Generalidades de Queratitis Micótica / Overview of Mycotic Queratitis

La queratitis micótica es una importante causa de discapacidad visual en los países desarrollados. En los últimos años ha aumentado su incidencia en países de regiones tropicales, relacionado con el aumento de las conductas de riesgo como el uso indiscriminado de antifúngicos y corticoides oftálmicos en la práctica médica. La confirmación del diagnóstico es necesaria, no sólo en caso de queratitis micótica, sino también en otras enfermedades oculares infecciosas para así iniciar la terapia oportuna y exacta, y evitar el uso innecesario de antimicrobianos. El pronóstico visual de los pacientes dependerá del diagnóstico temprano y el tratamiento médico oportuno.

Fungal keratitis is a major cause of visual disability in developed countries. In recent years its incidence has increased in tropical countries, related with risk behaviors such as indiscriminate use of antifungal and corticosteroid ophthalmic in clinical practice. Diagnostic confirmation is needed, not only in cases of fungal keratitis, but also for other infectious eye diseases, to initiate timely and accurate therapy, and avoid the unnecessary use of antimicrobials. The visual prognosis of patients depends on rapid diagnosis and prompt medical treatment.

Eficácia de antifúngicos tópicos em diferentes dermatomicoses: uma revisão sistemática com metanálise / Efficacy of topical antifungal drugs in different dermatomycoses: a systematic review with meta-analysis

OBJETIVO: Avaliar e comparar a eficácia dos antifúngicos tópicos empregados no tratamento de cada dermatomicose. MÉTODOS: Foi desenvolvida uma revisão sistemática de ensaios clínicos randomizados, publicados em português, espanhol ou inglês até julho de 2010, que comparassem o uso de antifúngicos azólicos e alilamínicos entre si ou com placebo, no tratamento de candidíase cutânea, e das tineas versicolor, pedis, cruris e corporis. Os desfechos de eficácia avaliados foram cura micológica ao final do tratamento e cura sustentada. RESULTADOS: Dos 4.424 estudos inicialmente identificados, 49 alcançaram os critérios de seleção, sendo incluídos nas metanálises. Os dados agrupados de eficácia demonstraram superioridade dos antifúngicos frente a placebo, independente da dermatomicose avaliada, com valores de odds ratio (OR) variando de 2,05 (IC 95% 1,18-3,54) a 67,53 (IC 95% 11,43-398,86). Alilaminas foram superiores aos azólicos apenas para o desfecho cura sustentada (OR 0,52 [IC 95% 0,31-0,89]). CONCLUSÃO: Há evidência consistente da superioridade dos antifúngicos com relação ao uso de placebo, não sendo mais justificável a realização de estudos controlados por placebo. Alilaminas mantêm a cura micológica por períodos mais extensos que fármacos azólicos. Dada a significativa diferença de custo entre as classes, recomenda-se a realização de análises farmacoeconômicas.

OBJECTIVE: To evaluate and compare the efficacy of topical antifungal drugs applied to the treatment of each dermatomycosis. METHODS: A systematic review of randomized clinical trials, published in Portuguese, Spanish and English until July 2010, which compared the use of azole and allylamine antifungal drugs among themselves and with placebo in the treatment of cutaneous candidiasis and T. versicolor, T. pedis, T. cruris and T. corporis was performed. The efficacy outcomes evaluated were mycological cure at the end of treatment and sustained cure. RESULTS: Of the 4,424 studies initially identified, 49 met the selection criteria and were included in the meta-analyses. The grouped efficacy data evidenced the superiority of antifungal drugs compared to placebo, regardless of the dermatomycosis under evaluation, with odds ratio values ranging from 2.05 (95% CI 1.18-3.54) to 67.53 (95% CI 11.43-398.86). Allylamines were better than azoles only for the outcome sustained cure (OR 0.52 [95% CI 0.31-0.89]). CONCLUSION: There is consistent evidence of the superiority of antifungal drugs over the use of placebo, and placebo-controlled studies are no longer justifiable. Allylamines maintain the mycological cure for longer periods compared to azole drugs. Given the significant cost difference among the classes, pharmacoeconomic analyses should be performed.

A small amount of ketamine with oxycodone induced an acute hyperactive delirium due to voriconazole, a CYP3A4 inhibitor, in a case of multiple myeloma with cancer pain

This is a report on a case of delirium due to a small amount of ketamine with voriconazole. A 58 year old male was treated for multiple myeloma and hip pain due to an extramedullary tumor following the administration of oxycodone, and voriconazole was administrated for his suspected mycotic pneumonia. His pain was refractory, so we started the administration of a small dose of ketamine (4 mg/hr) for analgesia, added to oxycodone. About 30 hours later, the delirium appeared but he complained of worsening hip pain, so we added 2 mg of ketamine rapidly. Immediately after the additional administration of ketamine, his delirium became more serious. We think the reason why a small amount of ketamine induced delirium is an interaction of ketamine and voriconazole. Ketamine is metabolized to norketamine, which is thought to be more harmless than ketamine, by cytochrome P 450 (CYP) (a part of by CYP3A4) and voriconazole is an inhibitor of CYP3A4. In cases of patients treated with voriconazole, ketamine should be more carefully administrated.

