Costo-efectividad de la ketanserina vs sulfadiazina de plata micronizada ehn el paciente con pie diabético / Cost-effectiveness of the ketanserin vs sulfadiazine on the patient with diabetic foot

Objetivo. Determinar el costo-efectividad de la ketanserina vs sulfadiazina en el paciente con pie diabético. Material y método. Estudio de costo efectividad en pacientes con pie diabético, se integraron dos grupos, los manejados con ketanserina (n=50) y los manejados con sulfadiazina (n=30), se incluyeron a todos los que acudieron al servicio. El costo contempló los insumos para la curación y el medicamento. La efectividad se midió con la reducción de la lesión medida en centímetros y el porcentaje de pacientes curados. Se realizó análisis incremental. Resultados. El costo del centímetro cuadrado de curación en ketanserina es de $22,43 US y en sulfadiazina $120,44 US. La proyección del costo a 5000 pacientes con una lesión de 10 centímetros es $1.121.651 US en ketanserina y $6.021.787 US en sulfadiazina de plata. Conclusión. En el manejo del pie diabético la relación costo-efectividad de la ketanserina es mejor que la sulfadiazina.

Objective. Determine the cost-efectiveness of the ketanserin vs. sulfadiazine on the patient with diabetic foot. Methodology. Study of the cost efectiveness on patients with diabetic foot, there were integrated two groups; the ones managed with ketanserin (n=50), and the ones managed with sulfadiazine (n=30), all that came to the service were included. Te cost contemplates the inputs for the cure and the medication. Te efectiveness was measured with the reduction of the injury measured in centimeters and the cured patient’s percent. Sensitivity and incremental analysis was performed. Results. Te cost of square centimeter of healing in ketanserin is $22.43 US and in the sulfadiazine $120.44 US. Te cost of 5000 patients whit an 10 centimeter injury is $1,121,651 US in ketanserin and $6,021,787 US in sulfadiazine. Conclusion. Te relation cost-efectiveness of the ketanserin is better than the sulfadiazine one in the management of the diabetic foot.

Uso tópico de ketanserina na cicatrização de feridas cutâneas induzidas em equinos / Topical use of kentaserin on healing of experimentally-induced skin wounds in horses

Estudou-se a eficácia do uso tópico de ketanserina como promotor da cicatrização de feridas cutâneas induzidas em equinos. As feridas foram produzidas em ambos os metâmeros na região da garupa de oito cavalos adultos, em formato quadrangular, medindo cinco centímetros de lado. Aleatoriamente um dos metâmeros foi escolhido como tratado, permanecendo o contralateral como controle. As lesões do grupocontrole foram lavadas somente com água e detergente neutro e no grupo tratado foi realizado o mesmo procedimento seguido de aplicação tópica de ketanserina. A evolução macroscópica e microscópica do processo cicatricial foi avaliada e a área de cada ferida determinada no decorrer do período experimental. Não foram verificadas diferenças significativas entre as feridas do grupo-controle e do grupo tratado com ketanserina durante 56 dias de avaliação.

The efficiency of topical use of kentaserin on healing evolution of induced skin wounds in horses was studied. The experimental surgical wounds were made in both sides of the croup of eight adult horses. The wounds were square-shaped measuring 5cm of each side. One side was considered control and the opposite one treated. Both control and treated animals were rinsed with water and neutral soap. Additionally, the wound on the treated horses received the topical treatment with ketanserin. Macroscopic and microscopic healing evolution of the wounds was evaluated and their areas were determined during the experimental period. The use of topical ketanserin showed no difference between the control and the treated wounds during a period of 56 days.

Estudio comparativo de la cicatrización en piel de conejo entre sucralfato y tartrato de ketanserin / Comparative study of wound healing in rabbit skin between sucralfate and ketanserin tartrate

