Efecto antimicrobiano como medicación intraconducto de la pasta triantibiótica / Antimicrobial effect as intracanal mediation of tri-antibiotic paste

Un tratamiento endodóncico se basa en la preparación química mecánica del sistema de conductos radiculares, pero este procedimiento no es suficiente para eliminar todas las bacterias alojadas en los conductos, entre las más encontradas están las que se asocian a infecciones primarias como gramnegativas y anaerobias, además de las asociadas a infecciones secundarias como Enterococcus faecalis que es un coco grampositivo facultativo. Por esta razón se han estudiado los medicamentos más efectivos contra patógenos, como el metronidazol, ciprofloxacina y minociclina, la combinación adquiere el nombre de pasta triple antibiótica. La investigación se realizó con el objetivo de analizar la bibliografía referida al efecto antimicrobiano de la pasta mediante triantibiótica como medicación intraconducto, la cual tiene como función eliminar de manera efectiva los microorganismos localizados en los conductos radiculares y sus zonas periféricas, buscando mantenerlos asépticos la aplicación de la pasta (AU)

An endodontic treatment is based on the mechanical chemical preparation of the root canal system, but this procedure is not sufficient to eliminate all the bacteria lodged in the canals, among the most encountered are: those associated with primary infections such as Gram negative and anaerobic, in addition to those associated with secondary infections such as Enterococcus faecalis which is a Gram positive coccus facultative. For this reason, the most effective drugs against pathogens have been studied, such as metronidazole, ciprofloxacin and minocycline, the combination is called triple antibiotic paste. The research was carried out with the objective of analyzing the bibliography referred to the antimicrobial effect of the tri-antibiotic paste as an intra-canal medication, which has the function of effectively eliminating the microorganisms located in the root canals and their peripheral areas, seeking to keep them aseptic during the application of the paste (AU)

Papilomatosis confluente y reticulada de Gougerot-Carteaud / Confluent and reticulated papillomatosis of Gougerot-Carteaud

La papilomatosis confluente y reticulada es una dermatosis infrecuente, benigna, de curso crónico y etiopatogenia desconocida. Actualmente, se acepta que se debe a un trastorno de la queratinización. Se caracteriza por máculas y pápulas hiperpigmentadas, que coalescen en el centro y adoptan un patrón reticular en la periferia. Se la puede confundir con otras patologías, como la pitiriasis versicolor y la acantosis nigricans. Con la administración de minociclina por vía oral suelen obtenerse excelentes resultados. Se comunica el caso de un paciente con diagnóstico de papilomatosis confluente y reticulada. Se describen sus características clínicas, criterios diagnósticos y trata-miento instaurado.

Confluent and reticulated papillomatosis is an infrequent, benign dermatosis of chronic course and unknown etiopathogenesis. Currently it is accepted that this dermatosis is due to a keratinization disorder. It is characterized by hyperpigmented macules and papules that coalesce in the center and adopt a reticular pattern in the periphery. It can be confused with other pathologies such as pityriasis versicolor and acanthosis nigricans. Oral minocycline usually shows excellent results. The present work reports a case of a patient with a diagnosis of confluent and retic-ulated papillomatosis, describing its clinical characteristics, diagnostic criteria and established treatment.

Hipomelanosis macular progresiva: respuesta al tratamiento con minociclina / Progressive macular hypomelanosis: response to treatment with minocycline

La hipomelanosis macular progresiva (HMP) es una dermatosis caracterizada por máculas hipopigmentadas, que se observa con mayor frecuencia en las mujeres y en los fototipos III y IV. Se ha asociado a Cutibacterium acnes (C. acnes) de tipo III como factor etiológico. Se presenta el caso de una paciente de 30 años, con máculas hipopigmentadas redondeadas en el tronco y la raíz de los miembros inferiores, de 10 años de evolución. El estudio histológico informó disminución del número de melanocitos y de pigmento melánico en la capa basal e infiltrado inflamatorio mononuclear perivascular superficial. Se indicó minociclina 100 mg/día por vía oral durante 8 meses, tras lo cual se observó la resolución total de las lesiones.

Progressive macular hypomelanosis (PMH) is a dermatosis characterized by hypopigmented macules, most frequently found in females and in phototypes III and IV. Cutibacterium acnes (C. acnes) type III has been associated as an etiological factor. We present the case of a thirty-year-old female patient with a 10-year history of nummular hypopigmented macules located on the top of the lower limbs and on the trunk. The histological study reported a decrease in the number of melanocytes and melanotic pigment in the basal layer and the presence of superficial perivascular mononuclear inflammatory infiltrate. After an 8-month regimen of oral minocycline 100 mg/day, there was a complete resolution of the lesions.

