Maculopatía en ojo de buey por uso de cloroquina. Presentación de un caso / Maculopathy in bull's eye due to the use of chloroquine. Presentation of a case

RESUMEN Se reportó el caso de un paciente con maculopatía en ojo de buey, asociada al uso de cloroquina. El uso de cloroquina en patologías reumatológicas puede provocar daño retinal relacionado con la dosis y el tiempo de evolución del tratamiento. Puede provocar desde afectación visual leve hasta daño irreversible de la visión, lo que depende del tiempo en que se realice el diagnóstico. Se presentó una paciente de 72 años, con diagnóstico de artritis reumatoide desde hace 21 años y tratamiento con cloroquina desde hace 15. Acudió a consulta con disminución de la visión lenta y progresiva bilateral. En el examen oftalmológico de fondo de ojo se diagnosticó maculopatía en ojo de buey. Este diagnóstico se confirmó por estudios de autofluorescencia y por la tomografía de coherencia óptica (AU).

ABSTRACT A case is reported of a patient with maculopathy in bulls' eye associated to the use of chloroquine. The use of chloroquine associated with rheumatologic diseases can cause retinal damage related to the dose and the time of treatment evolution. It can cause from mild visual impairment to irreversible vision damage depending on the time the diagnosis is made. A 72-year-old female patient is presented with a diagnosis of rheumatoid arthritis for 21 years and treatment with chloroquine for 15 years. She assisted the consultation with a slow and progressive bilateral vision decrease; at the ophthalmological examination of the fundus a maculopathy in bull's eye was diagnosed, later confirmed by auto fluorescence and optical coherence tomography studies (AU).

Safety assessment of homeopathic medicines: The Adonis vernalis paradox and the 'analysis trap' of using different pharmacopeias.

Regulatory agencies have to ensure the end-user safety of botanically derived homeopathic medicines prepared with diluted starting materials derived even from toxic plants. In the case of plant-derived homeopathic products, assessment must consider the particular characteristics of an extract and its component molecules, even if diluted. The identification and quantification of these molecules have a crucial role in risk assessment, as it allows complete toxicological evaluation in a regulatory perspective. Different results can be achieved using different approaches and references supported by the same regulatory framework, as different methods of preparation used, assays and test analysis performed in compliance with different referent pharmacopoeias. All these facts can introduce a bias in the safety assessment and the paradoxical outcome for homeopathic Adonis vernalis underlines the need for caution. The case also demonstrates the relevance of considering the analytical method for assessment of all herbal medicinal products or herbal supplements, with the purpose of finding the total amount of toxicants as a good approach.

Evaluation of the toxicity of Adonis aestivalis in sheep.

To determine the toxicity of Adonis aestivalis (adonis) in sheep, adult Suffolk ewes were administered 1 per cent bodyweight adonis via surgically placed rumen cannulas in an acute, high-dose toxicity study, and 0.2 per cent bodyweight daily in a two-week, low-dose toxicity study. The ewes received cardiac examinations before dosing, 24 and 48 hours after dosing with 1 per cent bodyweight adonis, and after continuous low-dose administration. All the ewes administered adonis had transient sinus arrhythmias after receiving 1 per cent bodyweight adonis. Two of the three ewes had transient reduced fractional shortening after administration with 1 per cent bodyweight adonis; the same two ewes had reduced fractional shortening after the low-dose treatment regimen. No gross or microscopic lesions were seen when the ewes were examined postmortem at the end of the study.