Al sanar una herida se activa un proceso de reepitelización para generar una epidermis. Este proceso de cicatrización debe ocurrir rápido y efectivamente para prevenir los ataques provenientes del medio ambiente. Existe una gran variedad de cremas regeneradoras, dentro de las cuales se encuentran sucralfato (Cicalfate ®), de utilidad en medicina humana, y tartrato de ketanserin (Vulketan ®), utilizado como tratamiento convencional en medicina veterinaria. El objetivo general de este estudio fue comparar el grado de cicatrización y reacción inflamatorio entre sucralfato y tartrato de ketanserin en heridas quirúrgicas en piel del área superior de la pared torácica de conejos (Oryctologus cuniculis), los cuales se utilizaron como modelos animales para medir parámetros cicatriciales que son complicados de evaluar en forma rutinaria en estudios clínicos en el ser humano. Se emplearon 15 conejos machos. Sucralfato y tartrato de ketonserin fueron aplicados simultáneamente en 10 animales. Sucralfato se aplicó en el lado derecho y tartrato de ketanserin, en el lado izquierdo. Cinco conejos fueron tratados con suero fisiológico como grupo control. La evaluación se realizó mediante la Escala de Vancouver durante 19 días. Los resultados revelan que en el caso de ambas cremas regeneradoras no existe diferencia significativa en torno a los signos de vascularidad. Con respecto o los signos de plegabilidad, altura, pigmentación y dolor, sí existe diferencia significativa (P < 0,05) contribuyendo mejor sucralfato, por lo que se concluye que éste presento ventaja comparativa con respecto o tartrato de ketanserin al momento de realizar un tratamiento tópico para heridas en piel.

In healing o process of reepithelialization to generate epidermis start. This process must take place quickly and effectively to prevent attacks from the environment. There is a great variety of regenerative creams available such as sucralfate (Ciclalfate®) in human medicine and ketaserin tartrate (Vulketan®) used as a conventional treatment in veterinary medicine. The main objective of this study was to compare the healing degree and inflammatory reaction between sucralfate and ketanserin tartrate in surgical wounds on skin of the upper thoracic wall of rabbits (Oryctolagus cuniculis), which were used as animal models for measuring cicatricial parameters that are complicated to evaluate routinely in clinical trials in humans. Fifteen male rabbits were used Sucralfate and ketanserin tartrate were used simultaneously in 10 animals. Sucralfate was used on right side and ketanserin trartrate on the left side. Five rabbits were treated with physiological saline solution (control group). Wound evaluation were compared with the Scale of Vancouver during 19 days. The results showed that both regenerative creams had no significant differences in vascularity. In relation to pliability height, pigmentation and pain there was a significant difference (P < 0,05) between the two products in favor of sucralfate in the topical treatment of skin injuries.

Behavioral and neuropharmacological evidence that serotonin crosses the blood-brain barrier in Coturnix japonica (Galliformes; Aves)

This study was carried out aiming to reach behavioral and neuropharmacological evidence of the permeability of the blood-brain barrier (BBB) to serotonin systemically administered in quails. Serotonin injected by a parenteral route (250-1000 æg.kg-1, sc) elicited a sequence of behavioral events concerned with a sleeping-like state. Sleeping-like behaviors began with feather bristling, rapid oral movements, blinking and finally crouching and closure of the eyes. Previous administration of 5-HT2C antagonist, LY53857 (3 mg.kg-1, sc) reduced the episodes of feather bristling and rapid oral movements significantly but without altering the frequency of blinking and closure of the eyes. Treatment with the 5-HT2A/2C antagonist, ketanserin (3 mg.kg-1, sc) did not affect any of the responses evoked by the serotonin. Quipazine (5 mg.kg-1, sc) a 5-HT2A/2C/3 agonist induced intense hypomotility, long periods of yawning-like and sleeping-like states. Previous ketanserin suppressed gaping responses and reduced hypomotility, rapid oral movements and bristling but was ineffective for remaining responses induced by quipazine. Results showed that unlike mammals, serotonin permeates the BBB and activates hypnogenic mechanisms in quails. Studies using serotoninergic agonist and antagonists have disclosed that among the actions of the serotonin, feather bristling, rapid oral movements and yawning-like state originated from activation of 5-HT2 receptors while blinking and closure of the eyes possibly require other subtypes of receptors.