Estudo in vitro da ação antimicrobiana de medicações intracanal experimentais sobre biofilmes de Enterococcus faecalis / In vitro study of the antimicrobial action of experimental intracanal medications on Enterococcus faecalis biofilm

Introdução: A eliminação do Enterococcus faecalis dos canais radiculares é fundamental para o sucesso do tratamento endodôntico, uma vez que esses microrganismos são de difícil eliminação, principalmente quando organizados em forma de biofilmes. A busca por drogas ou suas combinações que possam eliminar esses microrganismos é um dos principais objetivos terapêuticos. Objetivo: O presente estudo avaliou a ação antimicrobiana de medicações intracanal experimentais sobre biofilmes de Enterococcus faecalis. Métodos: Quarenta dentes bovinos unirradiculares foram utilizados; suas coroas foram seccionadas e as raízes foram instrumentadas e esterilizadas. As raízes foram contaminadas com suspensão contendo Enterococcus faecalis, mantidas em estufa a 37°C por 30 dias e divididas em quatro grupos, de acordo com a medicação intracanal: GI) medicação experimental 1 (clorexidina [CHX] 0,2%/metronidazol, doxiciclina); GII) medicação experimental 2 (CHX 0,2%/metronidazol, minociclina); GIII) clorexidina a 2% (CHX 2%); e GIV) solução salina. As raízes foram seladas e mantidas em estufa por 7 dias, em tubos contendo TSB. Dentina foi coletada e semeada por 24 h, para formação de UFCs. Os valores obtidos foram comparados pelos testes ANOVA e Tukey (p<0,05). Quando comparados os resultados, não houve diferenças entre os Grupos I, II e III; no entanto, eles foram significativamente diferentes do Grupo IV. Conclusão: As medicações intracanal experimentais exerceram ação antimicrobiana sobre biofilmes de Enterococcus faecalis (AU).

Background: The elimination of Enterococcus faecalis of the root canals is fundamental for endodontic success, since these microorganisms are difficult to killed, especially when organized in biofilms. The search for drugs or their combinations that can eliminate these microorganisms is one of the main therapeutic aim. This study evaluated the antimicrobial action of experimental intracanal medications on Enterococcus faecalis biofilms. Methods: Forty uniradicular bovine teeth were used; their crowns were removed, and the roots were instrumented and sterilized. The roots were contaminated with suspension containing Enterococcus faecalis and kept in an oven at 37°C for 30 days. The roots were divided into 4 groups according to the intracanal medication: I- experimental medication 1 (0.2% CHX/metronidazole/ doxycycline); II- experimental medication 2 (0.2% CHX/ metronidazole/minocycline), III- 2% chlorhexidine (2% CHX), and IV- saline solution. The roots were sealed and kept in tubes containing TSB in an oven for 7 days. Dentin was collected and seeded for 24 h for perform of CFUs. The values obtained were compared using ANOVA and Tukeys tests (p<0.05). When comparing the results, there were no differences among groups I, II and III; however, they were significantly different from group IV. Conclusion: The experimental intracanal medications exerted an antimicrobial action on Enterococcus faecalis biofilms (AU).

Estudo comparativo do uso da minociclina sistêmica versus corticoterapia sistêmica no tratamento de vitiligo em atividade / Comparative study on the use of systemic minocycline versus systemic corticosteroid therapy in the treatment of active vitiligo

Introdução: Vitiligo é uma doença cutânea adquirida crônica, que evolui com despigmentação. O controle da atividade da doença é um desafio terapêutico. Os corticosteroides sistêmicos, em uso diário ou sob a forma de pulsos, constituem o tratamento mais utilizado para a doença. Objetivo: Avaliar o efeito da minociclina no controle sobre a atividade do vitiligo em comparação ao corticosteroide. Métodos: Ensaio clínico randomizado com 16 pacientes com vitiligo vulgar em atividade, distribuídos em dois grupos: Grupo MINO - minociclina 100mg/dia, via oral, por três meses; e Grupo CORT - prednisolona 0,3mg/kg/dia, via oral, por dois meses e 0,15mg/ kg/dia no terceiro mês. Os pacientes foram avaliados antes e depois do tratamento por: registros fotográficos e avaliação das pontuações obtidas pelo escore VIDA (escore de atividade da doença vitiligo). Resultados: De acordo com os registros fotográficos, houve controle da atividade do vitiligo em 100% dos pacientes do Grupo MINO em comparação a 60% do Grupo CORT. Na comparação para o escore VIDA, notou-se diferença estatisticamente significante para ambos os grupos; porém, constatou-se que a redução foi maior no Grupo MINO, evidenciando maior efetividade da minociclina no controle da atividade do vitiligo. Conclusões: Este estudo demonstrou a eficácia da minociclina no controle do vitiligo em atividade em comparação a um esquema de corticoterapia sistêmica. Estudos adicionais devem ser realizados para confirmar sua eficácia.

