Locust bean gum hydrogels are bioadhesive and improve indole-3-carbinol cutaneous permeation: influence of the polysaccharide concentration

Abstract The locust bean gum (LBG) is a polysaccharide with thickening, stabilizing and gelling properties and it has been used in the preparation of pharmaceutical formulations. Hydrogels (HGs) are obtained from natural or synthetic materials that present interesting properties for skin application. This study aimed to develop HGs from LBG using indole-3-carbinol (I3C) as an asset model for cutaneous application. HGs were prepared by dispersing LBG (2%, 3% and 4% w/v) directly in cold water. The formulations showed content close to 0.5 mg/g (HPLC) and pH ranging from 7.25 to 7.41 (potentiometry). The spreadability factor (parallel plate method) was inversely proportional to LBG concentration. The rheological evaluation (rotational viscometer) demonstrated a non-Newtonian pseudoplastic flow behavior (Ostwald De Weale model), which is interesting for cutaneous application. The HET-CAM evaluation showed the non-irritating characteristic of the formulations. The bioadhesive potential demonstrated bioadhesion in a concentration-dependent manner. Permeation in human skin using Franz cells showed that the highest LBG concentration improved the skin distribution profile with greater I3C amounts in the viable skin layers. The present study demonstrated the feasibility of preparing HGs with LBG and the formulation with the highest polymer concentration was the most promising to transport active ingredients through the skin.

Cecropia pachystachya Trécul: a promising ingredient for skin-whitening cosmetics

Abstract Because it promotes the lightening of pigment spots, tyrosinase inhibition is one of the mechanisms of depigmenting cosmetic products. Considering the adverse effects produced by synthetic depigmenting actives, the search for new therapeutic options is desirable, and plant extracts are possible candidates for hyperpigmentation treatment. Glycolic extracts of Cecropia pachystachya Trécul are, therefore, the focus of this study. Its chemical characterization, antioxidant activity, tyrosinase inhibition, and cell viability were evaluated. Glycolic extracts were obtained by macerating the leaves of C. pachystachya in grain alcohol and glycerin or propylene glycol. Both had a similar chemical constitution, the glycerin being more efficient in concentrating phenolic compounds and flavonoids. Analyses by UHPLC-MS detected quinic acid, chlorogenic acid isomers, proanthocyanidin dimers type B and C, catechin/epicatechin, orientin/isoorientin, isoorientin 2"-O-xyloside, vitexin/isovitexin, and rutin. 5-O-caffeoylquinic acid was then quantified was then quantified, with predominance in the extract produced with propylene glycol. These extracts showed a high antioxidant capacity by the method of DPPH, ß-carotene, and nitric oxide. As for depigmenting activity, both extracts were able to inhibit tyrosinase. Cell viability assay also revealed that the extracts could safely be used in concentrations of ≤ 125 µg/mL. Thus, this study demonstrated for the first time that the glycolic extracts of C. pachystachya have promising chemical and biological characteristics for the development of a multifunctional cosmetic with antioxidant and tyrosinase-inhibition activities

A randomized half-body, double blind, controlled trial on the effects of a pH-modified moisturizer vs. standard moisturizer in mild to moderate atopic dermatitis,