Este estudo foi desenvolvido objetivando ampliar as evidências comportamentais e neurofarmacológicas da permeabilidade da barreira hematoencefálica (BHE) à serotonina administrada sistemicamente em codornas. A serotonina injetada por via parenteral (250-1000 æg.kg-1, sc) produziu uma seqüência de eventos relacionados com um estado semelhante ao sono. Comportamentos semelhantes ao sono começaram com o eriçamento das penas, movimentos orais rápidos, piscadelas e finalmente agachamento e fechamento dos olhos. A administração prévia do antagonista do receptor 5-HT2C, LY53857 (3 mg.kg-1, sc) reduziu significativamente os episódios de eriçamento das penas e movimentos orais rápidos, mas não alterou a freqüência de piscadelas e fechamento dos olhos. Tratamento com o antagonista do receptor 5-HT2A/2C, quetanserina (3 mg.kg-1, sc) não afetou nenhuma das respostas evocadas pela serotonina. A quipazina (5 mg.kg-1, sc), um agonista dos receptores 5-HT2A/2C/3, induziu intensa hipomotilidade e longos períodos de comportamentos semelhantes ao bocejo e ao sono. O tratamento prévio com quetanserina suprimiu as reações de bocejo e reduziu a hipomotilidade, os movimentos orais rápidos e as piscadelas, mas foi sem efeito para as demais respostas induzidas pela quipazina. Os resultados mostraram que, diferentemente dos mamíferos, a serotonina atravessa a BHE e ativa mecanismos hipnogênicos em codornas. Estudos com agonistas serotoninérgicos e antagonistas revelaram que, entre as ações da serotonina, o eriçamento das penas, os movimentos orais rápidos e o comportamento semelhante ao bocejo foram originados pela ativação de receptores 5-HT2, enquanto o piscar e o fechamento dos olhos possivelmente requereu outros subtipos de receptores.

Maternal aggression in Wistar rats: effect of 5-HT2A/2C receptor agonist and antagonist microinjected into the dorsal periaqueductal gray matter and medial septum

The objective of the present study was to assess the role of the 5-HT2A/2C receptor at two specific brain sites, i.e., the dorsal periaqueductal gray matter (DPAG) and the medial septal (MS) area, in maternal aggressive behavior after the microinjection of either a 5-HT2A/2C receptor agonist or antagonist. Female Wistar rats were microinjected on the 7th postpartum day with the selective agonist alpha-methyl-5-hydroxytryptamine maleate (5-HT2A/2C) or the antagonist 5-HT2A/2C, ketanserin. The agonist was injected into the DPAG at 0.2 (N = 9), 0.5 (N = 10), and 1.0 æg/0.2 æl (N = 9), and the antagonist was injected at 1.0 æg/0.2 æl (N = 9). The agonist was injected into the medial septal area (MS) at 0.2 (N = 9), 0.5 (N = 7), and 1.0 æg/0.2 æl (N = 6) and the antagonist was injected at 1.0 æg/0.2 æl (N = 5). For the control, saline was injected into the DPAG (N = 7) and the MS (N = 12). Both areas are related to aggressive behavior and contain a high density of 5-HT receptors. Non-aggressive behaviors such as horizontal locomotion (walking) and social investigation and aggressive behaviors such as lateral threat (aggressive posture), attacks (frontal and lateral), and biting the intruder were analyzed when a male intruder was placed into the female resident's cage. For each brain area studied, the frequency of the behaviors was compared among the various treatments by analysis of variance. The results showed a decrease in maternal aggressive behavior (number of bites directed at the intruder) after microinjection of the agonist at 0.2 and 1.0 æg/0.2 æl (1.6 ± 0.7 and 0.9 ± 0.3) into the DPAG compared to the saline group (5.5 ± 1.1). There was no dose-response relationship with the agonist. The present findings suggest that the 5-HT2A/2C receptor agonist has an inhibitory effect on maternal aggressive behavior when microinjected into the DPAG and no effect when microinjected into the MS. Ketanserin (1.0 æg/0.2 æl) decreased locomotion when microinjected into the DPAG and MS, but did not affect aggressive behavior. We interpret these findings as evidence for a specific role of 5-HT2A/2C receptors in the DPAG in the inhibition of female aggressive behavior, dissociated from those on motor activity.

Laceración de la mucosa septal, tratamiento con ketanserina. Diseño experimental / Septal mucosal tears, treatment with ketanserine, an experimental study

