The effects of various therapies on vulvovaginal atrophy and quality of life in gynecological cancer patients: a systematic review.

PURPOSE: Tumors affecting the female genital tract and their treatments have the potential to induce adverse modifications in vaginal health and impact personal aspects of patient's lives. Vulvovaginal atrophy is one of the morphological changes observed in individuals with a history of gynecological cancer, influenced both by the biological environment of tumors and the main therapeutic modalities employed. Therefore, the purpose of this study was to identify approaches to treat vulvovaginal atrophy while assessing the impact on the emotional and sexual health of women diagnosed with gynecological cancers. METHODS: To achieve this goal, a systematic review was conducted following the methodological guidelines outlined by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The databases used for literature research were PubMed and Web of Science. RESULTS: Initially, 886 articles were obtained. After eliminating duplicates and applying inclusion/exclusion criteria, seven articles were selected for analysis. The period of highest publication activity spanned from 2017 to 2020, with the majority conducted in Italy. Five treatment modalities were identified and categorized as vaginal suppository, oral medication, surgical procedure, CO2 laser therapy, and vaginal dilator. Twenty-four outcomes related to vaginal health and 30 outcomes related to overall, sexual, and emotional quality of life were analyzed. CONCLUSION: In general, all interventions demonstrated the ability to improve vaginal health or, at the very least, the sexual health of patients. Thus, despite limitations, all treatments have the potential to address vulvovaginal atrophy in patients with a history of gynecological cancer.

History of Rectal Product Use and Country of Residence Influence Preference for Rectal Microbicide Dosage Forms Among Young Sexual and Gender Minorities: A Multi-country Trial Comparing Placebo Douche, Suppository, and Insert Products.

The DESIRE Study (MTN-035) explored product preference among three placebo rectal microbicide (RM) formulations, a rectal douche (RD), a suppository, and an insert, among 210 sexually active transgender people and men who have sex with men in five counties: the United States, Peru, Thailand, South Africa, and Malawi. Participants used each product prior to receptive anal sex (RAS) for 1 month, following a randomly assigned sequence, then selected their preferred product via computer assisted self-interview. In-depth interviews examined reasons for preference. We compared product preference and prior product use by country to explore whether geographic location and experience with the similar products impacted preference. A majority in the United States (56%) and Peru (58%) and nearly half in South Africa (48%) preferred the douche. Most in Malawi (59%) preferred the suppository, while half in Thailand (50%) and nearly half in South Africa (47%) preferred the insert. Participants who preferred the douche described it as quick and easy, already routinized, and serving a dual purpose of cleansing and protecting. Those who preferred the insert found it small, portable, discreet, with quick dissolution. Those who preferred the suppository found the size and shape acceptable and liked the added lubrication it provided. Experience with product use varied by country. Participants with RD experience were significantly more likely to prefer the douche (p = 0.03). Diversifying availability of multiple RM dosage forms can increase uptake and improve HIV prevention efforts globally.

RESUMEN: El estudio DESIRE (MTN-035) exploró la preferencia de producto entre tres formulaciones de microbicida rectal (MR) de placebo, una ducha rectal, un supositorio y un inserto, entre 210 personas transgénero y hombres que tienen sexo con hombres en cinco países: los Estados Unidos, Perú., Tailandia, Sudáfrica y Malawi. Los participantes utilizaron cada producto antes del sexo anal receptive (SAR) durante un mes, siguiendo una secuencia asignada al azar, luego seleccionaron su producto preferido mediante una autoentrevista asistida por computadora. Las entrevistas en profundidad examinaron los motivos de preferencia. Comparamos la preferencia de producto y el uso previo del producto por país para explorar si la ubicación geográfica y la experiencia con la forma farmacéutica impactaron la preferencia. Una mayoría en los Estados Unidos (56%) y Perú (58%) y casi la mitad en Sudáfrica (48%) prefirieron la ducha rectal. La mayoría en Malawi (59%) prefirió el supositorio, mientras que la mitad en Tailandia (50%) y casi la mitad en Sudáfrica (47%) prefirió el inserto. Los participantes que prefirieron la ducha rectal la describieron como rápida y fácil, ya parte de su rutina y que tenía el doble propósito de limpiar y proteger. Los que prefirieron el inserto lo consideraron pequeño, portátil, discreto y de rápida disolución. Los que prefirieron el supositorio encontraron que tenía un tamaño y forma aceptables y proveía lubricación adicional. La experiencia con el uso del producto varió según el país. Los participantes con experiencia con duchas rectales tenían significativamente más probabilidades de preferir la ducha rectal (p = 0,03). Diversificar la disponibilidad de múltiples formas farmacéuticas de MR puede aumentar la aceptación y mejorar los esfuerzos de prevención del VIH a nivel mundial.

Development and Evaluation of Vaginal Suppository Containing Althaea officinalis L. Polysaccharide Extract

Abstract Intrauterine adhesions cause several gynecological problems. Althaea officinalis L. roots known as marshmallows contain polysaccharides (M.P.) which possess anti-inflammatory and anti-ulcerogenic activities also can form a bio-adhesive layer on damaged epithelial membranes prompting healing processes. Vaginal formulations of herbal origin are commonly applied to relieve cervico-uterine inflammation. Herein, we aim to develop and evaluate vaginal suppositories containing polysaccharides isolated from the A. officinalis root. Six formulations (four P.E.G.-based and two lipid-based suppositories containing 25% and 50% M.P.) met standard requirements, which were then subjected to qualitative and quantitative evaluation. All suppositories exhibited acceptable weights, hardness, content uniformity, melting point, and disintegration time, which fall within the acceptable recommended limits. Higher concentrations of M.P. in PEG-bases moderately increased the hardness (p<0.05). PEG-formulations showed content uniformity>90% of the average content while it was 75-83% for suppocire formulations. All formulations disintegrated in<30minutes. In-vitro release test revealed that M.P. release from 25%-MP formulations was higher than that of 50%-M.P. suppositories. Overall, results revealed the feasibility of preparing P.E.G.-or lipid-based suppositories containing M.P., which met the B.P. quality requirement

Rectal Levothyroxine for the Treatment of Hypothyroidism: A Case Study.

