Ensaio clínico randomizado, duplo-cego e controlado por placebo de ciproheptadina para estímulo do apetite na fibrose cística / A randomized, double-blind, placebo-controlled trial of cyproheptadine for appetite stimulation in cystic fibrosis

OBJETIVO: O objetivo deste estudo foi determinar se a administração de ciproheptadina é capaz de induzir ganho de peso em pacientes com fibrose cística. MÉTODOS: Foi realizado um estudo duplo-cego, controlado com placebo em dois centros no Brasil. Vinte e cinco pacientes com fibrose cística entre 5 e 18 anos completaram o estudo. Os pacientes foram randomizados em dois grupos, para receber ciproheptadina 4 mg três vezes por dia durante 12 semanas ou placebo. Todos os dados foram coletados no início e no final do período de estudo e incluíram peso, altura e espirometria. RESULTADOS: O ganho de peso médio foi de 0,67 kg e 1,61 kg nos grupos placebo e ciproheptadina, respectivamente (p = 0,036). O índice de massa corporal (IMC) diminuiu 0,07 kg/m² no grupo placebo e aumentou 0,46 kg/m² no grupo intervenção (p = 0,027). A mudança no IMC para a idade (escore z) foi de -0,19 no grupo placebo e 0,20 no grupo ciproheptadina (p = 0,003). O IMC escore z diminuiu 0,19 no grupo placebo e aumentou 0,2 no grupo ciproheptadina (p = 0,003). Alterações na função pulmonar não foram estatisticamente diferentes. CONCLUSÃO: O uso de ciproheptadina em pacientes com fibrose cística foi bem tolerado, apresentando um ganho de peso significativo e um aumento no IMC após 12 semanas. Foi encontrado um tamanho de efeito clinicamente relevante para o peso/idade (escore z) e IMC para idade (escore z). Tais achados sugerem que a prescrição de ciproheptadina pode ser uma abordagem alternativa para pacientes que precisam de suporte nutricional por um curto período de tempo.

OBJECTIVE: To determine whether the administration of cyproheptadine was able to induce weight gain in patients with cystic fibrosis. METHODS: We performed a double-blind, placebo-controlled trial in two centers in Brazil. Twenty-five patients with cystic fibrosis between 5 and 18 years completed the study. Patients were randomized into two groups, to receive either cyproheptadine 4 mg three times per day for 12 weeks or placebo. All data were collected at the beginning and at the end of the study period and included weight, height and spirometry. RESULTS: Average weight gain was 0.67 kg in the placebo group and 1.61 kg in the cyproheptadine group (p = 0.036). Body mass index (BMI) decreased 0.07 kg/m² in the placebo group and increased 0.46 kg/m² in the intervention group (p = 0,027). The change in BMI for age (z score) was -0.19 in the placebo group and +0.20 in the cyproheptadine group (p = 0.003). BMI z score decreased 0.19 in the placebo group and increased 0.2 in the cyproheptadine group (p = 0.003). Changes in pulmonary function were not statistically different. CONCLUSION: Use of cyproheptadine in cystic fibrosis patients was well tolerated, showing a significant weight gain and a significant increase in BMI after 12 weeks. A clinically relevant effect size for weight/age (z score) and body mass index for age (z score) was found. Such findings suggest that the prescription of cyproheptadine can be an alternative approach for patients who need nutritional support for a short period of time.

Síndrome serotonínico pediátrico: reporte de un caso / Serotonin syndrome pediatric: case report

El síndrome serotonínico es un cuadro neurológico agudo debido a hiperactividad serotoninérgica, por la interacción de drogas que refuerzan o mimetizan la acción del neurotrasmisor. La incidencia del síndrome de serotonina es ascendente por la disponibilidad creciente de fármacos serotoninérgicos como los antidepresivos. Por ello es importante que los médicos reconozcan y manejen adecuadamente el síndrome serotonínico. Este reporte de caso se refiere a una intoxicación accidental por el neuroléptico atípico olanzapina en un niño de 2 años, quien desarrolló manifestaciones clínicas como agitación, sudoración, mioclonías, clonus espontáneo e hipertermia, considerados como criterios diagnóstico del cuadro. La terapia consistió en descontaminación interna con lavado gástrico, carbón activado y sulfato de sodio, ciproheptadina, propranolol y furosemida. Su evolución fue satisfactoria. En nuestro país hay disponibilidad de la mayoría de los fármacos causales y tienen amplio uso, por lo que es probable el subregistro del síndrome. De allí la importancia de este reporte de caso

