Insulina tópica en el tratamiento del defecto epitelial persistente posúlcera corneal grave / Topical insulin for treating persistent post-severe corneal ulcer epithelial defect

El tratamiento del defecto epitelial refractario es un reto y está sujeto al desarrollo de estudios preclínicos y clínicos con el objetivo de obtener tratamientos eficaces, entre los que emerge la insulina tópica. El objetivo del presente artículo fue describir la respuesta cicatrizal del epitelio corneal bajo tratamiento con colirio de insulina. Se presentan dos pacientes con diagnóstico de defecto epitelial persistente posúlcera corneal. Se indicó insulina tópica una gota cada 6 horas, con evolución hacia la epitelización corneal total a los 10 días de iniciado el tratamiento. Se sugiere el mecanismo por el cual la insulina promueve la cicatrización corneal al lograr la restauración de los nervios corneales y favorecer la migración de células epiteliales. En ambos casos el colirio de insulina logró la promover la cicatrización epitelial total de la córnea por lo que se es útil en el tratamiento de defecto epitelial persistente(AU)

The treatment of refractory epithelial defect is a challenge and depends upon the development of preclinical or clinical studies aimed at obtaining effective treatments, among which topical insulin emerges. The objective of this article was to describe the healing response of the corneal epithelium under treatment with insulin eye drops. The cases are presented of two patients with a diagnosis of persistent post-corneal ulcer epithelial defect. Topical insulin was prescribed at one drop every six hours, with evolution towards total corneal epithelialization ten days after the treatment started. The mechanism is suggested by which insulin promotes corneal healing, thus restoring corneal nerves and favoring epithelial cell migration. In both cases, the insulin eye drops were able to promote total epithelial healing of the cornea, making it useful in the treatment of persistent epithelial defect(AU)

Tratamiento de la eritrodisestesia palmoplantar con una fórmula magistral de urea 20% + triamcinolona acetónido 0, 2% + lidocaína 2% / Treatment of palmoplantar erythrodysesthesia with a compounding of urea 20% + triamcinolone acetonide 0.2% + lidocaine 2%

La eritrodisestesia palmoplantar es una reacción adversa cútanea secundaria al tratamiento quimioterápico y relativamente frecuente. Cursa con enrojecimiento, hinchazón, ardor y sensibilidad; en los casos más graves produce descamación de la piel, ampollas y dolor intenso afectando a la deambulación y calidad de vida de los pacientes.Se presenta el caso de una mujer a tratamiento con capecitabina que en el tercer ciclo de tratamiento presenta eritrodisestesia palmoplantar con empeoramiento en el octavo ciclo. El Servicio de Dermatología solicita al Servicio de Farmacia la elaboración de una crema de alantoína 6%. Desde el Servicio de Farmacia se propone la adición de un corticoide por sus propiedades inflamatorias y un anestésico para alivio del dolor. A los 7 días de inicio de tratamiento la paciente describe una leve mejoría, pero continúa con descamación en los pies; por lo que el Servicio de Farmacia propone cambio de alantoína por urea e incorporar un corticoide más potente. Se mantiene la lidocaína y se cambia la base de O/W a W/O para favorecer la penetración de los fármacos en la zona palmar y plantar.La composición final de la fórmula magistral es (100 g): urea 20 g, lidocaína 2 g, acetónido de triamcinolona 0,2 g, glicerina 3 g, alantoína 1 g, aceite de argán 5 g, vaselina filante 9 g, agua conservante 35 ml y base de absorción PR W/O 25 g.Tras 45 días de tratamiento con la fórmula propuesta, la paciente presenta muy buena evolución y mejoría desde el punto de vista sintomático. Además, ha mejorado notablemente la deambulación haciendo vida normal. (AU)

Palmoplantar erythrodysesthesia is a relatively frequent adverse cutaneous reaction secondary to chemotherapy treatment. It produces redness, swelling, burning and sensitivity. In the most severe cases it produces skin desquamation, blisters and intense pain affecting patients’ ambulation and quality of life.We present the case of a woman on a capecitabine treatment who during the third cycle of treatment presents palmoplantar erythrodysesthesia, worsening during the eighth cycle. The Dermatology Department requested the Pharmacy Department the elaboration of a 6% allantoin cream. The Pharmacy Department proposes the addition of a corticosteroid, due to its anti-inflammatory properties, and the addition of an anesthetic for pain relief. 7 days after having started the treatment, the patient describes a slight improvement, but she still presents feet desquamation. Therefore, the Pharmacy Department proposed changing allantoin for urea and introducing a stronger corticosteroid. Lidocaine is maintained and the base is changed from O/W to W/O to favor the penetration of the drugs in the palmar and plantar areas.The final composition of the compounding is (100 g): urea 20 g, lidocaine 2 g, triamcinolone acetonide 0.2 g, glycerin 3 g, allantoin 1 g, argan oil 5 g, stringy vaseline 9 g, preservative water 35 mL and PR W/O absorption base 25 g.Afer 45 days of treatment with the proposed compounding, the patient shows a very good evolution and improvement from the symptomatic point of view. Moreover, she has significantly improved the ambulation and can return to normal life. (AU)

