[Translated article] Physicochemical and microbiological stability study of two new preservative-free methylprednisolone eye drops.

OBJECTIVE: To study the physicochemical and microbiological stability over 90 days of two preservative-free methylprednisolone sodium succinate (MTPSS) 1 and 10 mg/mL eye drops for use in ocular pathologies such as Sjögren's syndrome and dry eye syndrome. METHOD: The two eye drops were prepared from injectable MTPSS (Solu-moderin® and Urbason®), water for injection and normal saline solution. In accordance with ICH (International Council for Harmonization of Technical Requirements for Pharmaceuticals for Human Use) guidelines, they were then stored in triplicate under refrigerated conditions (5±3 °C), at room temperature (25±2 °C), and at 40 °C (±2 °C). In accordance with the USP (United States Pharmacopeia), physicochemical controls of the active ingredient content were carried out by HPLC-UV (High Performance Liquid Chromatography with Ultraviolet detection), together with controls of pH, osmolality, and visual examination. Microbiological sterility was also tested under refrigerated conditions up to 30 days in open containers and up to 90 days in closed ones. RESULTS: The eye drops stored at 5 °C were the most stable; in the 1 mg/mL eye drops, degradation of the drug fell below 90% from day 21, and in the 10 mg/mL eye drops, from day 42. pH change did not vary by ≥1 unit in formulations stored at 5 °C, unlike the other formulations. Changes in osmolality did not exceed 5% on day 90 in any storage conditions. Samples of non refrigerate eye drops at 10 mg/mL, presented a white precipitate from day 14 and 28, respectively. Non-refrigerated 1 mg/mL eye drops presented suspended particles on day 90. There were no color changes. Microbiological analysis showed that sterility was maintained for over 90 days in the closed containers, although microbial contamination was detected from day 21 in the open containers. CONCLUSIONS: 1 mg/mL MTPSS eye drops show physicochemical and microbiological stability for 21 days under refrigeration, compared to 42 days for 10 mg/mL eye drops stored under the same conditions. However, since they do not include preservatives in their composition, they should not be used for more than 7 days after opening.

Physicochemical and microbiological stability study of two new preservative-free methylprednisolone eye drops. / Estudio de estabilidad fisicoquímica y microbiológica de dos nuevos colirios de metilprednisolona sin conservantes.

OBJECTIVE: To study the physicochemical and microbiological stability over 90 days of two preservative-free methylprednisolone sodium succinate (MTPSS) 1 mg/ml and 10 mg/ml eye drops for use in ocular pathologies such as Sjögren's syndrome and dry eye syndrome. METHOD: The two eye drops were prepared from injectable MTPSS (Solu-moderin® and Urbason®), water for injection and normal saline solution. In accordance with ICH (International Council for Harmonisation of Technical Requirements for Pharmaceuticals for Human Use) guidelines, they were then stored in triplicate under refrigerated conditions (5 ±3 °C), at room temperature (25 ± 2 °C), and at 40 °C (±2 °C). In accordance with the USP (United States Pharmacopeia), physicochemical controls of the active ingredient content were carried out by HPLC-UV (High Performance Liquid Chromatography with Ultraviolet detection), together with controls of pH, osmolality, and visual examination. Microbiological sterility was also tested under refrigerated conditions up to 30 days in open containers and up to 90 days in closed ones. RESULTS: The eye drops stored at 5 °C were the most stable; in the 1 mg/ml eye drops, degradation of the drug fell below 90% from day 21, and in the 10 mg/ml eye drops, from day 42. pH change did not vary by ≥1 unit in formulations stored at 5 °C, unlike the other formulations. Changes in osmolality did not exceed 5% on day 90 in any storage conditions. Samples of non refrigerate eye drops at 10 mg/ml, presented a white precipitate from day 14 and 28 respectively. Non-refrigerated 1 mg/ml eye drops presented suspended particles on day 90. There were no color changes. Microbiological analysis showed that sterility was maintained for over 90 days in the closed containers, although microbial contamination was detected from day 21 in the open containers. CONCLUSIONS: 1 mg/ml MTPSS eye drops show physicochemical and microbiological stability for 21 days under refrigeration, compared to 42 days for 10 mg/ml eye drops stored under the same conditions. However, since they do not include preservatives in their composition, they should not be used for more than 7 days after opening.