Introduction: Vitiligo is a chronic acquired skin disease, which evolves with depigmentation. The control of disease activity is a therapeutic challenge. Systemic corticosteroids, in daily use or in pulse doses, are the most used treatment for the disease. Objective: To evaluate the effect of minocycline on the control over vitiligo activity compared with the corticosteroid therapy. Methods: Randomized clinical trial with 16 active vitiligo vulgaris patients, divided into two groups: MINO group: minocycline 100mg/day, orally, for three months; and CORT group: prednisolone 0.3mg/kg/day, orally, for two months, and 0.15 mg/kg/day in the third month. The patients were evaluated before and after the treatment by photographic records and evaluation of the scores obtained by the VIDA score (vitiligo disease activity score). Results: According to the photographic records, there was control of vitiligo activity in 100% of patients in the MINO group compared with 60% in the CORT group. In the comparison using the VIDA score, we noticed a statistically significant difference for both groups; however, we found that the reduction was greater in the MINO group, evidencing more effectiveness of minocycline in controlling the vitiligo activity. Conclusion: This study demonstrated the efficacy of minocycline in the control of active vitiligo compared with a systemic corticosteroid regimen. Additional studies should be performed to confirm its efficacy.

Lupus miliaris disseminatus faciei

Abstract: Lupus miliaris disseminatus faciei is a rare inflammatory dermatosis of unknown etiology that primarily affects young adults. Clinically, it is characterized by an asymptomatic papular eruption mainly involving the central face, typically on and around the eyelids. Characteristic histopathological features include dermal epithelioid cell granulomas with central necrosis and surrounding lymphocytic infiltrate with multinucleate giant cells. Lupus miliaris disseminatus faciei has a spontaneously resolving course, yet can be cosmetically debilitating given the location and potential for scarring. Treatment is difficult and there is a lack of controlled studies. We report a new case of lupus miliaris disseminatus faciei successfully treated with minocycline and systemic steroids, and briefly discuss its nosology and therapeutic options.

Enfermedad de Mucha-Habermann febril ulceronecrótica con respuesta favorable a minociclina, a propósito de un caso / Febrile ulceronecrotic Mucha-Habermann disease: report of one case

Pityriasis lichenoides et varioliformis acuta (PLEVA), pityriasis lichenoides chronica (PLC) and febrile ulceronecrotic Mucha-Habermann disease (FUMHD) are considered different manifestations of the same disease. Febrile ulceronecrotic Mucha-Habermann disease is a rare, and potentially lethal illness which is characterized by fast progression of numerous papules that converge, ulcerate and form a plaque with a necrotic center, together with hemorrhagic vesicles and pustules that are associated with high fever and variable systemic symptoms. We report a 16 years old male presenting with erythematous papules with crusts and fever. The diagnosis of febrile ulceronecrotic Mucha-Habermann disease was confirmed with the pathological study of the lesions. He was successfully treated with minocycline after a failed attempt of treatment with prednisone.

Pseudotumor cerebral secundario al consumo de minociclina en un paciente pediátrico / Pseudotumor cerebri secondary to consumption of minocycline in a pediatric patient

El pseudotumor cerebral se caracteriza por una elevación de la presión intracraneal mayor de 20 cmH2O, con ventrículos y líquido cefalorraquídeo de características normales. El consumo de minociclina es una de las causas asociadas a este síndrome. Presentamos una paciente de 13 años de edad con antecedentes de acné tratado con minociclina. Comenzó con cefalea intensa, diplopía y visión borrosa. Se constató el diagnóstico de pseudotumor cerebral y se indicó la suspensión inmediata del antibiótico y el inicio del tratamiento con acetazolamida. Aunque la patogénesis de pseudotumor cerebral no es totalmente conocida, se ha observado una asociación con el empleo de minociclina. Este antibiótico es de uso frecuente para el manejo del acné, por lo que es importante considerar sus complicaciones antes de ser prescrito.