Transient hypothyroidism can present itself as clinically asymptomatic or with few symptoms. Early treatment with levothyroxine (L-T4) prevents complications related to this disorder. We report a case of a male infant with concomitant short bowel syndrome and transient hypothyroidism treated with rectal L-T4. A 4-month-and-10-day-old boy with previous gastroschisis underwent multiple surgical approaches for small bowel resection and developed short bowel syndrome. We suspected hypothyroidism because of jaundice (direct bilirubin up to 59 mg/dL), the absence of evacuation, oral diet intolerance, and intestinal dysmotility. Because of a thyrotropin level of 34.45 µIU/mL and a free thyroxine level of 0.64 ng/dL, the diagnosis was confirmed. Because fasting was demanding, we started the patient on rectal diluted L-T4. After 4 weeks, the patient had spontaneous peristalsis, improvement of jaundice (direct bilirubin: 4.6 mg/dL), and normalized free thyroxine and thyrotropin values. In the present case, the patient was diagnosed with hypothyroidism and was on absolute fasting. An alternative route of drug administration was warranted. We empirically prescribed rectal diluted L-T4 when intravenous and suppository L-T4 were not available. This method was proven to be safe and effective in improving the patient's clinical and biochemical status. Rectal L-T4 is a possible alternative route of administration to treat hypothyroidism in patients who are unable to take the medication orally.

Eficacia y seguridad de supositorios de mesalazina en pacientes adultos con proctitis o proctosigmoiditis ulcerativa para las fases agudas y del mantenimiento de la remision / Efficacy and safety of mesalazine suppositories in adult patients with proctitis or ulcerative proctosigmoiditis for acute phases and maintenance of remission

INTRODUCCIÓN: Antecedentes: El presente dictamen presenta la evaluación de tecnología de la eficacia y seguridad de los supositorios de mesalazina para su uso en pacientes adultos con proctitis o proctosigmoiditis ulcerativa para las fases aguda y del mantenimiento de la remisión. Aspectos Generales: La colitis ulcerativa (CU) es la condición inflamatoria crónica más común de las enfermedades gastrointestinales. Frecuentemente se desarrolla entre los 15 y 25 años y 55 y 65 años, aunque no excluye la población fuera de estos rangos de edad. Esta enfermedad genera inflamación a nivel de la mucosa del colon, siendo variable la extensión de la inflamación y pudiendo llegar a afectar también el área del recto. Se caracteriza por fases de relapso y remisión. Tecnología Sanitaria de Interés: Mesalazina (Canasa®/Mesacron®/Pentasa®/Salofalk®/Asacol®) es un medicamento anti-inflamatorio de acción tópica compuesto químicamente por el ácido 5 aminosalicílico o 5-ASA. Tiene dos vías de administración, oral y rectal, siendo los supositorios rectales, la forma de presentación de interés de esta evaluación de tecnología. METODOLOGÍA: Estratégia de Búsqueda: Se realizó una estrategia de búsqueda sistemática de la evidencia científica con respecto a la eficacia y seguridad de supositorios de mesalazina para pacientes con proctitis o proctosigmoiditis ulcerativa en fases aguda y del mantenimiento de la remisión. Para la búsqueda primaria se revisó la información disponible por entes reguladoras y normativas como la Administración de Drogas y Alimentos (FDA), y la Dirección General de Medicamentos y Drogas (DIGEMID). Posteriormente, se buscaron guías de práctica clínica a través de los metabuscadores: Translating Research into Practice (TRIPDATABASE), The National Guideline of Clearinghouse (NGC), y Health Systems Evidence (HSE). Seguidamente, se realizó una búsqueda dentro de la información generada por grupos internacionales que realizan revisiones sistemáticas, evaluaciónes de tecnologías sanitarias y guías de práctica clínica, tales comoHealth Technology Assesment (HTA), la Biblioteca de Cochrane, el Instituto Nacional de la Salud y Excelencia en Cuidado (NICE), la Agencia Canadiense de Drogas y Tecnologías en Salud (CADTH), y el Consorcio Escocés de Medicinas (SMC). Adicionalmente se revisaron las bases National Library of Medicine (Pubmed-Medline), LILACS, EMBASE, OVID, y complementando la búsqueda con la página de ensayos clínicos www.clinicaltrials.gov, para identificar estudios primarios en elaboración o que no hayan sido publicados aún. RESULTADOS: Tras la búsqueda se encontró evidencia que sustenta la eficacia y seguridad de supositorios de mesalazina en pacientes adultos con proctitis o proctosigmoiditis ulcerativa para las fases aguda y del mantenimiento de la remisión.RESULTADOS: Tras la búsqueda se encontró evidencia que sustenta la eficacia y seguridad de supositorios de mesalazina en pacientes adultos con proctitis o proctosigmoiditis ulcerativa para las fases aguda y del mantenimiento de la remisión. Sinopsis de la Evidencia: Se encontró evidencia acerca de la eficacia y seguridad de supositorios de mesalazina en pacientes adultos con proctitis o proctosigmoiditis ulcerativa para las fases aguda y del mantenimiento de la remisión. CONCLUSIONES: La presente evaluación de tecnología evalúa la evidencia disponible a Febrero del 2016 para el uso de supositorios de mesalazina para pacientes adultos con proctitis o proctosigmoiditis para las fases agudas y del mantenimiento de la remisión. - Se ha encontrado evidencia que sustenta la eficacia y seguridad de supositorios de mesalazina, la cual está basada en dos guías de práctica clínica y dos revisiones sistemáticas de buena calidad metodológica. Cabe resaltar que esta eficacia ha sido demostrada únicamente para la población de pacientes con proctitis o proctosigmoiditis ulcerativa, mas no en otras áreas del colon en fases aguda. Sin embargo, para la fase del mantenimiento de la remisión no se ha encontrado evidencia directa que evalúe el potencial beneficio de supositorios de mesalazina. , El Instituto de Evaluación de Tecnologías en Salud e Investigación ­ IETSI, aprueba el uso de supositorios de mesalazina en pacientes adultos con proctitis o proctosigmoiditis ulcerativa para el tratamiento de fases aguda y del mantenimiento de la remisión. El presente Dictamen Preliminar tiene una vigencia de dos años a partir de la fecha de publicación.