Development of a carbocysteine 10% + urea 5% cream for the topical treatment of congenital ichthyosis.

OBJECTIVE: Optimization of a topical formula of N-acetylcysteine and urea for  the topical treatment of ichthyosis. METHOD: We reviewed the chemical structure of the N-acetylcysteine molecule  and its metabolic processes. A search was conducted of possible alternative  molecules with a chemical structure similar to that of N-acetylcysteine that  could have improved organoleptic properties. The following databases were  used: PubChem®, Botplus®, the Drug Information Centre of the Spanish  Agency of Medicines and Medical Devices. The molecule selection criteria were  as follows: structural similarity, same therapeutic group, same mechanism of  action, same authorized indication, absence of unpleasant smell, and being  marketed as raw material in Spain. To complete the pharmaceutical  development and validation of the compound, several tests and controls were  conducted following the emulsion production procedure of the National  Formulary. In order to establish the validity period, we followed the  recommendations of the "Guide to Good Drug Preparation Practices in Hospital  Pharmacy Services". RESULTS: N-acetylcysteine has a free sulfhydryl group, which is responsible for  its smell, and undergoes deacetylation. Its main metabolites are cystine and  cysteamine. The following molecules were assessed: cystine, cysteamine,  carbocisteine, cysteine and methionine. Carbocisteine was selected because it met all the selection criteria. Carbocisteine is  ractically insoluble in water and soluble in mineral acids and alkaline hydroxides solutions. Unlike N-acetylcysteine, it does not have a fetid smell. It reaches its  maximum stability at pH 5.5 to 7.5. The composition of the compound (100 g)  was as follows: carbocisteine (10 g), urea (5 g), glycerine (15 g), water (44  mL), sodium hydroxide (1 g), and Neo PCL® Oil/Water (O/W) (25 g). It has an expiration period of 30 days. The organoleptic characteristics, emulsion type,  and pH remained stable within the established expiration period. The  arbocisteine compound has been incorporated into the group of topical  treatments available for the treatment of patients with ichthyosis in our  hospital. CONCLUSIONS: The carbocisteine molecule is a good therapeutic alternative that  lacks the unpleasant smell of N-acetylcysteine. The  arbocisteine compound developed has been included as topical treatment for  ichthyosis due to its tolerability, acceptability, and effectiveness in the  treatment of patients affected by this genodermatosis.

