Test for abnormal niacin response syndrome in schizophrenia: reclaiming the oral route / Prueba de síndrome de respuesta a niacina anormal en pacientes con diagnóstico de esquizofrenia: reivindicando la vía oral.

Introduction: Although there is an abnormal presentation of Niacin Response Syndrome (ANRS) in schizophrenic patients (SZ) compared to subjects with other psychiatric illnesses and with healthy individuals. However, most of the literature is based on studies that have used tests of niacin topical administration, observing, on the other hand, less scientific production of its oral administration. The objective was to determine the sensitivity of the oral niacin test as a method of detecting ASRN in EZ. Methods: A non-randomized clinical trial was carried out. Two groups were formed, the experimental or SZ, with 21 patients diagnosed with schizophrenia according to DSM-IV-TR SZ or schizoaffective disorder, and the HC group, made up of 20 healthy controls. Both groups were exposed to an oral niacin test and clinical-semiological tools were applied to evaluate the NRS. Results: 90.5% of the SZ group presented ANRS. In contrast, no participant in the HC group presented ANRS (0%). Conclusions: Oral niacin administration was sensitive to the detection of ASRN in schizophrenia. Likewise, ASRN could be a gradual phenomenon and its prevalence could be dose-dependent, being lower the lower the dose of oral niacin used. Further trials with larger and randomized samples will be needed.

Introducción: En pacientes esquizofrénicos (EZ) existe un síndrome de respuesta a niacina (ASRN) anormal en comparación con sujetos con otras enfermedades psiquiátricas y con individuos sanos. Sin embargo, la mayor parte de la literatura se basa en estudios que han utilizado pruebas de niacina por vía tópica, observándose, en cambio, menor cantidad de ensayos utilizando su administración por vía oral, a pesar de existir algunas ventajas comparativas con el uso de esta última vía. El objetivo fue determinar la sensibilidad de la prueba de niacina por vía oral como método de detección del ASRN en EZ. Metodología: Se realizó un ensayo clínico no aleatorizado, conformando dos grupos, el grupo experimental o EZ, con 21 pacientes con diagnóstico de esquizofrenia según DSM-IV-TR SZ o trastorno esquizoafectivo, y el grupo CS, constituido por 20 controles sanos. Ambos grupos fueron expuestos a la prueba de niacina por vía oral y se aplicaron herramientas clínico-semiológicas para evaluar el SRN. Resultados: La prevalencia de ASRN fue del 90,5% en el grupo EZ, mientras que en el grupo CS fue nula (0%). Conclusiones: La administración oral de niacina fue sensible a la detección de ASRN en la esquizofrenia. Asimismo, la ASRN podría ser un fenómeno gradual y su prevalencia podría ser dosis-dependiente, siendo menor cuanto menor sea la dosis de niacina oral utilizada. Se necesitarán ensayos adicionales con muestras de mayor tamaño y aleatorizadas.

Need for Flexible Adjustment of the Treatment Schedule for Aprepitant Administration against Erlotinib-Induced Refractory Pruritus and Skin Rush.

Common dermatological side-effects associated with erlotinib, epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor (TKI), include pruritus and skin rash, which are mediated by substance P, leading to the occasional discontinuation of cancer treatment. Aprepitant is an antagonist of neurokinin-1 receptor, through which substance P activates the pruritogens. Thus, aprepitant is expected to offer a promising option for the treatment of erlotinib-induced pruritus. However, the appropriate treatment schedule for aprepitant administration is under consideration. Here, we discuss the need for flexible adjustment of the treatment schedule for aprepitant administration against erlotinib-induced refractory pruritus and skin rush. A 71-year-old female smoker presented with stage IV EGFR-mutated lung adenocarcinoma. She was started on erlotinib at 150 mg/day. However, by 28 days, severe pruritus and acneiform skin rush resistant to standard therapies occurred, resulting in the interruption of erlotinib therapy. After recovery, she was restarted on erlotinib at 100 mg/day. However, severe pruritus and skin rush developed again within 2 weeks. Then, we started the first 3-day dose of aprepitant (125 mg on day 1, 80 mg on day 3, and 80 mg on day 5) based on the results of the previous prospective study, which showed the success rate of 100% with at least the second dose of aprepitant. However, the pruritus and skin rush exacerbated again within 4 weeks. Therefore, we started the second 3-day dose of aprepitant, but in vain. At this point, as the patient-centered medicine, bi-weekly schedule of the 3-day dose of aprepitant was considered and, then, adopted. As the results, the pruritus and skin rush remained well-controlled throughout the subsequent treatment with erlotinib.