Recombinant streptokinase vs hydrocortisone suppositories in acute hemorrhoids: A randomized controlled trial.

AIM: To compare the efficacy and safety of recombinant streptokinase (rSK) vs hydrocortisone acetate-based suppositories in acute hemorrhoidal disease. METHODS: A multicenter (11 sites), randomized (1:1:1), open, controlled trial with parallel groups was performed. All participating patients gave their written, informed consent. After inclusion, patients with acute symptoms of hemorrhoids were centrally randomized to receive, as outpatients, by the rectal route, suppositories of rSK 200000 IU of one unit every 8 h (first 3 units) and afterwards every 12 h until 8 administrations were completed (schedule A), one unit every 8 h until 6 units were completed (schedule B), or 25 mg hydrocortisone acetate once every 8 h up to a maximum of 24 administrations. Evaluations were performed at 3, 5, and 10 d post-inclusion. The main end-point was the 5(th)-day response (disappearance of pain and bleeding, and ≥ 70% reduction of the lesion size). Time to response and need for thrombectomy were secondary efficacy variables. Adverse events were also evaluated. RESULTS: Groups were homogeneous with regards to demographic and baseline characteristics. Fifth day complete response rates were 156/170 (91.8%; 95%CI: 87.3-96.2), 155/170 (91.2%; 95%CI: 86.6%-95.7%), and 46/170 (27.1%; 95%CI: 20.1%-34.0%) with rSK (schedule A and B) and hydrocortisone acetate suppositories, respectively. These 64.6% and 63.9% differences (95%CI: 56.7%-72.2% and 55.7%-72.0%) were highly significant (P < 0.001). This advantage was detected since the early 3(rd) day evaluation (68.8% and 64.1% vs 7.1% for the rSK and active control groups, respectively; P < 0.001) and was maintained even at the late 10(th) day assessment (97.1% and 93.5% vs 67.1% for rSK and hydrocortisone acetate, respectively; P < 0.001). Time to response was 3 d (95%CI: 2.9-3.1) for both rSK groups and 10 d (95%CI: 9.3-10.7) in the hydrocortisone acetate group. This difference was highly significant (P < 0.001). All subgroup stratified analyses (with or without thrombosis and hemorrhoid classification) showed a statistically significant advantage for the rSK groups. Thrombectomy was necessary in 4/251 and 14/133 patients with baseline thrombosis in the rSK and hydrocortisone acetate groups, respectively (P < 0.001). There were no adverse events attributable to the experimental treatment. CONCLUSION: rSK suppositories showed a significant advantage over a widely-used over-the-counter hydrocortisone acetate preparation for the treatment of acute hemorrhoidal illness, as well as having an adequate safety profile.

Perfil de progesterona em novilhas com diferente atividade luteal e tratadas com implantes vaginais / Serum progesterone in heifers with different luteal activity treated with vaginal devices

O dispositivo de liberação de progesterona (DLP) é muito importante em protocolos de Inseminação Artificial em Tempo Fixo (IATF). Representa cerca de 43% dos custos e é objeto de estudos sobre a eficiência da sua reutilização. No entanto, perfis de liberação de progesterona (P4) em animais com diferentes concentrações endógenas desse esteroide não são claramente descritos. Este estudo teve como objetivo avaliar a concentração sérica de P4 em fêmeas com diferentes situações de atividade luteal, tratadas com DLP novo (1g de P4) por 8 dias. Trinta novilhas mestiças cíclicas foram divididas em três grupos: em G1 e G2, o DLP foi inserido (D0) sete dias após a ovulação induzida. Adicionalmente, 0,15mg de D-cloprostenol foi administrado três dias depois para promover a luteólise em G2. Para G3, o corpo lúteo foi lisado antes da inserção do DLP para que a P4 exógena fosse a única fonte desse hormônio. O sangue foi coletado no D0, D3, D5 e D8, e a P4 avaliada por RIA. Médias de P4 foram comparadas entre os grupos em cada dia e dentro do grupo, entre os dias, utilizando o teste Tukey. Antes da inserção do implante (D0), os níveis de P4 foram, nos grupos, semelhantes em G1 e G2, e superiores a G3 (5,3±3,1a e 5,3±1,4avs 0,6±0.3bng/mL, respectivamente-P<0,05). No D3, ocorreu o mesmo perfil (5,7±2,6a e 5,4±2,0a e 3,6±0.8bng/mL, respectivamente para G1 e G2 vs G3, P<0,05). Trinta e seis horas (D5) após a PGF, a P4 no G2 caiu para níveis semelhantes aos do grupo G3 e ambos diferiram (P<0,05) de G1 (3,3±1,6b vs 2,4±0,9b e 2,1±0.7bng/mL). Essa diferença se manteve (P<0,05) em D8 (3,1±1,3a, 1,8±0,8b e 1,6±0.6b ng/mL). O aumento da P4 após a inserção (D3 - D0) foi maior (P<0,05) em G3 que em G1 e G2 (2,8±0,9a vs 0,4±1,8b e 0,2±1.4bng/mL). Os animais com maior P4 endógena levam a menor liberação de P4 exógena a partir do DLP. Portanto, os níveis remanescentes de P4 no DLP após o uso dependem da concentração endógena de P4 do animal e possíveis alterações durante a permanência.(AU)