OBJETIVO: Optimización de una fórmula magistral tópica de N-acetilcisteína y urea para el tratamiento tópico de la ictiosis.Método: Se revisó la estructura química de la molécula de N-acetilcisteína y  sus procesos metabólicos. Se realizó una búsqueda de posibles moléculas  alternativas con una estructura química similar a la N-acetilcisteína que  pudiesen mejorar sus propiedades organolépticas. Bases de datos: PubChem®, Botplus®, Centro de Información de Medicamentos de la  Agencia Española de Medicamentos y Productos Sanitarios. Criterios de  selección de la molécula: similitud estructural, mismo grupo terapéutico,  mismo mecanismo de acción, misma indicación autorizada, ausencia de olor desagradable y estar comercializada como materia prima en España. Para el desarrollo galénico y validación de la fórmula se realizaron varios  ensayos y controles siguiendo el procedimiento de elaboración de emulsiones del Formulario Nacional. Para establecer el periodo de validez se  siguieron las recomendaciones de la "Guía de buenas prácticas de preparación  de medicamentos en los servicios de farmacia hospitalaria". RESULTADOS: La N-acetilcisteína presenta grupo sulfhidrilo libre, responsable del olor, sufre desacetilación y sus principales metabolitos son cistina y cisteamina. Las moléculas evaluadas fueron: cistina, cisteamina, carbocisteína, cisteína y metionina. Se seleccionó la carbocisteína  por  cumplir todos los criterios de selección. La carbocisteína es prácticamente insoluble en agua y soluble en disoluciones de ácidos minerales e hidróxidos  alcalinos. A diferencia de la N-acetilcisteína, carece de olor fétido.Presenta su  máxima estabilidad a pH 5,5-7,5. La composición de la fórmula magistral (100  g): carbocisteína (10 g), urea (5 g), glicerina (15 g), agua (44 ml), hidróxido  sódico (1 g) y Neo PCL® Oil/Water (O/W) (25 g). Periodo de caducidad: 30  días. Los caracteres organolépticos, signo de la emulsión y pH permanecieron  estables durante el periodo de caducidad establecido. La fórmula magistral de  carbocisteína elaborada se ha incorporado al arsenal de tratamientos tópicos  disponibles para los pacientes con ictiosis de nuestro centro. CONCLUSIONES: La molécula de carbocisteína resultó ser una buena alternativa  terapéutica que subsana el olor desagradable de la N-acetilcisteína. La fórmula  magistral de carbocisteína desarrollada fue incluida como tratamiento tópico de  la ictiosis gracias a su tolerabilidad, aceptabilidad y efectividad en el  tratamiento de pacientes afectos de esta genodermatosis.

Desarrollo de una crema de carbocisteína10% + urea 5% para el tratamiento tópico de las ictiosis congénitas / Development of a carbocysteine 10% + urea 5% cream for the topical treatment of congenital ichthyosis

Objetivo: Optimización de una fórmula magistral tópica de N-acetilcisteínay urea para el tratamiento tópico de la ictiosis.Método: Se revisó la estructura química de la molécula de N-acetilcisteínay sus procesos metabólicos. Se realizó una búsqueda de posiblesmoléculas alternativas con una estructura química similar a la N-acetilcisteínaque pudiesen mejorar sus propiedades organolépticas. Bases de datos:PubChem®, Botplus®, Centro de Información de Medicamentos de la Agencia Española de Medicamentos y Productos Sanitarios. Criterios de selecciónde la molécula: similitud estructural, mismo grupo terapéutico, mismomecanismo de acción, misma indicación autorizada, ausencia de olordesagradable y estar comercializada como materia prima en España. Parael desarrollo galénico y validación de la fórmula se realizaron varios ensayosy controles siguiendo el procedimiento de elaboración de emulsionesdel Formulario Nacional. Para establecer el periodo de validez se siguieronlas recomendaciones de la “Guía de buenas prácticas de preparación demedicamentos en los servicios de farmacia hospitalaria”.Resultados: La N-acetilcisteína presenta grupo sulfhidrilo libre, responsabledel olor, sufre desacetilación y sus principales metabolitos soncistina y cisteamina. Las moléculas evaluadas fueron: cistina, cisteamina,carbocisteína, cisteína y metionina. Se seleccionó la carbocisteína por cumplir todos los criterios de selección. La carbocisteína es prácticamenteinsoluble en agua y soluble en disoluciones de ácidos minerales e hidróxidosalcalinos. A diferencia de la N-acetilcisteína, carece de olor fétido.Presenta su máxima estabilidad a pH 5,5-7,5. La composición de la fórmulamagistral (100 g): carbocisteína (10 g), urea (5 g), glicerina (15 g),agua (44 ml), hidróxido sódico (1 g) y Neo PCL® Oil/Water (O/W)(25 g). Periodo de caducidad: 30 días.