Abstract Background: Higher skin pH in atopic dermatitis contributes to impaired epidermal barrier. A moisturizer compatible with physiological pH could improve atopic dermatitis. Objective: To determine the effect of a physiologically compatible pH moisturizer in atopic dermatitis. Methods: A randomized half body, double blind, controlled trial involving patients with stable atopic dermatitis was performed. pH-modified moisturizer and standard moisturizer were applied to half body for 6 weeks. Results: A total of 6 (16.7%) males and 30 (83.3%) females participated. Skin pH reductions from week 0, week 2 and 6 were significant at the forearms (5.315 [0.98] to 4.85 [0.54] to 5.04 [0.78], p = 0.02) and abdomen (5.25 [1.01], 4.82 [0.64], 5.01 [0.59], p = 0.00) but not at the shins (5.01 [0.80], 4.76 [0.49], 4.85 [0.79], p = 0.09) with pH-modified moisturizer. Transepidermal water loss (TEWL) at the forearms decreased (4.60 [2.55] to 3.70 [3.10] to 3.00 [3.55], p = 0.00), abdomen (3.90 [2.90] to 2.40 [3.45] to 2.70 [2.25], p = 0.046). SCORAD improved from 14.1 ± 12.75 to 10.5 ± 13.25 to 7 ± 12.25, p = 0.00. In standard moisturizer group, pH reductions were significant at the forearms (5.29 [0.94] to 4.84 [0.55] to 5.02 [0.70], p = 0.00) and abdomen (5.25 [1.09], 4.91 [0.63], 5.12 [0.66], p = 0.00). TEWL at the forearm were (4.80 [2.95], 4.10 [2.15], 4.60 [3.40], p = 0.67), shins (3.80 [1.40], 3.50 [2.35], 4.00 [2.50], p = 0.91) and abdomen (3.70 [2.45], 4.10 [3.60], 3.40 [2.95], p = 0.80). SCORAD improved from 14.2 ± 9.1 to 10.9 ± 10.65 to 10.5 ± 11, p = 0.00. Reduction in pH was observed with both moisturizers while TEWL significantly improved with pH-modified moisturizer. pH-modified moisturizer resulted in greater pH, TEWL and SCORAD improvements however the differences were not significant from standard moisturizer. Study limitation: Skin hydration was not evaluated. Conclusion: Moisturization is beneficial for atopic dermatitis; use of physiologically compatible pH moisturizer is promising.

Effects of a mucoadhesive formulation containing Curcuma longa L. on oral wound healing

Introduction: The aim of this study was to investigate the effects of a topical mucoadhesive formulation with Curcuma longa L. extract (MFC) on oral wound healing. Methods: Seventy-two Wistar rats were randomly assigned to 3 groups: Control, Vehicle, and MFC. Traumatic ulcers were made on the dorsum of the tongue with a 3-mm diameter punch. Vehicle and MFC groups received application of the products twice a day, while animals in the control group were cared for in identical conditions but received no product application. Six rats in each group were euthanized at days 3, 5, 10, and 14. Percentage of repair was calculated based on wound area. HE-stained histological sections were obtained for semi-quantitative analysis of re-epithelization and inflammation. Results: Clinical findings revealed that at days 3 and 5, animals from the MFC group exhibited a significantly higher percentage of wound repair. At day 5, animals from this group also demonstrated a significant increase in the degree of re-epithelization and inflammation. Conclusions: MFC is capable of accelerating oral wound repair in an in vivo model by modulating the inflammatory process and stimulating epithelial proliferation. (AU)

Exogenous Ochronosis (EO): Skin lightening cream causing rare caviar-like lesion with banana-like pigments; review of literature and histological comparison with endogenous counterpart

Ochronosis is a cutaneous disorder caused by the accumulation of phenols, either endogenously as homogentisic acid in patients with alkaptonuria (autosomal recessive disorder with deficiency of the enzyme homogentisic acid oxidase), or exogenously in patients using phenol products such as topical creams containing hydroquinone or the intramuscular application of antimalarial drugs. Exogenous ochronosis (EO) typically affects the face and was reported in patients with dark skin such as Black South Africans or Hispanics who use skin-lightening products containing hydroquinone for extended periods. Recently more cases have been reported worldwide even in patients with lighter skin tones, to include Eastern Indians, Asians, and Europeans. However, just 39 cases of EO have been reported in the US literature from 1983 to 2020. Here we present two cases; a 69 and a 45-year-old female who were seen for melasma, given hydroquinone 4% cream daily and tretinoin 0.05%. Both patients noticed brown spots on their cheeks, which progressively enlarged and darkened in color. The diagnosis of ochronosis was confirmed by characteristic histopathological features on the punch biopsy. Unfortunately, neither patient responded to multiple treatments (to include, tazarotene 0.1% gel and pimecrolimus ointment, topical corticosteroids, and avoidance of hydroquinone containing products). We also present a case of classic (endogenous) ochronosis in a patient with alkaptonuria to picture the histological similarities of these two entities. EO is an important clinical consideration because early diagnosis and treatment may offer the best outcome for this notoriously refractory clinical diagnosis.

