therapeutic effect of triamcinolone acetonide ointment as a relatively expensive medication has been compared with phenytoin syrup on aphthous ulcers in patients with Behcet's syndrome. Thirty out of 60 our patients with Behcet's syndrome were randomly treated by phenytoin syrup and the remaining were advised to use 0.1% triamcinolone acetonide ointment. After a week, they were visited again to determine the status of aphthous ulcers. Positive response in the triamcinolone acetonide group and phenytoin group was 86.7% and 53.3%, respectively. The effectiveness of triamcinolone acetonide ointment was more than phenytoin on aphthous ulcers in patients with Behcet's syndrome

CYP2C9 polymorphism in patients with epilepsy: genotypic frequency analyzes andphenytoin adverse reactions correlation / Polimorfismo do CYP2C9 em pacientes com epilepsia: estudo da frequência genotípica e correlação com os efeitos colaterais da fenitoína

OBJECTIVE: CYP2C9 is a major enzyme in human drug metabolism and the polymorphism observed in the corresponding gene may affect therapeutic outcome during treatment. The distribution of variant CYP2C9 alleles and prevalence of phenytoin adverse reactions were hereby investigated in a population of patients diagnosed with epilepsy. METHOD: Allele-specific PCR analysis was carried out in order to determine frequencies of the two most common variant alleles, CYP2C9*2 and CYP2C9*3 in genomic DNA isolated from 100 epileptic patients. We also analyzed the frequency of phenytoin adverse reactions among those different genotypes groups. The data was presented as mean±standard deviation. RESULTS: The mean age at enrollment was 39.6±10.3 years (range, 17-72 years) and duration of epilepsy was 26.5±11.9 years (range 3-48 years). The mean age at epilepsy onset was 13.1±12.4 years (range, 1 month-62 years). Frequencies of CYP2C9*1 (84 percent), CYP2C9*2 (9 percent) and CYP2C9*3 (7 percent) were similar to other published reports. Phenytoin adverse reactions were usually mild and occurred in 15 percent patients, without correlation with the CYP2C9 polymorphism (p=0.34). CONCLUSION: Our findings indicate an overall similar distribution of the CYP2C9 alleles in a population of patients diagnosed with epilepsy in the South of Brazil, compared to other samples. This sample of phenytoin users showed no drug related adverse reactions and CYP2C9 allele type correlation. The role of CYP2C9 polymorphism influence on phenytoin adverse reaction remains to be determined since some literature evidence and our data found negative results.

OBJETIVO: A CYP2C9 é uma das principais enzimas do metabolismo de drogas humano e o polimorfismo observado no respectivo gene pode afetar o resultado terapêutico durante o tratamento. Neste trabalho investigamos em uma população de pacientes portadores de epilepsia a distribuição dos alelos variantes do CYP2C9 e a frequência de efeitos adversos da fenitoína tentando estabelecer uma correlação. MÉTODO: Realizamos uma análise através de uma PCR alelo específica para determinar a frequência dos alelos variantes mais comuns, CYP2C9*2 e CYP2C9*3, isolados da amostra de 100 pacientes com epilepsia. Também levantamos a frequência de reações adversas da fenitoína nestes diferentes grupos genotípicos. Os dados são apresentados na forma de média e desvio-padrão. RESULTADOS: A idade média na inclusão foi 39,6±10,3 anos (variando de 17-72 anos) e a duração da epilepsia era 26,5±11,9 anos (variando de 3-48 anos). A idade média dos pacientes no início da epilepsia era 13,1±12,4 anos (variando de 1 mês-62 anos). As frequências do CYP2C9*1 (84 por cento), CYP2C9*2 (9 por cento) e CYP2C9*3 (7 por cento) foram similares a outros estudos publicados. As reações adversas da fenitoína foram frequentemente leves e ocorreram em 15 por cento dos pacientes, sem correlação com o polimorfismo do CYP2C9 (p=0.34). CONCLUSÃO: Nossos achados indicam uma distribuição similar dos alelos variantes *2 e *3 nesta população de pacientes com epilepsia comparado a outros estudos. Esta amostra de usuários de fenitoína mostrou não haver correlação entre efeitos colaterais relacionados à droga e o tipo de alelo variante. O papel da influência do polimorfismo do CYP2C9 nos efeitos colaterais da fenitoína precisam ser melhor determinados, já que algumas evidencias da literatura e este trabalho mostraram resultados negativos.