Objective: Optimization of a topical formula of N-acetylcysteine andurea for the topical treatment of ichthyosis.Method: We reviewed the chemical structure of the N-acetylcysteinemolecule and its metabolic processes. A search was conducted of possiblealternative molecules with a chemical structure similar to that of N-acetylcysteinethat could have improved organoleptic properties. The followingdatabases were used: PubChem®, Botplus®, the Drug Information Centreof the Spanish Agency of Medicines and Medical Devices. The moleculeselection criteria were as follows: structural similarity, same therapeuticgroup, same mechanism of action, same authorized indication, absenceof unpleasant smell, and being marketed as raw material in Spain. To completethe pharmaceutical development and validation of the compound,several tests and controls were conducted following the emulsion productionprocedure of the National Formulary. In order to establish the validityperiod, we followed the recommendations of the “Guide to Good DrugPreparation Practices in Hospital Pharmacy Services”.Results: N-acetylcysteine has a free sulfhydryl group, which is responsiblefor its smell, and undergoes deacetylation. Its main metabolites arecystine and cysteamine. The following molecules were assessed: cystine,cysteamine,carbocisteine, cysteine and methionine. Carbocisteine practicallyinsoluble in water and soluble in mineral acids and alkaline hydroxidessolutions. Unlike N-acetylcysteine, it does not have a fetid smell. It reachesits maximum stability at pH 5.5 to 7.5. The composition of the compound(100 g) was as follows: carbocisteine (10 g), urea (5 g), glycerine (15 g),water (44 mL), sodium hydroxide (1 g), and Neo PCL® Oil/Water (O/W)(25 g). It has an expiration period of 30 days. The organoleptic characteristics,emulsion type, and pH remained stable within the established expirationperiod.

Determinación del pH como criterio de calidad en la elaboración de fórmulas magistrales orales líquidas / pH determination as a quality standard for the elaboration of oral liquid compounding formula

Objetivo: El pH es un factor crítico para todos aquellos medicamentos que se encuentran en formas líquidas acuosas, ya que puede ejercer un efecto sobre la solubilidad del principio activo condicionando la estabilidad de los medicamentos, la tolerancia biológica de la forma farmacéutica y la actividad del principio activo. El objetivo de este trabajo es establecer el rango óptimo de pH de las fórmulas orales líquidas más frecuentemente elaboradas en el Servicio de Farmacia para estandarizar e incorporar dicho valor en los protocolos normalizados de trabajo como criterio de control de calidad. Método: El estudio se desarrolló en tres fases. En una primera fase se realizó un estudio retrospectivo de los registros de elaboración de las fórmulas orales líquidas elaboradas, al menos 5 veces, desde enero de 2015 a diciembre de 2016 en nuestro Servicio de Farmacia, y se calculó el valor medio y la desviación estándar de los valores de pH registrados para cada fórmula. En una segunda fase se realizó una búsqueda bibliográfica para conocer el pH de máxima estabilidad del principio activo y comprobar si esta característica se registra como requisito de control de calidad en los procedimientos descritos en los formularios de referencia. En una tercera fase se comprobó si los pH determinados se correspondían con el de máxima estabilidad descrito en la literatura y se establecieron rangos de aceptación. Resultados: Se revisaron un total de 31 fórmulas (14 soluciones/17 suspensiones). Se conocía el valor del pH de máxima estabilidad de 19 (61,3%) de los principios activos y/o fórmulas orales líquidas evaluadas, de las cuales 15 (78,9%) se encontraban dentro del mismo y las 4 restantes (21,1%) presentaron una desviación estándar de ± 0,5 con respecto al valor de pH referenciado en la bibliografía. El rango de pH para un mismo procedimiento normalizado de trabajo oscilaba entre 0,32 y 1,51. Se estableció como control de calidad un rango de aceptación de pH de ± 0,75