Development of stability-indicating LC method assisted by Design of Experiment for fenticonazole cream analysis in presence of degradation product

Fenticonazole is an antifungal drug widely used in a cream formulation including as a generic medicine. Stability studies of fenticonazole in a cream formulation are very scarce. In this research, we intent to contribute to generic medicines quality control and provide reliable data seeking for insertion of fenticonazole monograph in official compendia. Therefore, in this work it was studied the behavior of fenticonazole under several conditions and developed a stability-indicating LC method to separate the degradation products and quantify the drug in presence of them, using the Design of Experiments (DoE) as tool to achieve robust and easy transferable method. Fenticonazole stability was evaluated under aqueous, alkaline (0.1 M NaOH), acidic (0.1 M HCL) and oxidative (3% v/v, H2O2) at ambient temperature and heating at 90°C, over 6 hours. The drug shows to be unstable under all stressed test conditions. It was completely degraded under acid medium with arising of degradation products. The robust and stability indicating LC method was validated. It is able to reveal the fenticonazole instability and to separate its degradation product with accuracy and precision (CV ˂ 2%) and without any placebo interferences.(AU)

Producción científica sobre fotoprotección en menores de 14 años de países latinoamericanos: Un estudio bibliométrico / Scientific production on photoprotection in children under 14 from Latin American countries: A bibliometric study

Objetivo: Identificar la producción científica sobre nivel de conocimientos, actitudes y prácticas sobre fotoprotección en padres de menores de 14 años latinoamericanos. Materiales y métodos:Estudio bibliométrico descriptivo y transversal. Se realizó una búsqueda bibliográfica en las bases de datos: PubMed, Scopus y la Biblioteca Virtual de Salud, utilizando las palabras claves: "fotoprotección" "niños", "escolares", entre el primero de enero del 2013 al 31 de junio del 2018. Se excluyeron artículos no originales o que no midieran conocimiento sobre fotoprotección. Resultado: Se encontró un total de seis artículos el 28.3% de los padres reportaron que sus hijos se exponen más de 60 minutos al sol entre semana; en el fin de semana se incrementa a un 42.8%. En Chile, el 14.2% de los niños han presentado alguna vez quemadura solar, con 2/3 de la población de estudio pasan más de 2 horas diarias al exterior. En Uruguay, El 55% de los padres afirmó que se protegen del sol, el 30% solo a veces y el 15% no se protege. En Cuba el 72.5% han presentado al menos una quemadura solar. En Perú, El estudio peruano demostró que el 48% utiliza protector solar en crema, el 46% ropa de protección y el 51% gorro o sombrero. Conclusiones: Se requieren intervenciones sanitarias para incrementar el conocimiento de los padres sobre fotoprotección, en México demuestra que una intervención educativa puede incrementar en un futuro el conocimiento de los jóvenes en el cuidado de la piel. (AU)

Objective: To identify scientific production on the level of knowledge, attitudes, and practices on photoprotection in parents of children under 14 years of age in Latin America. Materials and methods: Descriptive and transversal bibliometric study. A bibliographic search was carried out in the databases: PubMed, Scopus and the Virtual Health Library, using the keywords: "photoprotection" "children", "school children", between January 1, 2013, and June 31, 2018, We excluded articles that were not original or that did not measure knowledge about photoprotection. Result: A total of six articles were found, 28.3% of parents reported that their children are exposed to more than 60 minutes in the sun during the week; in the weekend it increases to 42.8%. In Chile, 14.2% of children have ever presented sunburn, with 2/3 of the study population spending more than 2 hours a day abroad. In Uruguay, 55% of parents said they protect themselves from the sun, 30% only sometimes and 15% do not protect themselves. In Cuba, 72.5% have presented at least one sunburn. In Peru, the Peruvian study showed that 48% use sunscreen cream, 46% protective clothing and 51% hat or hat. Conclusions: Health interventions are required to increase parents' knowledge about photoprotection, in Mexico it shows that an educational intervention can increase the knowledge of young people in skin care in the future. (AU)

Dermocosmetic care for rosacea

ABSTRACT Rosacea is a chronic inflammatory skin disease that primarily affects the central area of the face; it is characterized by erythema, papules, pustules, nodules, and telangiectasia. This condition arises between 30-60 years of age, and it usually occurs in fair-skinned people. Rosacea is characteristic of sensitive skin, as it is a disease marked with punctuated phases of exacerbated signs and symptoms that alternate with periods of remission. Humans have long incorporated cosmetics in their daily habits; given the scientific and technological developments that emerged in cosmeceuticals or dermocosmetics, the current cosmetic options are now used for much more than adornment or cleansing. The purpose of cosmetic care in rosacea is to restore the balance of the skin, while reducing the underlying inflammation, sensitivity, and dehydration. This review aims to highlight the various dermocosmetic care options that can reduce discomfort for and bring benefit to patients who have reactive and sensitive skin associated with rosacea. Additionally, this report discusses how pharmacists - public health agents - can and should offer counseling and support interventions to patients once oral or topical medications are dispensed to this pathology.