Efectividad y seguridad de un jarabe de isoniazida 50 mg/mL para uso pediátrico / Effectiveness and safety of a 50 mg/mL isoniazid syrup for pediatric use

Introducción: La tuberculosis pediátrica ha sido una epidemia mundial oculta durante décadas con dificultades para su control, entre las que se encuentra el difícil cumplimiento terapéutico debido a la correcta administración del tratamiento en niños que no pueden deglutir presentaciones farmacéuticas sólidas. El tratamiento de la tuberculosis es una terapia combinada, por lo que en su diseño se tiene que tener en cuenta el volumen final a administrar de todas las formulaciones así como su palatabilidad para favorecer la adherencia terapéutica.Objetivo: Evaluación de la efectividad y seguridad de una fórmula magistral de isoniazida 50 mg/mL.Material y métodos: Estudio observacional retrospectivo de 5 años de duración, incluyendo a todos los pacientes que recibieron dicha fórmula.Se registraron las siguientes variables: edad, sexo, indicación, reacciones adversas y evolución. Bases de datos: Silicon® (soporte informático de dispensación) y IANUS® (historia clínica electrónica). La efectividad se valoró mediante criterios clínicos, radiológicos y/o analíticos. Para la detección de reacciones adversas se realizaron analíticas de sangre y se evaluó la aparición de síntomas asociados a la ingesta de sorbitol que contiene la fórmula.Resultados: Composición de la fórmula (100 mL): isoniazida 5 g, agua conservans 50 mL (contiene Nipagin® 0,08% y Nipasol® 0,02%) y sorbitol 70% 50 mL. El periodo de caducidad establecido fue de 30 días coincidiendo con el referenciado en la bibliografía. El pH de la fórmula orale líquida (FOL) elaborada fue de 6,45±0,05 que corresponde con el de máxima estabilidad del principio activo. (AU)

Introduction: Pediatric tuberculosis has been a global epidemic hidden for decades with difficulties in its control, among which is difficult compliance with treatment due to the correct administration of treatment in children who cannot swallow solid pharmaceutical presentations. The treatment of tuberculosis is a combined therapy, so its design must take into account the final volume to be administered of all the formulations as well as its palatability to promote therapeutic adherence.Objective: Evaluation of the effectiveness and safety of a magisterial formula of isoniazid 50 mg/mL.Material and methods: A 5-year retrospective observational study, including all patients who received this formula.The following variables were recorded: age, sex, indication, adverse reactions and evolution. Databases: Silicon® (dispensing computer support) and IANUS® (electronic medical record). The effectiveness was assessed using clinical, radiological and/or analytical criteria. To detect adverse reactions, blood tests were performed and the appearance of symptoms associated with the intake of sorbitol containing the formula was evaluated.Results: Composition of the formula (100 mL): isoniazid 5 g, preservative water 50 mL (contains Nipagin® 0.08% and Nipasol® 0.02%) and sorbitol 70% 50 mL.The established expiration period was 30 days, coinciding with that referenced in the bibliography. The pH of the elaborated liquid oral formula (LOF) was 6.45±0.05, which corresponds to the maximum stability of the active principle. (AU)

Extemporaneous benznidazole oral suspension prepared from commercially available tablets for treatment of Chagas disease in paediatric patients.

OBJECTIVE: To develop an extemporaneous 1% benznidazole (BNZ) suspension, with masked taste and adequate stability starting from available commercial tablets. The quality of compounding was evaluated through content uniformity measurement and physical and microbiological stability evaluation, under different storage conditions during 90 days. METHODS: Six batches of 1% BNZ suspension were prepared using safe excipients currently available in a galenic area of Hospital Pharmacy and then stored at 5 and 25 °C for 90 days. The BNZ content was determined by UV spectrophotometry. Physical stability was defined as the absence of colour, odour and/or flavour changes and the re-suspension of solid phase by a reasonable amount of simple 15-s shaking. The compliance with microbiological attributes of non-sterile pharmaceutical products was also evaluated. RESULTS: An oral liquid suspension, containing 1% of BNZ, was developed from commercially available BNZ tablets. The formulations stored for 90 days were easily re-dispersed after a simple 15-s shaking, ensuring the pouring of a liquid volume containing the desired dose of BNZ. All samples were within the acceptable range of BNZ concentration with minimal standard deviations. There were no detectable changes in colour, odour, viscosity, pH and microbial growth, complying with official quality requirements. The quality attributes were not affected by storage, room or refrigeration conditions or by the frequent opening or closing of the multidose containers. CONCLUSION: Paediatric oral liquid suspension containing 1.0% of BNZ was easily prepared starting from commercial tablets, being an interesting alternative for optimising the paediatric treatment of Chagas disease.