Comportamiento del estatus convulsivo en niños atendidos en la UCI-P del Hospital Fernando Vélez Paiz de enero 2008-diciembre 2009 / Convulsive status behavior in children treated at the ICU-P Fernando Velez Paiz Hospital January 2008-December 2009

El estudio realizado en niños con Estatus Convulsivo ingresados en la UCIP del HFVP de Enero 2008- Diciembre 2009 la muestra fue de 16 pacientes.En relación a la edad y el sexo, el grupo etareo más afectado fue de 1- 5 años con 58%(9), siendo 6(38%) masculino y 19%(3) femeninas, seguido del 6-10 años con el 19%, de estos13%(2) masculino y 6%(1) femenino.Al revisar los antecedentes patológicos personales el 38%(6) tenía antecedentes de convulsión febril, Epilepsia 25%(5) y el 13%(2) asfixia perinatal. La principal etiología del EC fue la Epilepsia en 44%(7), seguida de la supresión del tratamiento anticonvulsivante y la fiebre en un 25% respectivamente. En el tratamiento se utilizó la Difenilhidantoina en 15 pacientes, la dosis de impregnación fue 18-20 mg/kg en el 80%(12), el Fenobarbital se utilizó en 3 pacientes, con dosis de impregnación de 10mg/kg/d en el 60% de los pacientes que se uso. En el tratamiento de mantenimiento el fármaco más utilizado fue la Difenilhidantoina en 12 pacientes, a dosis 5mg/kg/día en el 75%, seguido del Acido Valproico en 7 pacientes a dosis de 15 mg/kg/día y Fenobarbital en 4 pacientes a dosis 5mg/kg/día .La ventilación mecánica se utilizó en 5 pacientes, de estos el 40% estuvo 4-6 días con soporte ventilatorios.Dentro de los estudios complementarios realizados en los pacientescon estatus convulsivo: al 75% se les realizó Ionograma encontrando Hipocalcemia en el 44%(7), e Hiponatremia e hipernatremia en el 13%(2) de los casos respectivamente.Se presentaron complicaciones en 7 pacientes, y la complicación que se presento con mayor frecuencia fue las alteraciones electrolíticas en el 50%(7), seguida del edema cerebral 35%(5), la hemorragia intracraneal y el infarto isquémico en el 7% respectivamente.La condición de egreso el 100% de los pacientes estudiados fue dado de alta y de estos el 88%(14) no presento ninguna secuela, solo el 13%(2) presentó secuelas dentro de ellas hemiparesias e hipotonía.

Acute intermittent porphyria: diagnosis per chance.

OBJECTIVES: To report a case of acute intermittent porphyria (AIP) diagnosed by chance during routine investigations. CLINICAL PRESENTATION AND INTERVENTION: A 21-year-old female presented with vague gastrointestinal symptoms. Upon admission, she was disoriented. Later she developed generalized seizures and was treated with phenytoin, but the condition worsened. Upon investigation, her liver function, renal function, blood sugar level and electrolytes were within normal limits. When kept for routine laboratory testing, the color change in urine prompted us to investigate for porphyria. It was positive for phorphobilinogen (PBG) and urophorphyrin. Since AIP had been diagnosed, the initial treatment with phenytoin was discontinued with a favorable outcome. A screening test for PBG in urine by Ehrlich's reagent was performed on the patient's mother and was positive. CONCLUSION: A high degree of suspicion at the laboratory can also determine the diagnosis of AIP, which is often missed by the clinician.