Myogenic elephant skin cream combined with Vacuum sealing drainage (VSD) for the treatment of bedsores / 中国骨伤

<p><b>OBJECTIVE</b>To discuss the efficacy of the myogenic elephant skin cream combining with VSD for treating severe bedsores.</p><p><b>METHODS</b>Twenty-nine cases of III and IV degree bedsores were treated from June 2009 to June 2013. Among them, 15 cases were treated by myogenic elephant skin cream combined with VSD (VSD group) including 7 males and 8 females with an average age of (69.0±5.3) years old ranging from 17 to 96 years;other 14 cases were treated by the treatment of conventional dressing change (control group) including 6 males and 8 females with an average age of (71.0±4.2) years old ranging from 40 to 86 years. At 7, 14, 21, 28 d after treatments, specimens of wound two groups were respectively taken to examine immunohistochemical CD34 adopted SABC, the number of wild vascular cross were observed as capillary density value under high magnification microscope. It was used to assess the hyperplasia of granulation tissue of wound. The capillary density value and the visual wound observation were indicators for evaluation of clinical efficacy.</p><p><b>RESULTS</b>Seventeen of 19 cases got complete data of specimens of wound at 7, 14, 21, 28 d,included 9 cases of VSD group,8 of control group. In the microscope view, the capillary density of VSD group was higher than that of control group significantly (P<0.05), it showed the application of VSD technology improved hyperplasia of granulation tissue much faster than conventional dressing change. In VSD group, 13 cases with 15 wounds healed, 2 cases with 3 wounds improved; in control group,3 cases with 3 wounds healed,7 cases with 9 wounds improved, 4 cases with 5 wounds were unhealed.</p><p><b>CONCLUSION</b>Using the VSD technology with continuous high pressure suction to clean the drainage of wound and lacuna thoroughly can effectively control infection,promote the growth of granulation tissue, and then applying myogenic elephant skin cream to improve partial blood supply while prompting rapid growth of new granulation tissue and epithelial cell. The risk of this treatment is low,and the course of treatment is short, this provides a safe and effective method for treating bedsores.</p>

Estabilidad de la crema reformulada de nitrato de miconazol al 2 % / Stability of reformulated 2 % miconazol nitrate cream

INTRODUCCIÓN: la Empresa Productora Roberto Escudero Díaz, llevó a cabo la reformulación de la crema de nitrato de miconazol al 2 por ciento, por incumplimiento de algunas especificaciones de calidad y contaminaciones microbiológicas de varios lotes industriales, por lo que hubo que realizar cambios mayores a la composición de la formulación registrada. OBJETIVO: determinar la estabilidad de la nueva formulación de nitrato de miconazol crema al 2 por ciento, para determinar su período de validez. MÉTODOS: se realizaron los estudios según las regulaciones vigentes. Se emplearon tres lotes elaborados a escala piloto, envasados en tubos comprimibles de aluminio por 25 g. Se emplearon como métodos analíticos una técnica por cromatografía líquida de alta resolución y una por cromatografía en capa delgada previamente validadas para estos propósitos. Se consideraron dos temperaturas de almacenamiento: 30 ± 2 ºC (vida de estante) y 40 ± 2 ºC (estabilidad acelerada). Se determinaron los parámetros: propiedades organolépticas, pH, área de extensibilidad, valoración, contenido de sustancias relacionadas y/o productos de degradación, y además se evaluó la calidad de la formulación desde el punto de vista microbiológico. RESULTADOS: desde el punto de vista químico, los lotes evaluados mostraron contenidos superiores al 98 por ciento de analito y niveles muy bajos de sustancias relacionadas, independientemente del lote y la temperatura de almacenamiento. No se detectaron manchas adicionales por cromatografía en capa delgada atribuibles a posibles productos de degradación. La extensibilidad mostró un decrecimiento normal debido a la estructuración progresiva del sistema, y el pH también disminuyó discretamente pero dentro de los límites propuestos. Además se comprobó la elevada estabilidad microbiológica del medicamento a los 12 meses. CONCLUSIONES: la crema es estable química, física y microbiológicamente a temperatura ambiente durante 12 meses, por lo que se propone este tiempo como período de validez provisional(AU)

