Acetilcisteína: Una actualización clínica y farmacológica sobre su efecto mucolítico. Estudio de revisión / Acetylcisteine. A clinical and pharmacological actualization with special. Reference to its mucolytic efect

The authors present a clinical and farmacological evaluation of the effect and safety of N-acetylcysteine in chronic obstructive diseases. The N-actylcysteine (NAC) is a sulphorated amino acid employed as an mucolytic agent. The efficacy and tolerability of oral NAC as compared with other agents was determined, in the mucolytic treatment on mucus hypersecretion and in the management of respiratory tract fluids and sputums from cigarette smokers, and also as a bronchial mucus fluidifying agent. A sistematic review and analysis of the effect of NAC and its effectiveness. In the treatment of acute respiratory disorders in children was determined

Biotransformation of bromhexine by Cunninghamella elegans, C. echinulata and C. blakesleeana

Abstract Fungi is a well-known model used to study drug metabolism and its production in in vitro condition. We aim to screen the most efficient strain of Cunninghamella sp. among C. elegans, C. echinulata and C. blakesleeana for bromhexine metabolites production. We characterized the metabolites produced using various analytical tools and compared them with mammalian metabolites in Rat liver microsomes (RLM). The metabolites were collected by two-stage fermentation of bromhexine with different strains of Cunninghamella sp. followed by extraction. Analysis was done by thin layer chromatography, high performance thin layer chromatography, Fourier transform infrared spectroscopy, high performance liquid chromatography and Liquid chromatography–mass spectrometry. The role of Cytochrome P3A4 (CYP3A4) enzymes in bromhexine metabolism was studied. Fungal incubates were spiked with reference standard – clarithromycin to confirm the role of CYP3A4 enzyme in bromhexine metabolism. Three metabolites appeared at 4.7, 5.5 and 6.4 min retention time in HPLC. Metabolites produced by C. elegans and RLM were concluded to be similar based on their retention time, peak area and peak response of 30.05%, 21.06%, 1.34%, and 47.66% of three metabolites and bromhexine in HPLC. The role of CYP3A4 enzyme in metabolism of bromhexine and the presence of these enzymes in Cunninghamella species was confirmed due to absence of peaks at 4.7, 5.4 and 6.7 min when RLM were incubated with a CYP3A4 enzyme inhibitor – clarithromycin.

[Comparative evaluation of the effect of Malva sylvestris and bromhexine on mucociliary system of trachea in chicken]

Malva sylvestris [M.S] with various drug effects, especially on mucociliary system as dilutor drug and sputum collection is known. This study examined the effects of M.S and Bromhexine HCL [B.H] in mucociliary system of trachea chicken. In this experimental study five groups of Leghorn chickens were studied under identical conditions. Four groups received oral B.H and oral M.S extract and nebulas normal saline and nebulas M.S extract during 12 days, respectively and one group was considered as control. After 12 days the chicks were killed and the biopsy samples from the middle tracheal were taken for histopathology study using PAS and H and E methods under light microscopy. Finally Image tools II Software were used for counting of size and number of mucous glands and cilia. Results of the analysis of data showed that nebulizing of M.S increases the number and the size of mucous glands, also the size of cilia compare to 3 groups: control, oral B.H, normal saline significantly. The oral M.S extract group showed significant differences in number of the mucous glands compared with other 3 groups. According to more mucolitic effects of M.S extract than Bromhexine HCL and side effects for drugs mucolitic is recommended to be used that respiratory and inflammatory diseases of the M.S extract

[Comparative effects of Alcea sulphurea and bromhexine HCL on mucociliary system of chicken trachea]

Alcea sulphurea [A.S] with various drug effects, especially on mucociliary system as dilutor drug and sputum collection is known. This study examined the comparative effects of A.S and Bromhexine HCL [B.H] on mucociliary system chicken trachea. In this experimental study 30 Leghorn chickens were randomly divided into five groups of six. One group was considered as Control and the other four groups during 12 days received oral B.H, oral A.S extract, nebulas normal saline and Nebulized A.S extract respectively. After 12 days the chicks were killed and the biopsy samples from the middle tracheal were taken for histopathology study using PAS methods under Light microscopy. Finally Image tools 3 Software were used for counting of size and number of mucous glands and cilia. Results of the analysis of data showed a significant increase of number and the size of mucous glands, also the size of cilia in Nebulized A.S group in comparison to Control group, oral B.H, normal saline. The oral A.S extract group showed the increase in numbers and sizes of cilia and mucous glands but they weren't significant. According to more mucolytic effects of A.S extract than Bromhexine HCL and side effects for drugs mucolytic is recommended to be used that respiratory and inflammatory diseases of the A.S extract

Oromandibular dystonia and persistent psychiatric symptoms in extra-pontine myelinolysis.