The progesterone (P4) device is a very important step in the ovulation control in Timed Artificial Insemination (TAI) protocols. It represents about 43% of the hormone costs, thus it has been the subject of several studies on efficiency of the reused device as an alternative to reduce TAI costs. However, to our knowledge, profiles for P4 release in animals with different endogenous concentrations of P4 are not clearly described. This study aimed to evaluate serum concentration of P4 in females with different ovarian conditions - related to luteal activity - and treated with a new intravaginal device (1g of P4) for 8 days. Thirty normally cyclic crossbred heifers were divided into three groups: for G1 and G2, P4 device was inserted (D0) seven days after ovulation (7 day old CL). Additional PGF (0.15 mg of D-cloprostenol) was given three days later to promote luteolysis in the G2 group. For G3, CL was killed before P4 insertion and the exogenous progesterone was the only source of this hormone. Blood samples were collected on D0, D3, D5 and D8 and P4 concentration was measured by radioimmunoassay (RIA). Means for P4 concentration were compared among groups in each day and within the group among days using the Tukey test. Before P4 device insertion (D0), P4 levels were higher (P<0.05) in G1 and G2 when compared to G3 (5.3±3.1 and 5.3±1.4 vs. 0.6±0.3ng/mL, respectively). Three days later (D3), the same pattern was observed (5.7±2.6 and 5.4±2.0 and 3.6±0.8ng/mL, respectively for G1 and G2 vs. G3, P<0.05). Thirty-six hours (D5) after PGF injection (G2), P4 in G2 dropped to levels similar to the G3 group and both differed (P<0.05) from G1 (3.3±1.6 vs. 2.4±0.9 and 2.1±0.7ng/mL, G1 vs. G2 and G3, respectively). There were no differences (P>0.05) among groups on D8 (3.1±1.3, 1.8±0.8 and 1.6±0.6ng/mL, respectively, for G1, G2 and G3). Progesterone increase after P4 insertion (D3 - D0) was higher (P<0.05) in G3 compared to G1 and G2 (2.8±0.9 vs. 0.4±1.8 and 0.2±1.4ng/mL, respectively). The interpretation was that animals with higher endogenous P4 promote less release of the exogenous P4 from the device. Therefore, the remaining P4 levels from used progesterone devices depend on the physiological condition of the animal at the time of insertion and possible changes during the treatment.(AU)

Mesalazina enema e supositório para tratamento da Doença de Crohn / Mesalazine enema and suppository for treatment of Crohn's Disease

A DOENÇA: A doença de Crohn (DC) é uma doença inflamatória intestinal de origem não conhecida e caracterizada pelo acometimento focal, assimétrico e transmural de qualquer porção do tubo digestivo, da boca ao ânus. Apresenta-se sob três formas principais: inflamatória, fistulosa e fibroestenosante.Os segmentos do tubo digestivo mais acometidos são íleo, cólon e região perianal. A DC não é curável clínica ou cirurgicamente e sua história natural é marcada por agudizações e remissões. TRATAMENTO: O tratamento da DC é definido segundo a localização da doença, o grau de atividade e as complicações. As opções são individualizadas de acordo com a gravidade, a resposta sintomática e a tolerância ao tratamento. O tratamento medicamentoso envolve o uso de anti-inflamatórios esteroidais e não esteroidais, antibióticos, imunomoduladores, e anticorpos monoclonais anti-fator de necrose tumoral (anti-TNF). Os primeiros incluem corticosteroides e aminossalicilatos (sulfassalazina e mesalazina). JUSTIFICATIVA DA EXCLUSÃO: Aminossalicilatos e antibióticos não têm ação uniforme ao longo do trato gastrointestinal, enquanto corticosteroides, imunomoduladores e terapias anti-TNF parecem ter uma ação mais constante em todos os segmentos gastrointestinais. Os aminossalicilatos não atingem concentração terapêutica no esôfago e no estômago, pois são formulados de maneira a serem liberados em segmentos mais distais no trato digestivo. Pacientes com doença ileal devem ser tratados com corticosteroide (qualquer representante e via de acordo com a situação clínica), uma vez que a mesalazina, o aminossalicilato que atinge níveis terapêuticos nesta região, tem efeito muito modesto quando comparado ao placebo. Desta forma, aminossalicilatos são indicados apenas no tratamento de doença colônica e ileocolônica. DELIBERAÇÃO FINAL: A CONITEC, na presença dos membros, na reunião do plenário do dia 02/07/2015 deliberou por unanimidade recomendar a exclusão da mesalazina nas apresentações enema e supositório para o tratamento da doença de Crohn conforme Protocolo Clinico e Diretrizes Terapêuticas estabelecidos pelo Ministério da Saúde. Foi assinado o Registro de Deliberação nº 129/2015. DECISÃO: PORTARIA Nº 36, de 24 de julho de 2015 - Torna pública a decisão de excluir a mesalazina nas apresentações enema e supositório para o tratamento da doença de Crohn no âmbito do Sistema Único de Saúde - SUS.