Prácticas agrícolas para el cultivo de Cajanus indicus Spreng (gandul) con fines terapéuticos / Agricultural practice for cultivation of Cajanus indicus Spreng (gandul) for therapeutic purposes

Introducción: Cajanus indicus Spreng (gandul), presenta gran interés terapéutico, sobre todo en la búsqueda de compuestos de origen vegetal que mediante mecanismo antimitótico inhiban el desarrollo de procesos cancerosos. Objetivos: determinar los aspectos agrícolas que proporcionen mayor producción de la parte aérea para su explotación con estos fines. Métodos: durante 2007-2009 se hicieron diferentes investigaciones en la Estación Experimental de Plantas Medicinales Dr. Juan Tomás Roig; en julio de 2007 se realizó un estudio para analizar el comportamiento de la planta y determinar la altura de corte que proporcionara su mejor rebrotación, posteriormente se estudió por 2 años consecutivos, febrero de 2008 hasta febrero de 2009, 2 distancias de siembra: 90 x 30 cm y 90 x 60 cm; y 2 momentos de inicio de cosecha: 3 y 4 meses de edad...

Introduction: Cajanus indicus Spreng. (gandul) is of great therapeutic interest mainly in the search of vegetal compounds capable of inhibiting cancerous processes through the antimycotic mechanism. Objectives: to determine the agricultural aspects that favour higher production of the aerial part of this plant to this end. Methods: in the 2007-2009 period, several research studies were performed in Dr Juan Tomás Roig experimental center of medicinal plants. In July, 2007 a study was conducted to analyze the behaviour of the plant and to determine the cutting height that will encourage the best sprout. From February 2008 to February 2009, 2 sowing distances (90 x 30 cm and 90 x 60 cm) and 2 times of harvest starting (3 and 4 months of age) were studied...

Fungus infection of the cornea: a review of 43 cases

Forty-three proven cases of fungus infection of the cornea have been studied in the Philippine Eye Research Institute since 1968. Clinical features that suggested the nature of the infection included the (a) history of previous ocular trauma due to some vegetable matter, (b) severity of the pain on the affected eye, (c) non-response to prolonged anti-bacterial therapy, (d) preponderance of hard ulcers indicating minimal tissue necrosis, and the (e) hypopyon, when present, tended to be stringy and well-adherent to the back surface of the corneaEtiologic diagnosis requires demonstration of the organism in smears, cultures or preferably in the biopsy specimens. For this purpose, it is advised that the specimens should include portions of the advancing borders of the lesionsFusarium and Aspergillus which are plant pathogens were the most common fungi isolated from the cases. Others included Mycelia sterila, Hormodendrum, Curvularia, Phialophora verrucosa, Cephalosporium, Paecilomyces and Candida kruseiMedical therapy of the infection was not very encouraging. Part of the reason is that while the antifungal drugs are effective in-vitro against a wide variety of fungal cultures, they poorly penetrate the cornea. Surgical excision of the lesion removed a bulk of the infecting organisms and when used in conjunction with the antimycotic drugs, the procedure helped control the infection. (Summary)

RESEARCH INTO FHARMACODYNAMICS OF BIF ONAZOLE / 重庆医科大学学报

In this experiment,topical application of 1% Bifonazole cream or ethanol solution on guinea-pig trichopkytosis model, 0.3g or 0.3ml once a day for two weeks, showed the satisfying effoet.But topical application of 0.5%,0.1% Bifonazole cream or ethanol solution was less effective.The remaining time of Bifonazole on the skin was about 72 hours.During interval, it would protect the guinea-pigs from mycotic infection

CLINICAL AND LABORATORY RESEARCH ON BIFONAZOL FOR DERMATITS SEBORRHEICA CAPITIS / 重庆医科大学学报

1 8 casts of dermatitis seborrfceica capitis were topically treated with 1% Bifon- azol tincture. All the cases were cured clinically and of the cases turned negative in pathogen cultures. The MIC of Bifonazol to piturosponim ovale were tested in six strains isolated from dandruff.The MIC Bifonazol to Microsporum is 0.25-0.5/ml, slightly superior to Ketokon-azol and Micooazol.The results show that Bifonazol is a hopeful drug for dermatitis seborrheica capi tis and also support the theory that pitytosporem cvale is an opportunistic patogen for dermatitis seborrheica capitis

RESEARCH INTO PHARMACODYNAMICS OF BIFONAZOLE / 重庆医科大学学报

Bifonazole is a new imidazolyl derivative, with broad spectrum anlimycotic activity. In our experiment, 100 strains of common dermatophytes in clinical practice were used to evaluate the MIC of Bifonazole. All the species tested, were sensitive to this agent, and the MIC values of 79% of strains were under 4g/ml. The MIC value was influenced by inoculum size, the larger the inoculum size, the larger the MIC value. It was found that the efficacy of Bifonazole is comparable to Mico-nazole