Pseudotumor cerebri is a syndrome characterized by an elevated intracranial pressure greater than 20 cmH2O with ventricles and cerebrospinal fluid of normal characteristics. Consumption of minocycline have been described among the causes associated with this syndrome. We present a 13-year old female patient with a history of acne treated with minocycline who began with severe headache, diplopia and blurred vision. The diagnosis of pseudotumor cerebri was made, indicating the immediate antibiotic suspension and the beginning of the treatment with acetazolamide. Although the pathogenesis of pseudotumor cerebri is not fully known, an association with minocycline has been observed. This antibiotic is often used by health professionals for the management of acne, so it is important to consider its complications before being prescribed.

Characteristics of hospitalized children infected with macrolide-resistant Mycoplasma pneumoniae

BACKGROUND: The aim of this study was to clarify retrospectively the characteristics of children hospitalized for respiratory tract infection caused by macrolide-resistant Mycoplasma pneumoniae (M. pneumoniae). METHODS: Children who were hospitalized for respiratory tract infection due to M. pneumoniae were enrolled in this study. The diagnosis of M. pneumoniae infection was made on the grounds of polymerase chain reaction results. RESULTS: Thirty-three children were hospitalized due to lower respiratory tract infection with M. pneumoniae. Of the 33 children, 31 (median age five years) were identified as being infected with macrolide-resistant M. pneumoniae (A2063G:30, A2064G:1) by sequence analysis. Of the 31 children infected with macrolide-resistant M. pneumoniae, 21 (68%) had received 14- or 15-membered macrolide antibiotics and four (13%) had received minocycline before hospitalization. During hospitalization, minocycline was administered to 16 (52%) of the 31 children infected with macrolide-resistant M. pneumoniae. Of the 20 children infected with macrolide-resistant M. pneumoniae under eight years of age, six (30%) were treated with minocycline during hospitalization. The difference in total febrile days between children receiving minocycline treatment before hospitalization and children not receiving minocycline treatment was three days. CONCLUSIONS: The majority of hospitalized children with respiratory tract infection due to macrolide-resistant M. pneumoniae infection was of preschool age and had received 14- or 15-membered macrolide antibiotics before hospitalization. Because macrolide-resistant M. pneumoniae is widespread in Japan, the administration of minocycline as a second-line antibiotic in children under eight years of age cannot be withheld when clinical symptoms do not improve with macrolide antibiotics. .

Protección frente a la tinción dentaria en dientes tratados con tetraciclinas al aplicar un antioxidante (ácido ascórbico) / Protection from the tooth stain on teeth treated with tetracycline applying an antioxidant (ascorbic acid)

En la presente investigación pretendemos optimizar los resultados, evitando la coloración coronal, en procedimientos odontológicos donde sea imprescindible el uso de tetraciclinas así como evaluar la disminución de las coloraciones coronales, al aplicar un antioxidante (Acido Ascórbico) en dientes tratados con tetraciclinas (Minociclina y Doxiciclina). Estudio experimental de investigación básica, de tipo ensayo clínico. En los dientes tratados con minociclina y doxiciclina observamos cambios en la coloración dentaria apreciables tanto en corona como en la raíz, mientras que en los grupos dentarios donde se añadió el antioxidante (ácido ascórbico) a la tetraciclina no se obtuvo esa tinción. La adición de ácido ascórbico a minociclina y doxiciclina provoca que la tinción dentaria no se produzca o que se vea significativamente reducid a.

In this research we want to optimize the results, avoiding the coronal coloring, in dental procedures in where the use of tetracyclines is essential as well as evaluating the reduction of coronal discoloration, by applying an antioxidant (ascorbic acid) in the teeth treated with tetracyclines (minocycline and doxycycline). Experimental study of basic research, clinical trial type. Results: In the teeth treated with minocycline and doxycycline we observed changes in the coloration of the teeth both in crown and in the root, while in the tooth groups in which the antioxidant was added to tetracycline we observed that no staining was obtained. The addition of Ascorbic acid to minoclynine and doxyclycline causes that dental stain will not occur or be significant reduced.

Minocycline, but not ascorbic acid, increases motor activity and extends the life span of Drosophila melanogaster / La minociclina, pero no el ácido ascórbico, incrementa la actividad motora y extiende el período de vida de Drosophila melanogaster

In the present study we compared the effects of minocycline and ascorbic acid in the life span, motor activity and lipid peroxidation of Drosophila melanogaster, in an effort to find a substance capable of providing protection against oxidative stress in aging. In the flies treated with minocycline a very significant increase in the life span (101 ± 1.33 days) was observed when compared to those treated with ascorbic acid and controls (42.3% and 38.4%, respectively). The motor activity of minocycline treated flies also increased significantly with respect to control and ascorbic acid fed flies, from the 3rd to the 9th week of treatment. With regard to lipid peroxidation, it was found that the levels of malondialdehyde (MDA) in flies treated with minocycline showed no statistical differences to the control on the first day of treatment, but a significantly lower content on the day of 50% survival. In contrast, in flies treated with ascorbic acid significantly elevated levels of MDA compared to control and minocycline treated flies were detected throughout. These results suggest a protective effect of minocycline against oxidative stress and aging in D. melanogaster. An inhibitory effect on reactive oxygen species production may be an important contributing factor.