A 32 years female presented with gradually progressive dysarthria, dysphagia, oromandibular dystonia and mild generalized weakness. She had several episodes of acute psychotic behavior. She had abnormal saccadic eye movements, generalized hypertonia and exaggerated jerks in upper limbs. She was previously treated in a peripheral hospital for severe vomiting and diarrhea. MRI of brain revealed symmetrical T-2 weighted hyperintensities in bilateral putaminal and caudate region along with pons and midbrain suggesting demyelination due to a metabolic insult. Her power improved gradually over days and the dysarthria, dysphagia and oromandibular dystonia improved gradually over several weeks with supportive measures but the psychiatric manifestations are still persisting.

Synchronous germinomas in the pineal and suprasellar region.

Synchronous primary intracranial germ cell tumors are rare. Only 5-10% of all germ cell tumors are found as synchronous lesion in pineal and suprasellar region. They are also known by the entity "double mid-line atypical teratoma". An 11-year-old male child presented with polyuria, polydipsia and features of raised intracranial tension. CT scan head revealed well-defined homogenously enhancing lesions in the pineal and suprasellar region. Histopathology examination showed the lesion to be of germ cell origin.

A Case of Hepatocellular Carcinoma Complicating Cardiac Cirrhosis Caused by Constrictive Pericarditis / 대한소화기학회지

Hepatocellular carcinoma (HCC) is one of the most common malignancies. Many factors are considered to be etiology associated with HCC; the important factors are hepatitis B and C viruses and alcohol. Cirrhosis is present in the majority of patients with HCC. It is assumed that all diseases, which lead to liver cirrhosis, may be complicated by the development of HCC. We report a 36-year-old man with HCC which developed from cardiac cirrhosis caused by constrictive pericarditis in whom both hepatitis B virus and hepatitis C viral marker tests were all negative. CT scan of his heart showed pericardial calcification with diastolic dysfunction of right ventricle. Abdominal CT scan revealed mottled mosaic pattern of contrast enhancement of liver parenchyme and two hepatic lesions that were considered to be HCCs. Left lateral segmentectomy of liver was performed. There were two well-circumscribed masses which were confirmed to be HCC and the remaining hepatic parenchyma showed bridging fibrosis between central zonal regions. To our knowledge, this is the first case of HCC complicating cardiac cirrhosis in Korea.

Parotiditis crónica recurrente en el niño / Chronic recurrent parotiditis in children

La Parotiditis crónica recurrente (PCR) en niños es una enfermedad de etiología desconocida y evolución autolimitada caracterizada por episodios de aumento de volumen parotídeos dolorosos asociados a sialectacia parotidea no obstructiva. Su estudio y tratamiento no obedece a criterio único. El objetivo del presente trabajo es revisar nuestra experiencia con el uso de mucolíticos como tratamiento sintomático en los periodos agudos de la enfermedad. Pacientes y MÚtodo: Se estudiaron en forma retrospectiva las características clínicas, estudio de imágenes y respuesta clínica al uso de mucolítico (Bromhexina) en 25 pacientes tratados por parotiditis crónica recurrente entre 1993 y 1999, en el policlínico de cirugía del Hospital Roberto del Río. Resultados: La distribución por gÚnero del grupo en estudio fue de 16 hombres y 9 mujeres, con una relación de 1,8:1. El 92 por ciento se tenía entre 4 a 10 años. El aumento de volumen como síntoma estuvo presente en el total de los casos y al momento de la primera consulta todos los pacientes habían presentado por lo menos 1 episodio antes. Hubo respuesta clínica favorable al uso de mucolíticos en el 100 por ciento de los casos, manifestada como disminución del dolor entre 48 y 96 h luego de comenzada la administración del mucolítico. La Parotiditis crónica inespecífica, como todas las enfermedades crónicas con periodos de reagudización ofrece algunas dificultades para su evaluación y tratamiento. El uso de mucolíticos disminuye el periodo sintomático en relación a los descrito en la literatura y puede ser una buena alternativa terapÚutica.