Serotonin syndrome is an acute neurologic picture due to serotonergic hyperactivity, due to the interaction of drugs that enhance or mimic the action of the serotonin. The incidence of serotonin syndrome is rising because of the growing availability of serotonergic drugs such as antidepressants. It is therefore important that clinicians recognize and manage appropriately this syndrome. This case report refers to an accidental poisoning by the atypical neuroleptic olanzapine in a 2 year old boy who developed clinical manifestations such as agitation, sweating, myoclonus, spontaneous clonus and hyperthermia, considered as diagnostic criteria for the syndrome. Therapy consisted of internal decontamination with gastric lavage, activated charcoal and sodium sulfate, cyproheptadine, propranolol and furosemide. The clinical outcome was satisfactory. In our country the majority of the causal drugs are easily available and widely employed, for which reason it is probable that this syndrome is under registered. Hence the importance of this case report

Futura study: evaluation of efficacy and safety of rupatadine fumarate in the treatment of persistent allergic rhinitis / Estudo futura: avaliação da eficácia e segurança do fumarato de rupatadina no tratamento da rinite alérgica persistente

Allergic rhinitis affects 10-30 percent of the population, negatively impacting one's quality of life and productivity. It has been associated with sinusitis, otitis media, sleep disorders, and asthma. Rupatadine is a second generation antihistamine with increased affinity to histamine receptor H1; it is also a potent PAF (platelet-activating factor) antagonist. It starts acting quite quickly, offers long lasting effect, and reduces the chronic effects of rhinitis. AIM: this study aims to assess the efficacy and safety of rupatadine in the treatment of persistent allergic rhinitis. MATERIALS AND METHOD: this is a multi-centric open prospective study. This study included 241 patients from 13 centers in Brazil and was held between October of 2004 and August of 2005. Signs and symptoms of rhinitis and tolerance to medication were analyzed after one and two weeks of treatment. RESULTS: reduction on general scores from 8.65 to 3.21 on week 2 (p<0.001). All signs and symptoms improved significantly in the first day of treatment (p<0.001), except for nasal congestion and secretion, which improved from the second day of treatment (p<0.001). Adverse events occurred in 19.9 percent of the cases, 27.7 percent on week 1. CONCLUSION: rupatadine effectively controls persistent allergic rhinitis; it is safe and presents low incidence of side effects.

A rinite alérgica acomete 10 a 30 por cento da população, interferindo na qualidade de vida e na capacidade produtiva. Está associada à sinusite, otite, roncopatias e asma. A Rupatadina é um anti-histamínico de segunda geração, com elevada afinidade ao receptor histamínico H1 e potente inibição do fator ativador plaquetário (PAF). Tem rápido início de ação, longa duração e reduz os efeitos crônicos da rinite. OBJETIVO: Avaliar a eficácia e segurança da rupatadina no tratamento da rinite alérgica persistente. MATERIAL E MÉTODO: Estudo multicêntrico, aberto, prospectivo. Foram selecionados 241 pacientes em 13 centros no Brasil durante o período de outubro de 2004 a agosto de 2005. Foram analisados os sinais e sintomas da rinite e a tolerabilidade após 1 e 2 semanas. RESULTADOS: Redução do escore geral de 8,65 para 3,21 na semana 2 (p<0,001). Todos os sinais e sintomas melhoraram significativamente, e no primeiro dia de tratamento (p<0,001), com exceção da obstrução e secreção nasal, a partir do segundo dia (P<0,001). A frequência de eventos adversos foi 19,9 por cento, sendo 27,7 por cento na 1ª semana. CONCLUSÕES: A rupatadina é eficaz no controle da rinite alérgica persistente, é segura e apresenta baixos índices de efeitos colaterais.

Acquired Blaschkoid dermatitis.

Acquired Blaschkoid dermatitis characterised by unilateral relapsing inflammatory disease along the lines of Blaschko. A 40-year-old Indian male presented with unilateral erythematous, itchy grouped papules on the left side of the chest, abdomen, back and left arm of 15 days duration. The eruption stopped abruptly at the midline of the torso, completely sparing the right side of the body. The lesions were arranged in whorls and streaks corresponding to the lines of Blaschko. Skin biopsy showed hyperkeratosis and features suggestive of sub-acute spongiotic dermatitis with lymphocytic infiltrate around the blood vessels in the dermis. Patient was diagnosed as a case of Blaschkoid dermatitis. To the best of our knowledge, this is the first case of this condition being reported from India.

Tratamiento médico de los tumores hipofisiarios productores de corticotrofina y tirotrofina / Medical treatment of adrenocorticotrophin and thyrotrophin-secreting pituitary tumors

Se analiza el estado actual del tratamiento médico de los tumores hipofisiarios productores de corticotrofina (ACTH) y tirotrofina (TSH). Se presentan las investigaciones comunicadas por diversos autores en el tratamiento de la enfermedad de Cushing y el síndrome de Nelson con moduladores de la secreción de ACTH, la bromocriptina, la ciproheptadina, la ritanserina, el ácido valproico y la somatostatina. Los resultados positivos cubren un pequeño número de casos. La primera opción de tratamiento de estos tumores es la cirugía seguida de la radioterapia. Cuando no se logra extirpar completamente los tumores, el uso de drogas que actúan inhibiendo la esteroidogénesis suprarrenal constituye una terapia paliativa. Entre estas drogas se cuentan el ketoconazol, la aminoglutetimida, la metopirona, el mitotano y el trilostan, con diversos grados de efectividad y tolerancia. Los pacientes que presentan tumores hipofisiarios productores de TSH han sido tratados con éxito con análogos de la somatostatina de acción prolongada, octreotide y lanreotide SR. Se ha logrado dramática supresión de la TSH y de la subunidad alfa, así como control del hipertiroidismo y disminución del tamaño de los tumores. Estas drogas ofrecen posibilidades de tratamiento médico para los pacientes que no logran control de su enfermedad con la cirugía

Cold urticaria in Thai children: comparison between cyproheptadine and ketotifen in the treatment.