En el presente estudio se compararon los efectos del ácido ascórbico y la minociclina en la duración del periodo de vida, la actividad motora y la peroxidación lipídica de Drosophila melanogaster en un esfuerzo por encontrar una sustancia capaz de proporcionar protección contra el estrés oxidativo en el envejecimiento. En las moscas tratadas con minociclina se observó un aumento significativo en la duración de la vida (101 ± 1,33 días) en comparación con los tratados con ácido ascórbico y los controles (42,3% y 38,4%, respectivamente). La actividad motora de las moscas tratadas con minociclina aumentó significativamente cuando se comparó con las tratadas con ácido ascórbico y el control, desde la 3ra hasta la 9na semana de tratamiento. Con respecto a la peroxidación lipídica, se encontró que los niveles de malondialdehído (MDA) en moscas tratadas con minociclina no mostraron diferencias estadísticas con relación al control en el primer día de tratamiento; sin embargo, se detecto una disminución significativa de la concentración de MDA cuando se alcanzó el 50% de sobrevida. En contraste, en moscas tratadas con ácido ascórbico observamos que los niveles de MDA estaban significativamente elevados, cuando se compararon con las moscas tratadas con minociclina y el control a lo largo de todo el tratamiento. Estos resultados sugieren un efecto protector de la minociclina frente al estrés oxidativo y el envejecimiento en D. melanogaster, aunque un efecto inhibidor sobre la producción de especies reactivas del oxígeno puede ser un factor contribuyente importante.

Síndrome DRESS inducido por minociclina con desarrollo de nefritis intersticial aguda / DRESS syndrome induced by minocycline with development of acute interstitial nephritis

El síndrome DRESS (reacción a medicamentos con eosinofilia y síntomas sistémicos) es una rara y severa reacción de hipersensibilidad, caracterizado por anormalidades hematológicas y compromiso multiorgánico. Se reporta el caso de una mujer de 35 años con síndrome DRESS inducido por minociclina, la paciente desarrolló falla renal, nefritis intersticial severa, requiriendo manejo de soporte con hemodiálisis. La función renal se normalizó después de ocho semanas de tratamiento con corticoesteroides. (Acta Med Colomb 2012; 37: 89-92).

DRESS syndrome (drug reaction with eosinophilia and systemic symptoms) is a rare and severe hypersensitivity reaction characterized by multiorgan involvement and hematological abnormalities. We present the case of a 35 year old woman with minocycline-induced DRESS syndrome. The patient developed severe interstitial nephritis with renal failure, requiring hemodialysis support management. Renal function returned to normal after eight weeks of treatment with corticosteroids. (Acta Med Colomb 2012; 37: 89-92).

Estudo duplo-cego randomizado e comparativo entre minociclina e placebo no tratamento da hipomelanose macular progressiva / Randomized, double-blind study of minocycline vs. placebo in the treatment of progressive macular hypomelanosis

Introdução: A hipomelanose macular progressiva (HMP) é hipopigmentação comum da pele, porém pouco diagnosticada. Ocorre em todas as raças e tem sido encontrada no mundo todo. Atinge adultos jovens, especialmente mulheres, sendo muitas vezes confundida compitiríase alba e pitiríase versicolor. Caracteriza-se por máculas hipopigmentadas numulares, não descamativas, bem definidas e simétricas, em áreas corporais de maior concentração de glândulas sebáceas (tronco, tórax, abdome e região lombar). Não há tratamento efetivo, e sua etiologia é pouco conhecida, mas recentemente foi descoberta fluorescência vermelha nas lesões, o que sugere a presença de porfirina, produzida pelo Propionibacterium acnes. Objetivo: Avaliar a eficácia clínica do uso da minociclina 100mg/dia no tratamento dahipomelanose macular progressiva, comparado com grupo placebo. Métodos: Foram incluídos 20 pacientes maiores de 18 anos, com tempo de doença superior a três meses, sem alergias a derivados de tetraciclinas, sem tratamento prévio pelo menos nos últimos três meses, e houve a randomização aleatória em dois grupos (10 pacientes no grupo placebo e 10 no grupo da minociclina). As seguintes avaliações foram realizadas (pré-tratamento, 30 e 90 dias após o término do tratamento): lâmpada de Wood, exame clínico com descrição das lesões além da classificação na escala de cor e fotografias padronizadas. Resultados: Dos 20 pacientes incluídos, 18 completaram o estudo. Destes, o grupo que tomouminociclina teve melhora estatisticamente significante (p< 0,05) em comparação ao grupo-controle. Conclusão: Minociclina 100mg/dia por 30 dias foi eficaz isoladamente no tratamento da HMP, relacionando o provável papel do Propionibacterium acnes na patogenia da doença.