Efficacy and safety of Ascoril in the management of cough--National Study Group report.

A total of 768 patients were recruited by 81 physicians and paediatricians all over the country in this National Study Group of 'Ascoril + Expectorant'. The results of this first large scale study of a cough formula indicates that 'Ascoril + Expectorant' is effective in controlling cough, breathlessness and decreasing the volume of sputum. No serious adverse events were noted. Ascoril was well accepted by the patients and its efficacy was rated very high by the physician. The National Study Group concludes that 'Ascoril + Expectorant' is highly effective in the management of cough associated with lower respiratory tract infection and COPDs.

Síndrome de Sjögren / Sjögren's syndrome

El síndrome de Sjögren es una inflamación crónica de las glándulas salivales y lagrimales, las que presentan una infiltración linfoplasmocitaria. Clínicamente se manifiesta por xeroftalmia y xerostomía. Se reconocen formas primarias y secundarias asociadas a algunas mesenquimopatías (lupus, esclerosis sistémica o artritis reumatoídea). Además del compromiso de las glándulas lagrimales y salivales, la afección tiene manifestaciones sistémicas especialmente pulmonares, renales y articulares. El diagnóstico es clínico y se confirma mediante sialografía parotídea, ecotomografía, cintigrafía salival y biopsia. El tratamiento es básicamente sintomático y está dirigido a disminuir la sequedad ocular y bucal

Efficacy and safety of Ascoril expectorant and other cough formula in the treatment of cough management in paediatric and adult patients--a randomised double-blind comparative trial.

The present study was undertaken to study the comparative safety and efficacy of two cough formulas viz, Ascoril expectorant and other cough formula in the management of cough associated with respiratory disorders. Fifty patients having cough associated with various respiratory disorders like bronchitis and upper or lower respiratory tract infections were randomly divided into 2 equal groups and were treated with one of the two cough formulas viz, Ascoril cough formula and other cough formula in double-blind manner over a period of 15 days. The evaluation of improvement was carried out by a rating scale using three clinical parameters--cough, sputum and breathlessness. The physicians were asked to rate the effectiveness of the therapy and patients were asked to rate the acceptability of therapy using pre-defined operational criteria. It was observed that the improvement and symptom relief was almost immediate, quicker and better in the group receiving Ascoril as compared to other group. On effectiveness parameter, 96% of the physicians rated Ascoril as having either 'very high effectiveness or high effectiveness' as opposed to only 34% of the physicians who rated other cough formula as having 'high' or 'very high effectiveness'. While on parameter of acceptability, 96% of the patients rated acceptability of Ascoril as 'high' or 'good' as opposed to only 24% of the patients who rated other cough formula 'high' or 'good'. The findings of this study suggests that Ascoril cough formula has better efficacy as well as better patient acceptability. Thus, Ascoril cough formula is superior to other cough formula in management of cough associated with respiratory disorders.

Síndrome Sjögren asociado a colagenopatías: presentación de un caso / Sjögren's syndrome associated to collagenophaties

Se describe un Síndrome Sicca en una mujer de 53 años de edad, internada en el Hospital Zenón Santillán, asociado a enfermedades del colágeno tales como: Artritis Reumatoidea, Vasculitis Leucocitoclástica y probable Tiroiditis. Los resultados de sus análisis bioquímicos, Rx de glándulas salivales, gammagrafía y la biopsia del labio inferior, confirman el diagnóstico. Se instituyó tratamiento con Bromhexina y gotas de Pilocarpina (medicación no habitual), obteniendo resultados satisfactorios.