Enteral nutrition and phenytoin administration in head trauma patients

Seizure is common after head trauma and neurosurgery. Phenytoin is the most common anti-convulsant drug used in epileptic patients and for prevention of seizure in patients with head trauma and stroke. This drug has unique pharmacokinetic and pharmacodynamic characteristics. Phenytoin administration along with enteral nutrition in ICU patients may be accompanied by decreased phenytoin absorption and inadequate therapeutic concentration. The present study was performed to assess the effect of enteral nutrition on the pharmacokinetic therapeutic parameters of phenytoin given to our patients. In a clinical trial, the study group was divided into two groups of 15 patients each. After obtaining steady-state phenytion serum concentration, two blood samples were obtained from each patient on 2 consecutive days and then analyzed. The mean was assessed on the basis of serum albumin level of the patient. Clearance and maximum metabolic capacity were also calculated. Serum phenytoin level was below the therapeutic range [10- 20 mg/l] in 70% of patients in group 1 and was higher than the therapeutic range in 70% of patients in group 2 who received oral phenytoin [by dissolving in water] 2h after enteral nutrition. Mean phenytion concentration was 6.3 +/- 4mg/l and 24.7 +/- 9.4mg/l in group 1 and group 2, respectively. We found oral phenytoin administration with enteral nutrition [gavage solutions] to result in a significant decrease in absorption and blood concentration of phenytoin. We recommend administration of phenytoin with water only. In addition, monitoring of phenytoin serum concentration is necessary for assessment of therapeutic concentration and prevention of side effects

Effect of doses on the bioavailability of phenytoin from a prompt-release and an extended-release preparation: single dose study.

OBJECTIVE: To determine the effect of doses on the bioavailability of a prompt-release and an extended-release phenytoin capsule after given as single doses. MATERIAL AND METHOD: Eight healthy male volunteers were given single oral doses of 100, 200, and 300 mg of a prompt-release preparation (Ditoin) and an extended-release phenytoin (Dilantin Kapseals) preparation in a crossover design with a two weeks washout period after an overnight fast. Serial blood samples were collected over 72 h post-dose. Plasma phenytoin concentrations were determined by HPLC and pharmacokinetic parameters were analyzed by non-compartmental model. RESULTS: Rate of phenytoin absorption from the prompt-release preparation was more prolonged after the 300mg dose (T(max) 4.5 h) than those of the 100- and 200-mg doses (T(max) 3.5 and 3 h, respectively). Similarly, the T(max) of the 200- and the 300-mg extended-release preparation (5.5 and 4 h) were more prolonged than the 100-mg dose (3 h). Bioequivalence analysis showed that the C(max) of all doses of the prompt-release preparation were higher than those values of the extended-release preparation with the mean C(max) ratio (90% CI) of 1.32 (1.24-1.40), 1.26 (1.14-1.40), and 1.29 (1.10-1.51) for the 100-, 200- and 300-mg doses, respectively. The extent of absorption (AUC(0-infinity)) of 100-mg phenytoin was bioequivalent between the two preparations [mean AUC ratio (90% CI) of 1.15 (1.11-1.18)], however, for higher doses, the prompt-release products produced higher bioavailability than the extended-release products [mean AUC ratio (90% CI) of 1.19 (1.07-1.33) and 1.17 (0.98-1.38), respectively for the 200- and 300-mg doses]. The difference in the bioavailability did not affect the elimination of phenytoin and their half-lives were comparable (11-13 h). CONCLUSION: The bioavailability of phenytoin from both preparations increased proportionally over the dose range of 100-300-mg, however, the bioavailability of the prompt-release preparation was higher than the corresponding doses of the extended-release product.