Objetivo: Demostrar que la aplicación de ketanserina en ungüento al 2 por ciento acelera el cierre de las laceraciones de la mucosa septal producidas intencionalmente en consejos Nueva Zelanda al compararlas con un placebo con el mismo vehículo que la ketanserina (polietilenglicol). Se realizó un estudio longitudinal, prospectivo, experimental, comparativo y ciego, utilizando 10 conejos Nueva Zelanda divididos en dos grupos al azar, a los que se les realizó rinotomía lateral y bajo visión microscópica se laceró la mucosa septal incluyendo mucopericondrio. Posteriormente se aplicó ungüento con placebo (polietilenglico) o ketanserina al 2 por ciento durante cinco días, tomando fotografía antes y después de la aplicación y muestras histológicas al primero, tercero y quinto días las cuales se analizaron en el departamento de Anatomía Patológica con tinción de hematoxilina-eosina. Se concluye que la ketanserina en ungüento al 2 por ciento acelera el cierre clínica e histológicamente (mayor cantidad de colágena y fibroblastos) al compararlas contra placebo. El análisis estadístico se realizó con la prueba de Pickman Welch, obteniendo una p< 0.05

Randomized single-blind trial of topical ketanserin for healing acceleration of diabetic foot ulcers

The objective of this study was to determine the efficacy of topically applied ketanserin for healing acceleration of diabetic foot ulcers. From august 1993 to september 1994, 140 NIDDM patients entered a randomized single-blind trial of topical ketanserin (Sufrexal, Janssen Pharmaceuticals; n=69) vs. normal saline (labeled here as placebo; n=71). All patients were subjected to surgical debridement of necrotic tissue and lavage with normal saline. Wound were <100 cm² in area. Persons with NIDDM and foot ulcers Wagner 2 and 3 with a median of 8 (interquartile range 4 -26) weeks duration were included. Ulcer area was measured at 0, 4, 8 and 12 weeks. The groups were similar in age, sex, years of diabetes duration, obesity, ulcer Wagner type, number of previous amputations and surgical debridements during this hospital stay. Average percent reduction in ulcer area at 12 weeks was 87 percent for ketanserin vs. 63 percent for placebo (p<0.001). The regression equations for the leastsquares fit to the area (y) against time (x) data points were y = 43.46-3.181x(r=0.995) for ketanserin and y= 39.46-2.016x(r=-0.999) for placebo (p<0.01). The 95 percent confidence limits for slopes were -3.181 ñ 0.98 and -2.016ñ0.15. Thus, average daily reduction in ulcer area was 4.5 mm²/day for ketanserin vs. 2.88 mm²/day for placebo. In clnclusion, topical ketanserin significantly accelerated wound healing in diaetic neurothrophic foot ulcers when applied as part of a comprehensive healing program

Ketanserina en el tratamiento de heridas provocadas quirúrgicamente / Ketanserine in the treatment of surgery wounds

Se trataron un total de 20 pacientes portadores de heridas provocadas quirúrgicamente con katanserina tópica al 2 por ciento: 5 pacientes por biopsia en sacabocado, 10 por biopsia por rasurado. Uno de los siguientes: cirugía de laser de CO2 por excisión, por cirugía de Mohs, extracción de uña y dermoabrasión. Se obtuvo control iconográfico y se evaluaron el tamaño, profundidad, presencia y ausencia de infecciones locales. Los resultados encontrados fueron: 10 pacientes con éxito terapeútico, 6 con buenos resultados, 1 con ausencia de mejoría. 1 con deterioro, 2 excluidos. Concluimos que la ketanserina tópica al 2 por ciento es eficaz en el tratamiento de las heridas provocadas qurúrgicamente, ya que acorta el tiempo de la cicatrización y disminuye la morbilidad

Behavioral effects of intra-amygdala injections of GABA and 5-HT acting drugs in the elevated plus-maze

The effect of drugs bilaterally injected into the basolateral/medial nuclei of the amygdala on the behavior of male Wistar rats (300-330 g) in the elevated plus-maze was measured. The benzodiazepine agonist midazolam (MDZ, 20 and 40 nmol, 0.2 µl; N = 8-14) significantly increased open-arm exploration (percent open-arm entries; control = 20.27 + or - 3.71; 40 nmol MDZ = 42.63 + or - 7.16), having thus an anxiolytic effect. On the contrary, the non-selective 5-HT2 antagonist ketanserin (KET, 1 and 10 nmol, 0.2 µl; N = 8-11) had an anxiogenic effect (percent open-arm entries: control = 35.61 + or - 6.41; 10 nmol KET = 18.65 + or - 3.89). The 5-HT1A full agonist 8-OH-DPAT (2, 4 and 8 nmol, 0.2 µl; N = 9.12) did not significantly achange rat behavior in the plus-maze. While the present anxiolytic effect of midazolam agrees with results reported by others using punished behavior, the effect of the serotonergic drugs does not. Therefore, the effect of 5-HT acting drugs injected into the amygdala may be determined by the type of experimental model of anxiety used