A Case of Sjogren Syndrome Associated with Acroosteolysis / 대한류마티스학회지

Acroosteolysis (AOL) refers to a destructive process involving distal phalangeal shaft while the tuft and base are preserved. It can be a manifestation of various diseases, such as scleroderma, Raynaud's disease, rheumatoid vasculitis, psoriasis, renal osteodystrophy and leprosy. Occupational exposure to polyvinyl chloride polymers, thermal injury, and repetitive mechanical injury can also cause this problem. Although the exact pathogenesis of AOL is uncertain, a unifying theme of vascular and mechanical injury is presented. Recently, we experienced a 32-year-old woman complained of xerophthalmia, zerostomia and polyarthralgia which was diagnosed as Sj6gren syndrome associated with acroosteolysis. After administration of prednisolone, cyclophosphamide and oral bromhexine, subsidence of her symptoms was observed. We report this case with a review of relevant literature.

Evaluación comparativa del tratamiento con yodo y bromhexina en la queratoconjuntivitis sicca / A comparative evaluation of the keratoconjuntivitis sicca treatment between iodine and bromhexine

Presentamos aqui los resultados de un estudio clinico, con la administracion de yodo en pacientes con Queratoconjuntivitis Sicca (QCS) o Sindrome de Sjogren (SS), con el fin de estimular su secreción lagrimal, más del 80%respondieron al tratamiento satisfactoriamente, asi como el 71%de los tratados con bromhexina (grupo control), conocida ya como lacrimoestimulantes. Ambos tratamientos mejoraron la xerostomia en la mayoria de pacientes son (SS)

Effect of bromhexine on nasal mucus clearance in chronic maxillary sinusitis.

Nasal mucus clearance (NMC) was studied in seventy patients with chronic maxillary sinusitis. Forty-five patients were treated with oral administration of bromhexine tablets along with oral antibiotics and nasal decongestants. Twenty-five patients received the same treatment but without bromhexine to evaluate the results. NMC was also studied in hundred healthy controls.

Effect of bromhexine on dry eye

A great immunological resemblance exists between the external eye and respiratory tract. Dryness lowers ocular resistance. Bromhexine gave excellent results in combating chest infection through augmentation of amount of bronchial secretion, being a bronchial mucolytic drug. We used bromhexine in treating dryness caused by Sjogren's syndrome and trachomatous cicatrisation in 100 eyes. Bromhexine proved to be effective in the majority of cases, but of very short duration. Cases were diagnosed and followed by quantitative rose bengal, and affirmed by Shirmer's test and B.U.T.

Uma associaçäo farmacológica em infecçöes respiratórias / A pharmacological combination in respiratory tract infections

Foram estudados, do ponto de vista clínico e bacteriológico, 32 pacientes, 29 com infecçöes broncopulmonares e 3 com infecçöes de vias aéreas altas, que foram tratados por via oral com a associaçäo Amoxicilina 500 mg + Bromexina 8 mg cada 8 horas, durante pelo menos 7 dias. A eficácia terapêutica foi muito boa, proporcionando cura e melhora clínica em 90,4% dos pacientes e cura bacteriológica em 90,6%. Em 7 pacientes registraram-se efeitos secundários a nível do tubo gastrintestinal (epigastralgia e diarréia), que näo levaram à interrupçäo do tratamento. Consideramos que esta associaçäo farmacológica é muito eficaz para o tratamento das infecçöes bacterianas provocadas por germes Gram-positivos e Gram-negativos mais freqüentemente identificados no aparelho respiratório

Influência da bromohexine sobre os níveis de lisozima da secreçäo lacrimal, o teste de rosa bengala e os sintomas oculares na síndrome de Sjögren / Influence of bromohexine on tear lysozyme level, rose-bengal test and ocular symptoms in Sjogren's syndrome

Foram estados, em 21 pacientes portadoras de Síndrome de Sjögren primária ou secundária, a influência da bromohexine sobre os níveis de lisozima da secreçäo lacrimal, teste de rosa bengala e sintomas oculares. Realizamos estudo cego com administraçäo de placebo (um comprimido por dia) e bromohexine (um comprimido de 48 mg por dia), durante 2 períodos consecutivos de 3 semanas (21 dias), com avaliaçöes do nível de lisozima lacrimal, sintomas oculares e teste de rosa bengala no dia antecedente ao ínicio do tratamento e após o uso de placebo (22§) e de bromohexine (44§ dia). Näo houve influência estatisticamente significante da bromohexine sobre os parâmetros analisados