Objective: pH is a critical factor for all those medications prepared as aqueous liquid forms, because it has an impact on the solubility of the molecule, determining the stability of medications, the biological tolerability of the formulation, and the activity of the molecule. The objective of this study is to determine the optimum pH range for the oral liquid formulations more frequently prepared at the Pharmacy Unit, in order to standardize and incorporate said value into the standard protocols of action as a quality control criterion. Method: The study was conducted in three stages. The first stage consisted in a retrospective study of the records of preparation of those oral liquid formulations prepared at least 5 times since January, 2015 to December, 2016, in our Pharmacy Unit; the main value and standard deviation of the pH values recorded for each formulation were calculated. In a second stage, there was a bibliographic search in order to understand the pH for the maximum stability of the molecule, and to confirm if this characteristic was recorded as a requirement for quality control in the procedures described in the formulation guidelines. In the third stage, it was confirmed if the pH values determined coincided with the maximum stability pH described in literature, and acceptance ranges were established. Results: In total, 31 formulations were reviewed (14 solutions / 17 suspensions). The maximum stability pH value was known for 19 (61.3%) of the molecules and/or oral liquid formulations evaluated; 15 (78.9%) of these were within this range, and the remaining 4 (21.1%) presented a standard deviation of ± 0.5 regarding the pH value referenced in the bibliography. The pH range for the same standard work procedure ranged between 0.32 and 1.51. An acceptance pH range of ± 0.75 was determined as quality control

pH determination as a quality standard for the elaboration of oral liquid compounding formula.

OBJECTIVE: pH is a critical factor for all those medications prepared as aqueous  liquid forms, because it has an impact on the solubility of the molecule, determining the stability of medications, the biological tolerability of  the formulation, and the activity of the molecule. The objective of this study is to determine the optimum pH range for the oral liquid formulations more frequently prepared at the Pharmacy Unit, in order to standardize and incorporate said  value into the standard protocols of action as a quality control criterion. METHOD: The study was conducted in three stages. The first stage consisted in a retrospective study of the records of preparation of those oral liquid formulations prepared at least 5 times since January, 2015 to December, 2016, in our  Pharmacy Unit; the main value and standard deviation of the pH values recorded for each formulation were calculated. In a second stage, there was a  bibliographic search in order to understand the pH for the maximum stability of  the molecule, and to confirm if this characteristic was recorded as a requirement for quality control in the procedures described in the formulation guidelines. In  the third stage, it was confirmed if the pH values determined coincided with the  maximum stability pH described in literature, and acceptance ranges were  established. RESULTS: In total, 31 formulations were reviewed (14 solutions / 17  suspensions). The maximum stability pH value was known for 19 (61.3%) of the molecules and/or oral liquid formulations evaluated; 15 (78.9%) of these were  within this range, and the remaining 4 (21.1%) presented a standard deviation  of ± 0.5 regarding the pH value referenced in the bibliography. The pH range for the same standard work procedure ranged between 0.32 and 1.51. An  acceptance pH range of ± 0.75 was determined as quality control. CONCLUSIONS: An optimal pH range has been determined for the 31 oral liquid  formulations more widely prescribed in our hospital. This characteristic should be part of the galenic validation for these preparations, as well as of its routine  quality control, in order to ensure their quality and efficacy.