Tamizaje fitoquímico de Cassia uniflora Mill / Phytochemical screening of Cassia uniflora Mill

Introducción: Cassia uniflora Mill se emplea en el control aleloquímico de Parthenium hysterophorus; se ha reportado que presenta actividad larvicida frente a Aedes aegypti. Tradicionalmente se ha usado como antiespasmódico y para el tratamiento de erupciones cutáneas. Objetivo: realizar un tamizaje fitoquímico a los extractos etéreo, alcohólico y acuoso de la especie Cassia uniflora Mill para conocer los metabolitos secundarios que sean de interés biológico en la terapéutica. Métodos: se recolectaron partes aéreas y subterráneas de la planta, se lavaron, desinfectaron, secaron, pulverizaron y se sometieron a extracciones sucesivas con solventes de polaridad creciente. Los extractos se filtraron y se realizaron ensayos fitoquímicos de identificación. Resultados: el tamizaje fitoquímico, efectuado a los extractos etéreo, alcohólico y acuoso de las hojas, tallos, cáscaras de los frutos, semillas y raíces, demostró la existencia de varias familias de metabolitos secundarios de interés biológico y farmacológico, entre los que se destacan, por su significativa presencia, las quinonas y las coumarinas. Conclusiones: de acuerdo con la diversidad de metabolitos secundarios presentes en las partes evaluadas de C. uniflora, así como los efectos biológicos reportados para la especie, sería interesante realizar nuevos estudios que aporten evidencias sobre su eficacia y seguridad, como forma de avalar su empleo tradicional.

Introduction: Cassia uniflora Mill is used for the allelochemical control of Parthenium hysterophorus; and its larvicidal activity on Aedes aegypti has been reported. It has also been applied as antispasmodic agent and as treatment of cutaneous rash. Objective: to perform a phytochemical screening on alcoholic, ethereal and aqueous extracts from the Cassia uniflora Mill species to identify the secondary metabolites of biological interest in therapeutics. Methods: aerial and underground parts of the plant were harvested, washed, disinfected, dried, powdered and subjected to successive extractions with solvents of increasing polarity. The extracts were filtered to carry out phytochemical tests for identification. Results: the phytochemical screening of ethereal, alcoholic and aqueous extracts from leaves, stems, fruit peels, seeds and roots, confirmed the existence of several families of secondary metabolites of biological and pharmacological interest such as quinones and coumarins that stand out because of their significance presence. Conclusions: according to the diversity of secondary metabolites in the tested parts of Cassia uniflora Mill, as well as the biological effects reported for this species, it would be interesting to conduct new studies to find pieces of evidence on its effectiveness and safety, as a way of supporting traditional use of this plant.

Tamizaje fitoquímico de Cassia uniflora Mill / Phytochemical screening of Cassia uniflora Mill

Introducción: Cassia uniflora Mill se emplea en el control aleloquímico de Parthenium hysterophorus; se ha reportado que presenta actividad larvicida frente a Aedes aegypti. Tradicionalmente se ha usado como antiespasmódico y para el tratamiento de erupciones cutáneas. Objetivo: realizar un tamizaje fitoquímico a los extractos etéreo, alcohólico y acuoso de la especie Cassia uniflora Mill para conocer los metabolitos secundarios que sean de interés biológico en la terapéutica. Métodos: se recolectaron partes aéreas y subterráneas de la planta, se lavaron, desinfectaron, secaron, pulverizaron y se sometieron a extracciones sucesivas con solventes de polaridad creciente. Los extractos se filtraron y se realizaron ensayos fitoquímicos de identificación. Resultados: el tamizaje fitoquímico, efectuado a los extractos etéreo, alcohólico y acuoso de las hojas, tallos, cáscaras de los frutos, semillas y raíces, demostró la existencia de varias familias de metabolitos secundarios de interés biológico y farmacológico, entre los que se destacan, por su significativa presencia, las quinonas y las coumarinas. Conclusiones: de acuerdo con la diversidad de metabolitos secundarios presentes en las partes evaluadas de C. uniflora, así como los efectos biológicos reportados para la especie, sería interesante realizar nuevos estudios que aporten evidencias sobre su eficacia y seguridad, como forma de avalar su empleo tradicional.(AU)

Introduction: Cassia uniflora Mill is used for the allelochemical control of Parthenium hysterophorus; and its larvicidal activity on Aedes aegypti has been reported. It has also been applied as antispasmodic agent and as treatment of cutaneous rash. Objective: to perform a phytochemical screening on alcoholic, ethereal and aqueous extracts from the Cassia uniflora Mill species to identify the secondary metabolites of biological interest in therapeutics. Methods: aerial and underground parts of the plant were harvested, washed, disinfected, dried, powdered and subjected to successive extractions with solvents of increasing polarity. The extracts were filtered to carry out phytochemical tests for identification. Results: the phytochemical screening of ethereal, alcoholic and aqueous extracts from leaves, stems, fruit peels, seeds and roots, confirmed the existence of several families of secondary metabolites of biological and pharmacological interest such as quinones and coumarins that stand out because of their significance presence. Conclusions: according to the diversity of secondary metabolites in the tested parts of Cassia uniflora Mill, as well as the biological effects reported for this species, it would be interesting to conduct new studies to find pieces of evidence on its effectiveness and safety, as a way of supporting traditional use of this plant.(AU)