Protocolo de manejo de diente permanente avulsionado para el servicio de salud oral de la Fundación Hospital La Misericordia y la Facultad de Odontología de la Universidad Nacional de Colombia, sede Bogotá (2011) / Protocol for Treatment of Avulsed Permanent Tooth at the Dental Care Unit of the La Misericordia Hospital Foundation and the National University of Colombia Dental School, campus Bogotá (2011)

Objetivo: la presente guía se elaboró con el fin de actualizar y complementar la guía demanejo de trauma dentoalveolar de la Fundación Hospital de la Misericordia y la Facultadde Odontología de la Universidad Nacional de Colombia. Métodos: se realizó una búsquedade literatura internacional en diferentes bases de datos y se analizaron los protocolos másrecientes y con mejores resultados en cuanto a la disminución de la aparición y al progresode la reabsorción radicular por remplazo, principal complicación al ser reimplantado undiente permanente avulsionado. Resultados: con esta actualización se pretende sugerir lamodificación de la terapia medicamentosa intraconducto y el acondicionamiento radicular,al encontrarse mejores mecanismos de acción de los medicamentos utilizados actualmente.Se recomienda llevar a cabo una socialización y aplicación de esta guía de manejo dentro dela Facultad de Odontología de la Universidad Nacional de Colombia, como en el Servicio deSalud Oral de la Fundación Hospital de la Misericordia...

Objective: This guide was conducted to update and complement the current managementguide for dentoalveolar trauma at the La Misericordia Hospital Foundation and the NationalUniversity of Colombia Dental School. Methods: A search of international literature in differentdatabases was carried out as well as the analysis of the most recent protocols andwith better results for decreasing the occurrence of root resorption, the main complicationafter an avulsed permanent teeth has been replanted. Results: This update is intended tosuggest the modification of the intracanal drug therapy and root surface conditioning to findbetter mechanisms of action of drugs currently used. It is recommended to disseminate andimplement this guide at the National University of Colombia Dental School and the dentalcare unit of the La Misericordia Hospital Foundation...

Avaliação de hansenianos tratados com esquema alternativo dose única ROM (rifampicina, ofloxacina e minociclina), após sete a nove anos / Evaluation years in leprosy patients treated with single dose alternative scheme ROM (rifampin, ofloxacin, minocycline), after seven to nine

INTRODUÇÃO: Em 1997, após a realização de estudo multicêntrico, duplo cego e randomizado, em nove centros de tratamento de hanseníase na Índia, o Ministério da Saúde adotou o esquema alternativo dose única ROM para casos de lesão única, paucibacilar, sem nervo periférico afetado, índice baciloscópico negativo, em Centros de Referência da doença no Brasil. O estudo se propôs a avaliar a efetividade do esquema ROM em pacientes tratados no período de 1997 a 1999 no Serviço de Dermatologia da Santa Casa de Vitória. MÉTODOS: Foram selecionados e tratados com o esquema ROM, 54 pacientes das formas indeterminada e tuberculóide. Estes pacientes foram convocados de março a outubro de 2006 para reavaliação clínica. RESULTADOS: Vinte e nove pacientes avaliados (85,2 por cento; IC95 por cento: 70-100,4) estavam curados, cinco (14,7 por cento; IC95 por cento: 7,4-22,0) recidivaram e 20 pacientes não retornaram; porém, não havia outra notificação de reingresso ao tratamento no banco de dados da Secretaria Estadual de Saúde. CONCLUSÕES: O estudo evidenciou taxa de cura de 90,8 por cento e taxa bruta de recidiva de 9,2 por cento, após período de sete a nove anos da dose ROM. O tratamento alternativo ROM demonstrou melhor efetividade para lesão única menor que quatro centímetros e aparecimento há menos de cinco anos.