INTRODUCTION: Roberto Escudero Diaz drug producing company is carrying out the reformulation of 2 percent miconazole nitrate cream due to non-compliance with some quality specifications and the microbiological contamination of several industrial batches, so it was required to make major changes in the registered formulation composition. OBJECTIVE: to determine the stability of the new 2 percent miconazol nitrate cream formulation to verify its validity period. METHODS: the studies followed the regulations in force. Three pilot-scaled batches, packed in 25 g aluminum tubes, were used. The analytical methods were high resolution liquid chromatography technique and thin layer chromatography, being both methods previously validated for these purposes. The selected storage temperatures were 30 ± 2 °C (shelf life) and 40 ± 2 ºC (accelerated stability). The estimated parameters included organoleptic properties, pH, extensibility area, titration, content of related substances and/or degradation products in addition to evaluating the quality of formulation from the microbiological viewpoint. RESULTS: from the chemical viewpoint, the evaluated batches showed contents over 98 percent of analyte and very low levels of related substances, regardless of batch and the storage temperature. The thin layer chromatography did not detect any additional stain attributed to possible degradation products. The extensibility showed normal decrease resulting from progressive structuring of the system and the pH also lowered within the set limits. The microbiological stability of the drug was proved to be high after 12 months. CONCLUSIONS: the cream was chemically, physically and microbiologically stable at room temperature for 12 months, so this is the term suggested as the temporary validity period(AU

Comparative efficacy of topical mometasone furoate 0.1% cream vs topical tacrolimus 0.03% ointment in the treatment of atopic dermatitis

To compare the efficacy of mometasone furoate and tacrolimus in the treatment of atopic dermatitis. Sixty patients of atopic dermatitis were treated with mometasone furoate 0.1% [n=30] and tacrolimus 0.03% [n=30]. Both treatments were applied twice daily for 12 weeks. Patients were followed up monthly. The disease severity assessed by SCORAD index. A 4-point scale was used to measure the level of response to treatment. Before treatment the respective mean SCORAD was 30.57 +/- 13.62 and 30.90 +/- 17.17 in group A and B and at the end of treatment decreased to 11.87 +/- 12.04 and 11.20 +/- 13.85, respectively [p>0.05]. Percent reduction of severity from baseline to final follow-up was 69.20 +/- 23.41 in group A and 74.77 +/- 23.30 in group B [p=0.360]. At final follow-up 56.7% of group A and 63.3% of group B achieved excellent response, 13.3% of group A and 16.7% of group B achieved good response. We conclude that both treatments, mometasone furoate and tacrolimus, are effective in the treatment of atopic dermatitis

Moisturizing effect of stable cream containing Crocus sativus extracts

The present study is about to prepare stable cream of water-in-oil emulsion containing extracts of Crocus sativus against its base [without extracts] taken as control, to determine its stability on different storage conditions and effects on skin moisture contents and transepidermal water loss. The formulation contains 3% Crocus sativus [Saffron] concentrated extracts, and the base containing no extract, were formulated. Different stability tests were done on samples, which placed at 8°C, 25°C, 40° C and 40°C with 75% relative humidity, for 4 week period. These formulations [Creams] were applied on the cheeks of human volunteers for 8 week period. To evaluate any effect produced by these formulations different skin parameters were monitored every week. The significant results of this study explored the fact that water-in-oil emulsion topical cream of saffron formulated from Crocus sativus extract has absolute physical stability at different storage conditions. The increase in skin moisture contents and changes in transepidermal water loss were significant [p

Neuropathic truncal pain in patients with type 2 diabetes mellitus relieved by topical cream and nerve block

No abstract available.

Discussing of influence mechanism of Chinese herbal monomer on physical stability of cream / 中国中药杂志

This study left flavonoids and alkaloids Chinese herbal monomer with common parent nucleus as cream base carriages drug respectively, cream base were prepared with stable span 60-tween 80 emulsification system. The near-infrared stability analysis technology was performed to quantitatively characterize the physical stability of cream. Base on the theory of gel network structure, theory of emulsification, theory of solubility parameter and theory of double layer, the influence mechanism of Chinese herbal monomer on physical stability of cream was discussed. The results showed that tetrahydropalmatine, matrine and naringenin had similar solubility parameter value with cream base material, creams prepared with those Chinese herbal monomer have higher Zeta potential value and stronger physical stability, and that those creams had similar microstructure information with cream base. However, a larger solubility parameter difference exists between baicalin, baicalein, berberine, palmatine and cream base material. Creams prepared with those Chinese herbal monomers had lower Zeta potential value and poorer physical stability, and that those creams had great different microstructure information with cream base.