Estabilidad de supositorios de naproxeno para uso infantil y adulto / Stability of Naproxen suppositories for children and adults

Introducción: el naproxeno en supositorios para uso infantil y adulto constituye una de las líneas de investigación en desarrollo de la Empresa Roberto Escudero Díaz. Los estudios de estabilidad son una parte indispensable para el registro de una nueva formulación. Objetivo: determinar la estabilidad de los supositorios de naproxeno para uso infantil y adulto, teniendo en cuenta la estabilidad física y química del analito en las nuevas formulaciones. Métodos: se realizó el estudio de estabilidad para formulaciones en fase de desarrollo de supositorios de naproxeno para uso infantil y adulto, teniendo en cuenta la metodología propuesta por el Centro para el Control Estatal de la Calidad de los Medicamentos (CECMED). Se emplearon para cada dosis evaluada, supositorios de tres lotes pilotos envasados en tiras de aluminio termosellables. Se almacenaron los supositorios a temperatura de refrigeración (2-8 °C) y ambiente (30 ± 2 °C) durante un año, y se les realizaron muestreos a los 0, 1, 3, 6 y 12 meses de elaborados. Para el análisis de la estabilidad química, se consideraron los resultados del contenido de naproxeno obtenidos por volumetría de neutralización y por cromatografía líquida de alta resolución, así como la determinación de los posibles productos de degradación por cromatografía en capa delgada. Resultados: se demostró la adecuada estabilidad física de los supositorios de ambas dosis, independientemente de la temperatura de almacenamiento durante 12 meses, ya que se mantuvieron inalteradas las características organolépticas y el peso. Aunque el tiempo de liquefacción disminuyó durante el almacenamiento, siempre fue inferior al límite establecido. Con el método por cromatografía líquida de alta resolución, se detectaron pequeños cambios en la concentración de analito, por lo que este método fue superior para el seguimiento de la estabilidad química que la volumetría de neutral...(AU)

Introduction: Naproxen suppository for children and adults is one of the developing research lines of Roberto Escudero Diaz drug production enterprise. The stability studies are indispensable for the registration of a new formulation. Objective: to determine the stability of Naproxen suppositories for children and adults, taking the physical and chemical stability of the analyte into account in the new formulations. Methods: pursuant to the methodology of the Center for the State Quality Control of Drugs (CECMED), the stability study for developing formulations was conducted in Naproxen suppositories for children and adults. These products packaged in heat-seal aluminum blister packs from three pilot batches were used for each evaluated dose. They were stored at 2 to 8 °C refrigeration and at air temperature of 30 ± 2 °C during one year, and sampled at 0, 1, 3, 6 and 12 months after preparation. For the analysis of the chemical stability, the Naproxen content determined by the neutralizing volumetry and high performance liquid chromatography tests and the possible degradation products identified in the thin layer chromatography test were taken into account. Results: this study proved the adequate physical stability of suppositories at both doses regardless of the storage temperatures during 12 months because their organoleptic characteristics and weight remained unchanged. Although the liquefaction time decreased under the storage conditions, it was lower than the set limit. The high performance liquid chromatography detected slight changes in the analyte concentration, so this method was better for the chemical stability analysis than the neutralization volumetry method. The chromatographic techniques did not detect any degradation product in the suppositories. Conclusions: the suppositories were physically and chemically stable at a refrigerating temperature of 2 to 8 °C and at air temperature of 30 ± 2 °C during 12 months(AU)

Estabilidad de supositorios de naproxeno para uso infantil y adulto / Stability of Naproxen suppositories for children and adults

INTRODUCCIÓN: el naproxeno en supositorios para uso infantil y adulto constituye una de las líneas de investigación en desarrollo de la Empresa Roberto Escudero Díaz. Los estudios de estabilidad son una parte indispensable para el registro de una nueva formulación. OBJETIVO: determinar la estabilidad de los supositorios de naproxeno para uso infantil y adulto, teniendo en cuenta la estabilidad física y química del analito en las nuevas formulaciones. MÉTODOS: se realizó el estudio de estabilidad para formulaciones en fase de desarrollo de supositorios de naproxeno para uso infantil y adulto, teniendo en cuenta la metodología propuesta por el Centro para el Control Estatal de la Calidad de los Medicamentos (CECMED). Se emplearon para cada dosis evaluada, supositorios de tres lotes pilotos envasados en tiras de aluminio termosellables. Se almacenaron los supositorios a temperatura de refrigeración (2-8 °C) y ambiente (30 ± 2 °C) durante un año, y se les realizaron muestreos a los 0, 1, 3, 6 y 12 meses de elaborados. Para el análisis de la estabilidad química, se consideraron los resultados del contenido de naproxeno obtenidos por volumetría de neutralización y por cromatografía líquida de alta resolución, así como la determinación de los posibles productos de degradación por cromatografía en capa delgada. RESULTADOS: se demostró la adecuada estabilidad física de los supositorios de ambas dosis, independientemente de la temperatura de almacenamiento durante 12 meses, ya que se mantuvieron inalteradas las características organolépticas y el peso. Aunque el tiempo de liquefacción disminuyó durante el almacenamiento, siempre fue inferior al límite establecido. Con el método por cromatografía líquida de alta resolución, se detectaron pequeños cambios en la concentración de analito, por lo que este método fue superior para el seguimiento de la estabilidad química que la volumetría de neutralización. No se detectaron productos de degradación en los supositorios por ninguna de las técnicas cromatográficas utilizadas. CONCLUSIONES: los supositorios fueron estables desde el punto de vista físico y químico a temperatura de refrigeración (2-8 °C) y ambiente (30 ± 2 °C) durante 12 meses(AU)