The study was performed in 6 Thai children with primary acquired cold urticaria. They all suffered from generalized urticaria and two of them also had angioedema. All of them had normal erythrocyte sedimentation rate, complement 3 and negative VDRL, TPHA, hepatitis B screen and cold agglutinin titer. Cryoglobulin was checked in 3 cases and showed negative results A double-blind cross-over study to compare the effectiveness of cyproheptadine and ketotifen demonstrated that the efficacy of cyproheptadine and ketotifen on clinical symptoms and ice cube test was not significantly different (p > 0.05). Both of them showed good results in the treatment of cold urticaria with mild side effects. During the follow up, 5 cases showed complete recovery while the other one developed one or two exacerbations per year upon cold exposure. However, the symptoms were mild and subsided on administration of one or two doses of H1 antihistamine. Our data demonstrated that ketotifen was as effective as cyproheptadine in the treatment of cold urticaria in Thai children.

Comparative effect of antiinflammatory drugs on rat paw edema induced by human sterile dental plaque extract, carrageenan or dextran

Se hizo un estudio comparativo del efecto de drogas antihistamínicas (difenilhidramina), o antihistamínicas y antiserotonínicas (ciproheptadina), o tipo aspirina (AAS, indometacina), o corticoesteroides (dexametasona) sobre el edema inducido en la pata de la rata por inyección intraplantar de dextrano, carragina o extracto acuoso estéril de placa dental humana. Los resultados mostraron que: (a) el extracto de placa dental induce una inflamación dosis-dependiente cuando se administra intraplantarmente en la pata de la rata, confirmando que se trata de un potente agente flogístico; (b) este edema, aunque más parecido al inducido por carragina, en realidad difiere tanto del inducido por carragina como por dextrano, en su desarrollo y en la respuesta a las drogas antiinflamatorias; (c) en el edema inducido por placa, se libera histamina y serotonina, pero éstas no juegan un papel esencial; (d) los inhibidores de la formación de los metabolitos del ácido araquidónico (AAS, indometacina y dexametasona) inhiben esta inflamación sugiriendo que están presentes desde su primera fase

Ice cube test in children with cold urticaria.

The ice cube test performed in 24 children (6 cold urticaria, 6 healthy, 6 allergic and 6 chronic urticaria) showed that a 3 and 5-minute ice cube test was the appropriate time for the diagnosis of cold urticaria without false positive results. If the test was prolonged to 10 and 20 minutes, 17% and 33% respectively showed false positive results in chronic urticaria other than cold urticaria patients. After four weeks of cyproheptadine therapy, the ice cube test showed only 17% positive at 3 minutes and 33% at 5 minutes. When the ice cube test was performed for 10 and 20 minutes, 67% showed positive results. In conclusion, the ice cube test should be performed for 3 to 5 minutes to diagnose cold urticaria in children. The time should be increased to 10 or 20 minutes if the test shows negative results at 3 to 5 minutes after antihistamine therapy.

Síndrome de Cassidy-Scholte-Thorson-Björck-Waldestrom ou, simplesmente, síndrome carcinóide: relato de um caso / Cassidy-Scholte-Thorson-Björck-Wasdetrom syndrome: carcinoide syndrome; a case report

Os autores apresentam um caso de síndrome carcinóide com manifestaçöes clínicas típicas, exceto quanto ao broncoespasmo. Exibem a documentaçäo feita por biópsia hepática. Utilizaram o cipro-heptomicina, cuja eficácia foi discreta. Frisam que a literatura médica brasileira é escassa quanto a síndrome carcinóide

Comparative evaluation of dexamethasone with cyclophosphamide, chloramphenicol and cyproheptadine hydrochloride as immunosuppressive agents on skin homografts in rats and rabbits.

An experimental study on immunosuppressive action of cyclophosphamide, chloramphenicol and cyproheptadine hydrochloride in comparison with the control and dexamethasone was undertaken on skin homografts in rabbits and rats. The survival period of skin homografts in cyclophosphamide treated group was significantly increased (P less than 0.01) in rabbits, but there was insignificant increase in rats (P greater than 0.01). With chloramphenicol there was significant increase in survival period in both the species (P less than 0.01). Cyproheptadine did not show significant result in any of the species. The probable mechanisms of immunosuppressive action have been discussed.