Mano diabética: evaluación clínica y alternativas de tratamiento / Diabetic hand, clinical evaluation and treatment alternatives

Durante años se ha manejado el concepto de "pie diabético" para agrupar las complicaciones vasculares que se presentan en las extremidades inferiores, en esta publicación, hacemos énfasis en dichas complicaciones pero a nivel de extremidades superiores, que aunque en frecuencia son mucho menores, no dejan de tener importancia en la repercusión hemodinámica del paciente. Se revisaron las publicaciones nacionales e internacionales sobre este tipo de complicaciones y no encontramos una con un número tan extenso de pacientes por lo cual lo consideramos de relevante importancia. Se presentan los casos clínicos de pacientes diabéticos con lesiones cruentas, de diversas etiologías en extremidades superiores acompañadas de un fondo isquémico, secundarias a macro y microangiopatía diabética. Los 18 casos correspondieron a pacientes institucionales derechohabientes del IMSS y de consulta privada. Dos casos correspondieron a lesiones por quemaduras eléctricas, tres a quemaduras por químicos álcalis o ácidos, un caso secundario o mordedura de gato. Los demás pacientes presentaron un trauma mínimo acompañado de infección y/o necrosis. Se revisan los tratamientos tópicos actuales para valorar la utilidad de las mismas empleando los que consideramos de actualidad, aprobados por los servicios de Angiología, se agruparon a los pacientes en tres grupos empleando para ello, los dextranómeros, el apósito hidrocoloide oclusivo y la ketaserina en gel. Esta última fue útil por su fácil manejo, costo reducido y disminución del tiempo de curación de los pacientes en sus áreas cruentas empleando para ello un lapso de cinco semanas para su curación completa. En relación a las otras sustancias tópicas fue más eficaz y no se presentaron complicaciones adversas en su manejo. Muchas úlceras vasculares son resultado de trastornos circulatorios tanto venosos como arteriales. El éxito de un tratamiento depende del diagnóstico correcto y de la atención específica a los problemas de predisposición, así como del eficaz cuidado de la zona afectada

Influence of atropine and ketanserin on canine jejunal secretory and contractile effects of serotonin

A serotonina é um importante mediador da secreçao hidroeletrolítica e da motilidade intestinais. Diversas substâncias têm sido estudadas no sentido de controlar os efeitos hipersecretórios e motores, com conseqüênte diarréia severa, induzidos pela hiperserotoninemia. Este trabalho investiga a influência da atropina e da quetaserina sobre a secreçao hidroeletrolítia e a motilidade jejunais induzidas pela serotonina, en alças de Thiry-Vella de cao. Ambas as substâncias reduziram a secreçao de água, sódio, potássio e cloreto, bem como diminuíram a atividade motora de segmento jejunal isolado. Esses resultados sugerem uma possível açao benéfica da atropina e da quetanserina no tratamento de efeitos prejudiciais da serotonina sobre o intestino, como por exemplo a diarréia

Nuevo enfoque al tratamiento de la hipertensión arterial sistémica con un antagonista selectivo de la serotonina / A new approach in the treatment of systemic hypertension with a selective serotonin antagonist

Se efectuó un estudio prospectivo, comparativo, doble ciego, para evaluar el efecto de la ketanserina por vía oral 40 mg cada 12 h, con la hidroclorotiazida también por vía oral, 25 mg cada 12 h. Se trataron 46 pacientes ambulatorios con hipertensión arterial primaria, 20 hombres y 26 mujeres, con edad promedio de 44 años, el lapso total del estudio fue de cuatro meses, durante el primero se administró placebo y durante los otros el fármaco activo. La presión diastólica en decúbito descendió con kentanserina de 108.3 a 98.5 mmHg y con hidroclorotiazida de 107.4 a 98.1 con p<0.01 en ambos. La mediana del peso corporal, ascendió en el grupo con ketanserina 1.4 Kg y descendió en el otro grupo 0.5 Kg. Los efectos adversos fueron poco importantes, se presentaron en 24% del grupo de ketanserina y en 20% del grupo de hidroclorotiazida. No hubo anormalidades en los exámenes de laboratorio ni de gabinete, no hubo efecto de rebote al suspender el tratamiento