INTRODUCTION: Naproxen suppository for children and adults is one of the developing research lines of Roberto Escudero Diaz drug production enterprise. The stability studies are indispensable for the registration of a new formulation. OBJECTIVE: to determine the stability of Naproxen suppositories for children and adults, taking the physical and chemical stability of the analyte into account in the new formulations. METHODS: pursuant to the methodology of the Center for the State Quality Control of Drugs (CECMED), the stability study for developing formulations was conducted in Naproxen suppositories for children and adults. These products packaged in heat-seal aluminum blister packs from three pilot batches were used for each evaluated dose. They were stored at 2 to 8 °C refrigeration and at air temperature of 30 ± 2 °C during one year, and sampled at 0, 1, 3, 6 and 12 months after preparation. For the analysis of the chemical stability, the Naproxen content determined by the neutralizing volumetry and high performance liquid chromatography tests and the possible degradation products identified in the thin layer chromatography test were taken into account. RESULTS: this study proved the adequate physical stability of suppositories at both doses regardless of the storage temperatures during 12 months because their organoleptic characteristics and weight remained unchanged. Although the liquefaction time decreased under the storage conditions, it was lower than the set limit. The high performance liquid chromatography detected slight changes in the analyte concentration, so this method was better for the chemical stability analysis than the neutralization volumetry method. The chromatographic techniques did not detect any degradation product in the suppositories. CONCLUSIONS: the suppositories were physically and chemically stable at a refrigerating temperature of 2 to 8 °C and at air temperature of 30 ± 2 °C during 12 months(AU)

In vitro release of ketoprofen suppositories using the USP basket and the flow-through cell dissolution methods.

In order to study the release characteristics of ketoprofen suppositories under the hydrodynamic environment generated by USP Apparatus 1 and 4, the dissolution profiles of the Mexican reference product (100 mg) were determined. Phosphate buffer pH 8 and 1% sodium lauryl sulfate (SLS) aqueous solutions were proved as dissolution mediums. Baskets were rotated at 100 rpm with USP Apparatus 1 and different flow rates from 16-32 mL/min with USP Apparatus 4 were used. Drug samples were taken and quantified during 60 min by UV analysis at 260 nm. Mean dissolution time (MDT) and dissolution efficiency (DE) were calculated by model-independent methods. Data were also fitted to several kinetic models. Poor dissolution was found in both dissolution mediums when USP basket method was used (< 10% dissolved) while better results were obtained with USP Apparatus 4 when 1% SLS at 24 mL/min was used (43.6% dissolved, MDT of 25.5 min and DE of 25.0%). Kinetics showed a great variability when the USP Apparatus 1 was used, and Gompertz fitted well for data of 1% SLS at 24 mL/min (R(2)(adjusted) > 0.99). The results suggest the need to establish an adequate dissolution method to evaluate the release kinetics of ketoprofen from suppositories.

Recombinant streptokinase vs phenylephrine-based suppositories in acute hemorrhoids, randomized, controlled trial (THERESA-3).

AIM: To compare the efficacy and safety of recombinant streptokinase (rSK) and phenylephrine-based suppositories in acute hemorrhoidal disease. METHODS: A multicenter (14 sites), randomized (1:1), open, parallel groups, active controlled trial was done. After inclusion, subjects with acute symptoms of hemorrhoids, who gave their written, informed consent to participate, were centrally randomized to receive, as outpatients, rSK (200000 IU) or 0.25% phenylephrine suppositories, which had different organoleptic characteristics. Treatment was administered by the rectal route, one unit every 6 h during 48 h for rSK, and up to a maximum of 5 d (20 suppositories) for phenylephrine. Evaluations were performed at 3, 5 and 10 d post-inclusion. The main end-point was the 5(th)-day complete clinical response (disappearance of pain and edema, and ≥ 70% reduction of the lesion size). Time to response and need for thrombectomy were secondary efficacy variables. Adverse events were evaluated too. RESULTS: 5(th) day complete response rates were 83/110 (75.5%) and 36/110 (32.7%) with rSK and phenylephrine suppositories, respectively. This 42.7% difference (95%CI: 30.5-54.2) was highly significant (P < 0.001). The advantage was detected since the early 3(rd) day evaluation (37.3% vs 6.4% for the rSK and active control groups, respectively; P < 0.001) and was kept even at the late 10(th) day assessment (83.6% vs 58.2% for rSK and phenylephrine, respectively; P < 0.001). Time for complete response was significantly shorter (P = 0.031; log-rank test) in the rSK group (median: 4.9 d; 95%CI: 4.8-5.0) with respect to the active control (median: 9.8 d; 95%CI: 9.8-10.0). Thrombectomy was necessary in 1/59 and 8/57 patients with baseline thrombosis in the rSK and phenylephrine groups, respectively (P = 0.016). There were no adverse events attributable to the experimental treatment. CONCLUSION: rSK suppositories showed a significant advantage over a widely used over-the-counter phenylephrine preparation for the treatment of acute hemorrhoidal illness, with an adequate safety profile.

Fast-track management is safe and effective after bowel resection in children with Crohn's disease.

BACKGROUND: "Fast-track" management (FT) challenges traditional postoperative tenets in order to minimize discomfort and optimize inpatient care. We examined the outcomes of consecutively performed laparoscopic-assisted ileocecectomy for Crohn's disease (CD), with particular focus on FT's effects in patients with underlying bowel inflammation. METHODS: We retrospectively reviewed all patients undergoing isolated laparoscopic-assisted ileocecectomy for CD at our institution between 12/2000 and 12/2010, excluding patients with multiple areas of surgical CD, bladder involvement, or age >18years. RESULTS: Seventy-one patients aged 8-18years underwent isolated laparoscopic-assisted ileocecectomy for CD, of which 45 met FT criteria. Individual practice patterns primarily determined which patients were FT-managed. FT management led to decreased length of stay (LOS), time to first stool, time to full diet, and intravenous narcotic use. No significant difference in complications or disease progression was observed between the two groups during 2-year follow up. CONCLUSIONS: Our results suggest that FT is safe and effective in patients with CD. In a chronically ill population, counseling patients and families to expect early discharge is critical to the success of this strategy. Despite CD-related GI pathology, FT patients realized benefits in terms of LOS, time to bowel function, and narcotic use without any increase in complications.