Eficacia de gabapentina1, 200 mg en el ahorro de analgesicos de rescate comparada con difenilhidantoina 750 mg en pacientes Asa I y II bajo anestesia general en la unidad de cuidados posanestesicos en el Hospital Bertha Calderón Roque mayo-julio 2005 / Effectiveness of gabapentina1, 200 mg in the saving of analgesic of rescue compared with difenilhidantoina 750 mg in patients Roasts I and II under it anesthetizes general in the unit of having taken care of posanestesicos in the Hospital Bertha Cald

Se realizó un ensayo clínico controlado en el que se compararon dos fármacos coadyuvantes en el ahorro de analgesia de rescate en pacientes oncológicas sometidas a anestesia general. Se seleccionaron 66 pacientes elegibles y al azar en dos grupos de estudio en los que se les administro por vía oral Gabapentina 1.200 mg y en el otro grupo Difenilhidantoina 750 mg, en el período de mayo a julio de 2005. Evaluándose la eficacia por medio de la escala visual análoga valorándose la intensidad del dolor postquirúrgico durante 280 minutos. Se realizó la prueba de Chi2 para evaluar la eficacia de los fármacos en estudio. En los dos grupos de estudio según la EVA se observo un diferencia significativa en el ahorro de analgesia de rescate en el grupo de Gabapentina comparado con las pacientes que recibieron Difenilhidantoina los cuales tuvieron tendencia a aumentar el dolor postquirúrgico, conllevando a administrar dosis analgésica de rescate en este grupo. Se concluye que Gabapentina como fármaco coadyuvante es una excelente alternativa analgésica para tratar el dolor postquirúrgico, presentando excelente respuesta clínicas al dolor, administrándose previo a la realización quirúrgica...

Topical phenytoin ointment increases autograft acceptance in rats

To examine the effectiveness of topical phenytoin in preserving the skin viability and increasing acceptance rate of autograft. We conducted this study in the Central Laboratory Animal House of Jordan University of Science and Technology, Irbid, Jordan during the period from September 2004 to June 2005. Forty-two rats were divided into 2 equal groups; full thickness dorsal skin wound [4 cm2] was created in the rats. Twenty-one rats were treated with phenytoin [10% w/w ointment], the other 21 [control] were treated with standard dressing and Vaseline. An autograft was performed one week after treatment. Rats were examined for the presence of healthy granulation tissue, reduction in wound surface dimensions, and time for complete graft attachment. Phenytoin ointment had significantly increased wound bed viability and the rate of graft acceptance [p-value <0.0001]. Twenty rats had successful grafting [10% phenytoin]; while only 3 rats out of the 21 control had successful grafts. The mean time to complete graft attachment and hair growth in the grafted skin was 6.6 +/- 0.5 days. The mean wound contraction measurements [taken just before grafting] were as follow: control group 59.2 +/- 11.6%, and phenytoin group 55.7 +/- 9.2, difference in skin contractility was not statistically significant. Skin viability was evident by increased vascularity and granular tissue formation at the edges of the wound. Phenytoin appears to be an effective method for enhancing the take of the full-thickness skin graft. Further clinical use and evaluation of topical phenytoin ointment in skin grafting are merited

Appropriateness of intravenous loading dose of phenytoin treatment in Srinagarind Hospital.

Intravenous loading dose of phenytoin treatment (ILP) is a useful treatment but may cause serious adverse events. The present study assessed the appropriate use of ILP in Srinagarind Hospital. The authors reviewed all charts that ILP was ordered between January 1st, 2000 and December 31st, 2001, about indication, the infusion rate, and side effects. There were 206 cases treated with ILP Thirty-two cases (15.7%) received inappropriate treatment by ILP The most common indication was primary prophylaxis before brain surgery. There were 7 cases that developed side effects with 5 cases of high blood phenytoin level. These data showed that physicians should consider more carefully the use of ILP.