Drug-induced acne and rose pearl: similarities / Acne medicamentosa e a perola rosa: semelhancas

Drug-induced acne is a common skin condition whose classic symptoms can be similar to a rose pearl, as in the case of a male patient presenting with this condition after excessive use of a cream containing corticosteroids.

A acne medicamentosa é uma dermatose comum, que pode apresentar no seu quadro clássico semelhanças à pérola rosa, como no caso apresentado de um paciente do sexo masculino cujo quadro surgiu após uso intempestivo de creme contendo corticoesteróide.

Preliminary evaluation of antimicrobial activity of cream formulated with essential oil of Trachyuspermum ammi

In our present research we studied physiochemical properties and antimicrobial activity of T. ammi [Trachyuspermum ammi] seeds. The seeds yielded 2.86% essential oil. Refractive index, specific gravity, acid value, and easter values were 1.496, 0.9212, 1.12 and 2.80 respectively. GLC was used to determine the composition of oil. The major component of oil was Thymol [55.308%]. Antimicrobial activity of the oil was carried out against four species of bacteria and fungs. The oil was used to formulate a cream and the pH, physiochemical stability, phase separation and dermal irritation of cream were investigated. The cream was examined for healing wound in rabbits in comparison with Iodine tincture

[ comparative study for evaluation the quality parameters of topical creams produced in Syria containing steroids during shelf-life]

This research aims to make a comparative study for evaluation the quality parameters of topical creams locally produced containing steroids during shelf-life, and to ensure the compatibility of real shelf-life with labeled shelf-life through a set of quality tests which were applied to 47 samples of these creams. Creams were evaluated through appearance, microscopic test, viscosity measurement, determination of pH value, electrical conductivity measurement, and the active substances have been assayed by using HPLC according to assay methods mentioned in USP 30. The temperature cycling was applied also. As a conclusion these creams have the quality parameters required by the Pharmacopoeia, and steroids used as an active substance still maintain their chemical stability in creams even after their labeled expiry period, but the problem observed in the physical stability of cream, in which demonstrate the importance of reconsider the physical stability studies during the development of these formulations, also to follow good practice in transporting, distribution and storage of these creams and to follow the conditions which ensure protection of products from degradation

Periocular basal cell carcinoma: cost of topical immunotherapy versus estimated cost of surgical treatment / Carcinoma basocelular periocular: custo da imunoterapia tópica versus custo estimado do tratamento cirúrgico

PURPOSE: The objective of this study was to compare the estimated cost of clinical and surgical treatment for basl cell carcinoma of the eyelid. METHODS: This was a pilot study of 12 patients with basal cell carcinoma receiving treatment with 5% imiquimod cream at the ocular plastic surgery center, medical school University of São Paulo (HC-FMUSP, Brazil). The cost of clinical treatment was estimated based on the time of treatment and amount of medication consumed by patients in the home setting. The cost of surgical treatment was estimated by ophthalmologists with experience in reconstructive plastic surgery based on analysis of images of the same patients. Surgeons responded to a questionnaire with four questions about surgical technique, surgical materials required, estimated duration of surgery and type of anesthesia. RESULTS: Immunotherapy lasted from 8 to 12 weeks.All patients reported each coldstored sachet with 5% imiquimod cream lasted 3 days.According to the institution, a box with 12 sachets costs BRL 480.00. Patients required 1.58-3.11 boxes for complete treatment, corresponding to a total cost of BRL 758.401,492.80. Based on image analysis, surgeons evaluated surgery would require 1-3 hours. The estimated cost of surgery room and staff was BRL 263.00, to which the cost of supplies was added. Thus, the total cost of surgical treatment was BRL 272.61-864.82. On the average, immunotherapy was 57,64% more costly than surgical treatment. CONCLUSIONS: Malignant eyelid tumors are a common finding in clinical ophthalmology. Surgery is still the treatment of choice at our institution, but immunotherapy with 5% imiquimod cream may be indicated for patients with multiple lesions or high surgical risk and for patients declining surgery for reasons of fear or esthetic concerns.The ability to estimate costs related to the treatment of malignant eyelid tumors is an important aid in the financial planning of health care institutions. Further studies should evaluate the possibility of institutions equating the cost of immunotherapy and surgical treatment by acquiring similar but less expensive medications.