A suppository-base-matrix tablet for time-dependent colon-specific delivery system

Our research has focused on the main design features and release performances of time-dependent colon-specific (TDCS) delivery tablets, which relies on the relative constancy that is observed in the small intestinal transit time of dosage forms. But inflammatory bowel disease（IBD）can affect the transit time, and usually results in watery stool. Compared to the TDCS and wax-matrix TDCS tablet, a promising time-dependent colon-specific delivery system was investigated. In our study, a suppository-base-matrix coated tablet was evaluated. Water soluble suppository-base helps the expansion of tablet, facilitates uniform film dissolution and achives high osmotic pressure. Combining the expansion of carboxymethyl starch sodium (CMS-Na) and the moisture absorption of NaCl, the coated TDCS tablet obtained a burst and targeted drug delivery system. A very good correlation between in vitro drug release and in vivo outcome was observed. This TDCS coated tablet provides a promising strategy to control drug release to the desired lower gastrointestinal region.

Nossa pesquisa focou-se nas principais características de planejamento e de desempenho de liberação cólon-específica tempo-dependente (TDCS) de comprimidos, que leva em conta a constância relativa observada no tempo de trânsito intestinal das formas de dosagem. A doença inflamatória do intestino (IBD) pode afetar o tempo de trânsito e, geralmente, resulta em fezes aquosas. Comparando ao TDCS e a comprimidos TDCS com matriz-cerosa, investigou-se sistema promissor de liberação cólon-específica tempo-dependente. Em nosso estudo, avaliou-se comprimido revestido com matriz base de supositório. A base de supositório solúvel em água auxilia a expansão do comprimido, facilita a dissolução uniforme do filme e atinge alta pressão osmótica. Associando a expansão do carboximetil amido sódico (CMS-Na) à absorção de umidade do NaCl, o comprimido revestido TDCS originou sistema de liberação direcionado e de erupção. Observou-se correlação muito boa entre a liberação in vitro e a in vivo do fármaco. Este comprimido revestido TDCS representa estratégia promissora para o controle da liberação do fármaco na região gastrintestinal mais baixa.

Recombinant streptokinase suppositories in the treatment of acute haemorrhoidal disease. Multicentre randomized double-blind placebo-controlled trial (THERESA-2).

AIM: A four-arm multicentre randomized double-blind placebo-controlled trial was undertaken to assess the effect and safety of suppositories containing recombinant streptokinase (rSK) at two dose levels (100,000 IU and 200,000 IU) with sodium salicylate (SS) compared with placebo and SS for the treatment of acute haemorrhoidal disease. METHOD: Patients with acute symptoms of haemorrhoids were randomized to four treatment groups: (I) placebo, (II) SS, (III) SS + rSK 100,000 IU and (IV) SS + rSK 200,000 IU per suppository. Inpatient treatment was by four suppositories given every 6 h to discharge at 24 h. Evaluations were made at the time of discharge (24 h) and at 3, 5 and 20 days later. The main end-point was the degree of relief of pain, oedema and reduction in the size of the lesion by 90% on day 5. Adverse events and the occurrence of anti-SK antibodies were also determined. RESULTS: Eighty patients were included. Respective response rates in the four groups were 16%, 30%, 25% and 52%. In the last group there was a significant difference (36.8%) compared with control (95% CI 7.0-58.4%). The time to response was significantly shorter (median 5 days) in the 200,000 IU rSK group with respect to the others. There were no adverse events attributable to the treatment. No increase in anti-SK antibodies was detected 20 days after treatment. CONCLUSION: Suppositories with 200,000 IU rSK showed a significant improvement in symptoms of acute haemorrhoids, with an adequate safety profile.

Efecto protecto del supositorio de aceite de Copaifera officinalis L. "copaiba" en pacientes con hemorroides / Protective effect of Copaifera officinalis L. (copaiba) oil suppository in patients with hemorrhoids

La investigación tuvo como objetivo evaluar la eficacia y seguridad de supositorios de aceite de Copaifera officinalis L. "copaiba" en pacientes con diágnóstico definitivo de crisis hemorroidal aguda. El ensayo fue clínico prospectivo, controlado, comparativo, aleatorio y se realizó en el Instituto de Investigaciones Clínicas de la Facultad de Medicina de UNMSM. y Servicio de Gastroenterología del Hospital Nacional Dos de Mayo. Los pacientes evaluados presentaban diagnóstico definitivo de crisis hemorroidal aguda. El diagnóstico se realizó mediante estudio clínico y proctoscópico antes y después del tratamiento, además de exámenes auxiliares serológicos; 60 pacientes fueron enrolados voluntariamente al protocolo cumpliendo con los criterios éticos de investigación: los cuales fueron distribuidos en 3 grupos de 20 casos cada uno, administrándoseles supositorios de copaiba 120 mg bid, copaiba 120 mg/lidocaína 30 mg bid, y Prednisolona caproato 1,3 mg/Cincocaína clorhídrato 1 mg respectivamente durante 7 días. Los datos obtenidos como el alivio de la sintomatología, disminución del tamaño de las hemorroides y presencia de eventos adversos fueron evaluados mediante técnicas multivariadas (p<0,05). Se logró mejoría clínica y desaparición de síntomas de la enfermedad, sin efectos adversos significativos; dos presentaron dolor y ardor anal de manera transitoria, y no requirió suspensión de la medicación. Se concluyó que los supositorios de aceita de Copaifera officinalis es una alternativa eficaz y segura en el tratamiento de la crisis hemorroidal aguda.