Objetivo: El pH es un factor crítico para todos aquellos medicamentos que se  encuentran en formas líquidas acuosas, ya que puede ejercer un efecto sobre la  solubilidad del principio activo condicionando la estabilidad de los medicamentos, la tolerancia biológica de la forma farmacéutica y la actividad del principio  activo. El objetivo de este trabajo es establecer el rango óptimo de pH de las  fórmulas orales líquidas más frecuentemente elaboradas en el Servicio de  Farmacia para estandarizar e incorporar dicho valor en los protocolos  normalizados de trabajo como criterio de control de calidad.Método: El estudio se desarrolló en tres fases. En una primera fase se realizó  un estudio retrospectivo de los registros de elaboración de las fórmulas orales  líquidas elaboradas, al menos 5 veces, desde enero de 2015 a diciembre de  2016 en nuestro Servicio de Farmacia, y se calculó el valor medio y la desviación estándar de los valores de pH registrados para cada fórmula. En una segunda  fase se realizó una búsqueda bibliográfica para conocer el pH de máxima  estabilidad del principio activo y comprobar si esta característica se registra  como requisito de control de calidad en los procedimientos descritos en los  formularios de referencia. En una tercera fase se comprobó si los pH  determinados se correspondían con el de máxima estabilidad descrito en la  literatura y se establecieron rangos de aceptación.Resultados: Se revisaron un total de 31 fórmulas (14 soluciones/17  suspensiones). Se conocía el valor del pH de máxima estabilidad de 19 (61,3%) de los principios activos y/o fórmulas orales líquidas evaluadas, de las  cuales 15 (78,9%) se encontraban dentro del mismo y las 4 restantes 21,1%) presentaron una desviación estándar de ± 0,5 con respecto al valor de  pH referenciado en la bibliografía. El rango de pH para un mismo procedimiento normalizado de trabajo oscilaba entre 0,32 y 1,51. Se estableció  como control de calidad un rango de aceptación de pH de ± 0,75.Conclusiones: Se ha establecido un rango óptimo de pH para las 31 fórmulas  orales líquidas de mayor prescripción en nuestro hospital. Esta característica  debería formar parte de la validación galénica de estas preparaciones, así como  de su control de calidad rutinario, para asegurar la calidad y eficacia de las  mismas.

Low vitamin D status strongly associated with periodontitis in Puerto Rican adults.

BACKGROUND: Periodontitis and vitamin D deficiency are both highly prevalent in Puerto Rico. The aim of this pilot study was to evaluate the association between vitamin D levels and periodontal disease in Puerto Rican adults. METHODS: A sex-, age-, and BMI-matched case-control, cross-sectional study was conducted on 24 cases of moderate/severe periodontitis and 24 periodontally healthy controls aged 35 to 64 years. Each participant completed a socio-demographic questionnaire, underwent a full-mouth periodontal examination and provided blood sample to measure serum 25-hydroxyvitamin D (25 (OH) D) levels to assess vitamin D status. RESULTS: A total of 19 matched case-control pairs (28 females, 10 males) completed the study. Mean serum 25 (OH) D levels were significantly lower in cases (18.5 ± 4.6 ng/ml) than in controls (24.2 ± 7.1 ng/ml; p = 0.006). Lower odds of periodontal disease were observed per unit of 25 (OH) D level (OR 0.885; 95 % CI 0.785, 0.997; p < 0.05). CONCLUSIONS: Lower serum vitamin D levels are significantly associated with periodontitis in Puerto Rican adults.

Actinomicosis Periapical Radicular Reporte de un caso y revisiόn de la bibliografía

En una paciente femenina de 75 años de edad, se observó al estudio radiográfico, una imagen radiolúcida, ovoide, única, a nivel del eje axial del ápice del canino inferior izquierdo. Se realizó un estudio histopatológico en el cual se diagnosticó un quiste periapical y se observaron formaciones basófilas de Actinomyces.  Existe controversia en cuanto al porcentaje de casos reportados deActinomicosis Periapical, y aún mayor, en cuanto al aislamiento de Actinomyces  en infecciones dentoalveolares. A continuación se presenta un caso diagnosticado en el año 2003, en la Universidad Santa María (Caracas-Venezuela), además de una revisión bibliográfica de las posibles causas que han llevado a reportar en un porcentaje muy bajo la presencia de Actinomyces en lesiones dentofaciales.

In a radiographic study, an ovoid, unique radiolucid image, located at the apex of 3.5 was observed in a 75 years old female patient. A histophatological study of the lesion was performed and a periapical cyst and basophils formations of actinomyces were diagnosed. Currently, the number of reports of periapical actinomycosis and the isolation of actinomyces remains in controversy. This case was reported in the year 2003 at the “Universidad Santa María”, Caracas, Venezuela. In this paper, we analyzed the possible reasons of the lack of information related with periapical actinomycosis and the cause of such low reporting of the actinomyces presence in dentoalveolar lesions.