OBJETIVO: O objetivo deste estudo foi comparar os custos do tratamento clínico e cirúrgico para carcinoma basocelular palpebral. MÉTODO: Neste estudo piloto, doze pacientes com carcinoma basocelular atendidos no departamento de Plástica Ocular do Hospital das Clínicas da Universidade de São Paulo (HC-FMUSP) foram tratados com imiquimode creme 5%. O Custo do tratamento clínico foi estimado baseado no tempo de tratamento e quantidade de medicação utilizada pelo paciente no domicilio. O custo do tratamento cirúrgico foi baseado na análise das imagens dos mesmos pacientes submetidos ao tratamento clínico, por Oftalmologistas experientes em cirurgia plástica reconstrutiva. Os profissionais responderam um questionário com quatro perguntas relacionadas à técnica cirúrgica, à quantidade de material gasto, ao tempo cirúrgico estimado e anestesia utilizada. RESULTADOS: O tempo de tratamento clínico variou entre 8 a 12 semanas.Todos os pacientes referem que um sachê dura 3 dias e armazenaram na geladeira. O valor informado pela instituição na compra do imiquimode creme 5% foi de 40,00 reais/sachê, portanto o custo da caixa medicação foi de R$ 480,00 a caixa.A média de caixas consumidas por tratamento variou de 1,58 a 3,11 caixas, portanto o custo do tratamento clínico variou de R$ 758,40 a R$1.492,80. Os cirurgiões avaliaram as imagens dos pacientes submetidos ao tratamento clínico e informaram que o tempo estimado de cirurgia para cada paciente seria de 1 a 3 horas se a opção fosse cirúrgica.Foi estimado um custo de centro cirúrgico, incluindo espaço físico e pessoal de R$ 263,00 ao qual foi acrescido o valor do material que seria utilizado.Assim, observou-se que o valor variou entre R$ 272,61 a R$ 864,82 para o tratamento cirúrgico. O tratamento clínico em média foi de 57,64% superior ao tratamento cirúrgico. CONCLUSÃO: As lesões palpebrais malignas são responsáveis por uma porção importante na prática clínica oftalmológica. A cirurgia continua ...

efficacy and safety of topical EMLA cream application for minor surgery of the adult penis

A variety of surgical procedures of the penis can be performed under local anesthesia. We evaluated the efficacy and safety of EMLA cream anesthetic in such procedures. In total 330 adult patients were subjected to minor penile surgery including: Complete circumcision [73], short frenulum plasty [168], meatotomy [14], fulguration of penile warts [56] and fulguration of urethral [meatal] warts [19]. The level of anesthesia obtained by EMLA cream application along with any adverse effects was recorded. The use of EMLA on mucosal lesions provided excellent level of local anesthesia in almost all patients [245/246, 99.5%]. Anesthesia of skin lesions was in part influenced by the site of application. Circumcision patients showed the lowest efficacy of the EMLA cream as the majority [tilde 80%] required some form of further anesthesia until the completion of the procedure. No significant adverse effects were noted. A transient erythema was present in almost all mucosal applications. The topical anesthetic EMLA cream is a useful, efficient and safe tool for minor surgical procedures of the penis at the office setting, with the exception of circumcision, where an additional type of anesthesia is likely to be necessary. Side effects can be kept to a minimum when the suggested doses are respected [especially at mucosal application] and the time allowed for action is carefully tailored to the site of application and the type of procedure

Endogenous Zinc in Neurological Diseases

The use of zinc in medicinal skin cream was mentioned in Egyptian papyri from 2000 BC (for example, the Smith Papyrus), and zinc has apparently been used fairly steadily throughout Roman and modern times (for example, as the American lotion named for its zinc ore, 'Calamine'). It is, therefore, somewhat ironic that zinc is a relatively late addition to the pantheon of signal ions in biology and medicine. However, the number of biological functions, health implications and pharmacological targets that are emerging for zinc indicate that it might turn out to be 'the calcium of the twenty-first century'. Here neurobiological roles of endogenous zinc is summarized.