The present study aimed to evaluate the efficacy and safety of oil suppositories Copaifera officinalis L. "copaiba" in patients with a final diagnosis of acute hemorrhoidal crisis. The trial was prospective, controlled, comparative, randomized and performed in the Clinical Research Institute of the Faculty of Medicine UNMSM Gastroenterology and National Hospital Dos de Mayo. Patients evaluated had definite diagnosis of acute hemorrhoidal crisis. The diagnosis was made by clinical and proctoscópico before and after treatment, plus auxiliary serologic tests, 60 patients were enrolled voluntarily complying with the protocol ethical research, which were divided into 3 groups of 20 cases each, was administered suppositories 120 mg bid copaiba 120 mg/lidocaine 30mg bid, and prednisole caproate 13 mg/Cinchocaine hydrochloride 1 mg respectively for 7 days. Data obtained as relief of symptoms, decrease the size of hemorrhoids and presence of adverse events were assessed by multivariate techniques (p<0.05). was achieved clinical improvement and disappearance of symptoms of the symptoms of the disease, without significant adverse effects, two had anal burning pain temporaly, and did not require drug discontinuation. It was concluded that oil suppositories Copaifera officinalis is an effective and safe alternative in the treatment of acute hemorrhoidal crisis.

Validación de métodos analíticos para los estudios de estabilidad del naproxeno en supositorios para uso infantil y adulto / Validation of analytical methods for the stability studies of naproxen suppositories for infant and adult use

En el presente trabajo se realizaron los estudios analíticos y de validación para su aplicación en los estudios de estabilidad de las futuras formulaciones de supositorios de naproxeno para uso infantil y adulto. Se determinaron los factores que más influyeron en la estabilidad del naproxeno; la mayor degradación ocurrió en el medio ácido, oxidante y por acción de la luz. Se evaluó un método por cromatografía líquida de alta resolución, el cual mostró adecuado desempeño para cuantificar naproxeno en supositorios y fue selectivo frente a los productos de degradación. Se obtuvo un límite de cuantificación de 3,480 µg, por lo que fue válido para la realización de dichos estudios. Adicionalmente, se evaluaron los parámetros especificidad para estabilidad, límites de detección y de cuantificación para el método por volumetría ácido-base semiacuosa directa validado anteriormente para control de calidad, lo cual mostró resultados satisfactorios. No obstante, los métodos volumétricos no se consideran indicadores de estabilidad, por lo que este método será utilizado conjuntamente con los métodos cromatográficos de elección para determinar productos de degradación: cromatografía de capa delgada y cromatografía líquida de alta resolución(AU)

Analytical and validating studies were performed in this paper, with a view to using them in the stability studies of the future formulations of naproxen suppositories for children and adults. The most influential factors in the naproxen stability were determined, that is, the major degradation occurred in acid medium, oxidative medium and by light action. One high-performance liquid chromatography-based method was evaluated, which proved to be adequate to quantify naproxen in suppositories and was selective against degradation products. The quantification limit was 3,480 µg, so it was valid for these studies. Additionally, the parameters specificity for stability, detection and quantification limits were evaluated for the direct semi-aqueous acid-base method, which was formerly validated for the quality control and showed satisfactory results. Nevertheless, the volumetric methods were not regarded as stability indicators; therefore, this method will be used along with the chromatographic methods of choice, that is, thin-layer chromatography and high-performance liquid chromatography, to determine the degradation products(AU)

Desarrollo y validación de un método por cromatografía en capa delgada para los estudios de estabilidad del naproxeno / Development and validation of a thin-layer chromatography method for stability studies of naproxen

Se realizó la validación de un método analítico con vistas a su aplicación en los estudios de estabilidad de las futuras formulaciones de supositorios de naproxeno para uso infantil y adulto. Se determinaron los factores que más influyeron en la estabilidad del naproxeno; la mayor degradación ocurrió en el medio ácido, oxidante y por acción de la luz. Se determinó la posibilidad de formación de ésteres entre el grupo carboxilo libre presente en el naproxeno y el monoestearato de glicerilo presente en la base como una de las vías de degradación en la nueva formulación; se obuvieron resultados satisfactorios. Se desarrolló un método por cromatografía en capa delgada y se seleccionaron las mejores condiciones cromatográficas. Se emplearon placas de sílica gel GF254 y revelador ultravioleta a 254 nm. Se evaluaron 3 sistemas de disolventes entre los cuales el A, compuesto por: acético glacial:tetrahidrofurano:tolueno (3:9:90 v/v/v), permitió una adecuada resolución entre el analito y los posibles productos de degradación, con un límite de detección de 1 µg. La aplicación del método propuesto se limitó a la identificación de los posibles productos de degradación solo con fines cualitativos y no como prueba límite. El método fue suficientemente sensible y selectivo para aplicarlo con el objetivo para el cual fue diseñado, según los resultados obtenidos en la validación(AU)

The validation of an analytical method was carried out to be applied to the stability studies of the future formulations of naproxen suppositories for infant and adult use. The factors which mostly influenced in the naproxen stability were determined, the major degradation occurred in oxidizing acid medium and by action of light. The possible formation of esters between the free carboxyl group present in naproxen and the glyceryl monoestereate present in the base was identified as one of the degradation paths in the new formulation. The results were satisfactory. A thin-layer chromatography-based method was developed as well as the best chromatographic conditions were selected. GF254 silica gel plates and ultraviolet developer at 254 nm were employed. Three solvent systems were evaluated of which A made up of glacial acetic: tetrahydrofurane:toluene (3:9:90 v/v/v)allowed adequate resolution between the analyte and the possible degradation products, with detection limit of 1 µg. The use of the suggested method was restricted to the identification of possible degradation products just for qualitative purposes and not as final test. The method proved to be sensitive and selective enough to be applied for the stated objective, according to the validation results(AU)