Disminución de ácido fólico y alteraciones cognitivas en pacientes con epilepsia tratados con fenitoína o carbamazepina, estudio piloto / Decrease of folic acid and cognitive alterations in patients with epilepsy treated with phenytoin or cartnabazepine, pilot study

Introduction. Phenytoin and carbamazepine were the antiepileptic drugs most frequently used in Mexico and throughout the world. Epileptic patients who take these drugs have a variety of collateral effects including the decrease of Mates plas-matic level. Low serie folie acid concentration has been associated with a decline in cognitive functions. The administration of a combined treatment with folie acid could ameliorate these difficulties. Objective.To describe the effect of the folie acid in the cognitive function in epileptic patients who take phenytoin and carbamazepine. Methods. We chose patient who have epilepsy and that are being treated with phenytoin, carbamazepine or both and formed two groups. The study group was treated with a daily dose of 5 mg of folie acid and the control group was administered placebo for a period of six months, with nine patients in each group of same age, sex, education level, epilepsy's evolution, frequency of seizures, EEG abnormalities and antiepileptic drugs plasma levels. We registered data at the beginning (basal) and at the end of the study. Results.Measurements of basal folie acid plasma levels in both groups were under the referential value. The neuropsychological assessment at the beginning (Mini-Barcelona test) showed a deficit in the verbal memory skills in both groups. After six months of treatment with folie acid (study group), the folie acid plasma level was 12.2 mg/mL (p < 0.01) higher than the basal value. Verbal memory test has improved with respect to the basal value (p < 0.05). The numbers of seizures and the plasma levels of the antiepileptic drugs remained unchanged. On the other hand, the group treated with placebo did not improve. Conclusion.Treatment with folie acid is safe and without side effects, it improved the cognitive function in patients with epilepsy treated with phenytoin and carbamazepine.

Introducción. La difenilhidantoína (DFH) y la carbamazepina (CBZ) son los antiepilépticos más empleados en México y en el mundo, los pacientes con epilepsia que emplean estos fármacos presentan una disminución en las concentraciones séricas de ácido fólico, una de las causas que pueden contribuir a un deterioro cognitivo, por lo que la terapia sustitutiva con ácido fólico pudiera mejorar estas alteraciones. Objetivo. Describir el efecto de la disminución del ácido fólico en la cognición de pacientes con epilepsia tratados con difenilhidantoína y carbamazepina. Material y métodos. Incluimos pacientes tratados con carbamazepina, fenitoína o ambos, con epilepsia. Formamos dos grupos: Un grupo experimental recibió ácido fólico 5 mg/día y otro grupo control recibió placebo durante seis meses, nueve pacientes en cada grupo; pareados en la edad, sexo, escolaridad, tiempo de evolución, námero de crisis, alteraciones EEG, niveles séricos de anticonvulsivos, realizamos estudios neuropsicológicos al inicio (básales) y al final del estudio a ambos grupos. Resultados. Las básales del ácido fólico en ambos grupos estuvieron por debajo del valor de referencias. En las pruebas neuropsicológicas (básales) (prueba de Mini-Barcelona) se halló un déficit en el área de la memoria verbal en ambos grupos. Después de seis meses de tratamiento con ácido fólico (grupo experimental) los niveles de ácido fólico alcanzaron 12.2 ng/mL (p < 0.01) con respecto a su basal; las pruebas de memoria verbal mejoraron con respecto a su basal (p < 0.05); el námero de crisis y los niveles séricos de los anticonvulsivos no se modificaron. El grupo con placebo no presentó ninguna mejoría. Conclusiones. El tratamiento coadyuvante con ácido fólico es seguro, libre de efectos adversos y mejoró las alteraciones cognitivas (memoria verbal) de estos pacientes.