INTRODUCTION: In 1997, after obtaining a combined multi-state double-blind randomly controlled clinical trial study from nine Indian centers involved in the treatment of Hansen's Disease, the Ministry of Health adapted the single dose ROM Therapy approach in those cases involving the treatment of a single skin lesion, paucibacillary leprosy without evidence of peripheral nerve trunk involvement and indication of negative baciloscope, in the Referral Centers in Brazil. The study aimed to evaluate the effectiveness of the single dose ROM Therapy approach in those patients who were treated from the period of 1997 to 1999 in the Ambulatory Dermatologic Unit in the Hospital in Vitória, ES. METHODS: Fifty-four patients with tuberculoid and indeterminate leprosy were selected and treated with the single dose ROM Therapy approach. These patients were contacted from March 2006 up and until October 2006 for further clinical reevaluation. RESULTS: From the studies conducted, the following results were found to exist: 29 patients (85,2 percent; 95 percentCI: 70-100,4) were cured, 5 patients (14,7 percent; 95 percentCI: 7,4-22,0) relapsed, and 20 patients didn't return; however, there are no additional records of any notification of other treatment(s) in the State Department of Health's informational data banks. CONCLUSIONS: The study demonstrated a rate of cure of 90.8 percent and a rate of relapse of 9.2 percent after a period of seven to nine years using the single dose ROM Therapy approach. Additionally, this alternative treatment further demonstrated a better effectiveness for a single skin lesion smaller than four centimeters and with an appearance in less than five years.

Glutamate-N-methyl-D-aspartate receptor modulation and minocycline for the treatment of patients with schizophrenia: an update: [review]

Growing consistent evidence indicates that hypofunction of N-methyl-D-aspartate (NMDA) transmission plays a pivotal role in the neuropathophysiology of schizophrenia. Hence, drugs which modulate NMDA neurotransmission are promising approaches to the treatment of schizophrenia. The aim of this article is to review clinical trials with novel compounds acting on the NMDA receptor (NMDA-R). This review also includes a discussion and translation of neuroscience into schizophrenia therapeutics. Although the precise mechanism of action of minocycline in the brain remains unclear, there is evidence that it blocks the neurotoxicity of NMDA antagonists and may exert a differential effect on NMDA signaling pathways. We, therefore, hypothesize that the effects of minocycline on the brain may be partially modulated by the NMDA-R or related mechanisms. Thus, we have included a review of minocycline neuroscience. The search was performed in the PubMed, Web of Science, SciELO, and Lilacs databases. The results of glycine and D-cycloserine trials were conflicting regarding effectiveness on the negative and cognitive symptoms of schizophrenia. D-serine and D-alanine showed a potential effect on negative symptoms and on cognitive deficits. Sarcosine data indicated a considerable improvement as adjunctive therapy. Finally, minocycline add-on treatment appears to be effective on a broad range of psychopathology in patients with schizophrenia. The differential modulation of NMDA-R neurosystems, in particular synaptic versus extrasynaptic NMDA-R activation and specific subtypes of NMDA-R, may be the key mediators of neurogenesis and neuroprotection. Thus, psychotropics modulating NMDA-R neurotransmission may represent future monotherapy or add-on treatment strategies in the treatment of schizophrenia.

Estudo piloto para avaliar a eficácia da minociclina no tratamento da hipomelanose macular progressiva (HMp) / Pilot study to evaluate the efficacy of minocycline in the treatment of progressive macular hypomelanosis (PMH)

Introdução: A hipomelanose macular progressiva (HMP) se caracteriza por máculas hipopigmentadas no tórax, abdômen e região lombar. É frequentemente mal diagnosticada e tem etiologia desconhecida. Recentemente foi descoberta fl uorescência vermelha nas lesões, o que sugere a presença de porfi rina, produzida pelo Propionibacterium acnes. Objetivo: Avaliar a efi cácia da Minociclina 100mg/dia no tratamento da hipomelanose macular progressiva. Material e métodos: Foram incluídos pacientes maiores de 16 anos, com história mínima de três meses, sem alergias a derivados de tetraciclina e sem antibioticoterapia prévia por 90 dias. Foram realizadas fotografi as antes e após 30, 60, 90, 120 dias de tratamento. Resultados: Dos 19 pacientes incluídos, 11 completaram o estudo. Destes, em todos houve recuperação da cor nas áreas afetadas. O sucesso terapêutico pôde ser constatado em todos os pacientes incluídos no estudo, por um período mínimo de sete e um máximo de 11 meses após o fim do tratamento, dependendo do tempo de seguimento de cada paciente. Conclusão: Minociclina 100mg/dia por três meses foi efi caz isoladamente no tratamento da HMP, confi rmando o provável papel do P. acnes como agente etiológico da doença.