[Efficacy of 0.05% topical solution of tretinoin on healing of chronic ulcers and comparison of it with 1% topical cream of phenytoin]

Chronic ulcer with any kind of etiology is one of the therapeutic problems for patients and medical services. With respect to appropriate effects of retinoids on different stages of wound healing, we decided to evaluate efficacy of 0.05% topical solution of tretinoin on topical treatment of ulcers in comparison with 1% topical cream of phenytoin,that its effects on wound healing has been approved in several studies. In an interventional, clinical trial topical effect of these two drugs on healing of chronic ulcers of 30 patients with 37 ulcers was compared, with random allocation patients divided to two groups and finally 15 patients with 18 ulcers treated with l%topical cream of phenytoin and 15 patients with 19 ulcers treated with 0.05% topical solution of tretinoin. Then followed up for 6 weeks and evaluated for criteria of clinical recovery [size, depth, secretion and pain] in weekly visits. Analytic tests were done by using the chi-square test and P<0.05 was accepted as significant. 'At the end of, the treatment in phenytoin group 42.6 +/- 44.9% and in tretinoin group 44.7 +/- 43.4% of ulcers width were reduced. Also at this time ulcers' depth were diminished whereas in phenytoin group 55.6% and in tretinoin group 26.3% of those were in superficial dermis. Before treatment in phenytoin group 55.6% of ulcers were without pain though after it 100% of them had no pain. In tretinoin group ulcers without pain increased from 78.9% before to 84.2% after treatment. Percentage of ulcers with no secretion increased from 33.3% to 55.6% in phenytoin group and from 26.3% to 68.4% in tretinoin group With respect to results, tretinoin solution as phenytoin cream can be used as an appropriate topical treatment for chronic ulcer

Evaluation of phenytoin utilization based on key pharmacokinetic parameters in patients with head trauma

Phenytoin is commonly administered as an anticonvulsant agent to critically traumatic patients for seizure prophylaxis and treatment. It exhibits non-linear pharmacokinetic characteristic and requires frequent plasma level monitoring and dose adjustment. Based on the previous study, it is often difficult to achieve therapeutic levels in patients with head trauma using the recommended phenytoin dosing strategies. Therefore, we conducted a prospective, randomized study to evaluate pharmacokinetic parameters of phenytoin in patients with head trauma. In this prospective randomized study, eighty-three patients were enrolled. The dosing regimen of phenytoin was designed and individualized for each patient based on available population pharmacokinetic data and was compared with the administered dose. The peak and trough concentrations of collected blood samples were determined by TDX. Statistical analysis of the findings indicated that there were significant differences between administered doses of phenytoin and calculated doses based on peak and trough [P<0.0001]. Additonally, our findings indicate the significant difference between previous population Vmax and Vmax obtained from this study. Furthermore, this study showed that phenytoin plasma concentrations were sub therapeutic in the majority of cases [71%].It seems that blood level monitoring ot phenytoin in patients with neurosurgical trauma on the basis of drug pharmacokinetic parameters such as Vmax is necessary

Cerebral venous sinus thrombosis as presenting feature of Crohn's disease.

Hepatobiliary and vascular manifestations are rare form of extraintestinal manifestations in Crohn's disease. We report a 20-year-old man in whom cerebral venous sinus thrombosis was the presenting symptom and preceded the diagnosis of Crohn's disease.

Tratamento do estado de mal peiléptico / Treatment of status epilepticus

O estado de mal epiléptico (ENE) é uma emergência neurológica que necessita um tratamento efetico imediato para o controle da atividade epiléptica e da etiologia da mesma, no sentido de prevenirmos lesões neuronais e outros distúrbios sistêmicos associados...

Anticonvulsant potential of holy basil, Ocimum sanctum Linn., and its cultures.

Callus cultures from stem of O. sanctum were induced on slightly modified Murashige and Skoog's (MS) medium and supplemented with 2,4-dichlorophenoxyacetic acid (2,4-D, 1-2 ppm) and kinetin (kn, 1 ppm). Different extractives of stem, leaf and stem callus of O. sanctum were tested for anticonvulsant activity against standard drug phenytoin using maximal electroshock (MES) model. Ethanol and chloroform extractives of stem, leaf and stem calli were effective in preventing tonic convulsions induced by transcorneal electroshock.