Introduction: Progressive Macular Hypomelanosis (PMH) is characterized by hypopigmented maculae on the thorax, abdomen, and lumbar region. It is often misdiagnosed, and its etiology is unknown. Recently, lesions suggestive of porphyria, produced by Propionibacterium acnes, were discovered by red fl uorescence of the lesions. Objective: To evaluate the effi cacy of Minocycline, 100 mg/day, in the treatment of Progressive Macular Hypomelanosis. Material and methods: Patients older than 16 years with at least a three-month history, without allergies to tetracycline derivatives, and without a history of treatment with antibiotics for 90 days before the study, were included. Pictures were taken before beginning treatment and after 30, 60, 90, and 120 days and after this whenever possible. Results: Out of 19 patients, 11 completed the study. All of them showed recovery of the color in the affected areas. Treatment success could be demonstrated for a minimum of seven months and a maximum of 11 months after treatment. Conclusion: The isolated use of minocycline, 100mg/day for three months, was effective in the treatment of PMH, confi rming the probable role of P. acnes as the etiological agent.

Cateter venoso profundo recoberto com antibiótico para reduzir infecção: estudo piloto / Antibiotic coated catheter to decrease infection: pilot study

JUSTIFICATIVA E OBJETIVOS: A bacteremia associada a cateter venoso central (CVC) aumenta a morbidade e mortalidade hospitalar em pacientes internados em unidade de terapia intensiva (UTI). Os cateteres recobertos com rifampicina e minociclina (RM) reduzem a freqüência de colonização e bacteremia. No entanto, resultados de estudos recentes questionaram o seu impacto clínico. O objetivo deste estudo foi comparar a incidência de colonização e bacteremia associada à CVC recobertos com RM e não recobertos numa coorte de pacientes admitidos em UTI. METODO: Estudo prospectivo, controlado em UTI mista clínico-cirúrgica. Os pacientes receberam um CVC recobertos com RM ou não recoberto. Após remoção do CVC, foi feita cultura de ponta do cateter e hemoculturas foram coletadas. Avaliou-se a freqüência de colonização e bacteremia. RESULTADOS: Cento e vinte CVC foram inseridos e 100 puderam ser avaliados, 49 no grupo não recobertos e 51 no grupo recoberto. As características clínicas foram similares nos 2 grupos. Dois casos de bacteremia associada ao cateter (BAC) (3,9 por cento) ocorreram em pacientes que receberam CVC recobertos com RM comparado a 5 (10,2 por cento) casos de BAC no grupo não recobertos (p = 0,26). Seis (11,8 por cento) cateteres recobertos foram colonizados, comparados a 14 (28,6 por cento) no grupo não recoberto (p = 0,036). A análise de Kaplan-Meier não demonstrou diferença no risco de colonização ou BAC entre os dois grupos estudados. A taxa de BAC foi de 4,7 por 1000 cateteres-dia no grupo com CVC recobertos e 11,4 por 1000 cateteres-dia no grupo que recebeu cateteres não recobertos (p = 0,45). CONCLUSÕES: Neste estudo piloto, demonstrou-se menor freqüência de colonização em cateteres recobertos com RM, quando comparados a cateteres não recobertos. A freqüência de BAC não foi diferente entre os dois grupos.

BACKGROUND AND OBJECTIVES: Nosocomial catheter related bloodstream infections (CR-BSI) increase morbidity and mortality in critically ill patients. Central venous catheters (CVC) coated with rifampin and minocycline (RM) decrease rates of colonization and CR-BSI. However, recent trials challenged the clinical impact of such catheters. We designed this trial to compare rates of colonization and CR-BSI in RM catheters and controls in a cohort of critically ill patients in Brazil. METHODS: Prospective, controlled trial conducted in one medico-surgical ICU. Patients were assigned to receive a control or RM CVC. After removal, tips were cultured in association with blood cultures. Rates of colonization and CR-BSI were recorded. RESULTS: Among 120 catheters inserted, 100 could be evaluated, 49 in the uncoated and 51 in the coated group. Clinical characteristics of patients were similar in the two groups. Two cases of CR-BSI (3.9 percent) occurred in patients who received RM catheters compared with 5 (10.2 percent) in the uncoated group (p = 0.26). Six RM catheters (11.8 percent) were colonized compared with 14 (28.6 percent) control catheters (p = 0.036). Kaplan-Meier analysis showed no significant differences in the risk of colonization or CR-BSI. Rates of CR-BSI were 4.7 per 1000 catheter-days in the RM coated group compared to 11.4 per 1000 catheter days in the uncoated group (p = 0.45). CONCLUSIONS: In this pilot study, we showed lower rates of colonization in RM coated when compared with uncoated catheters. Incidence and rates of CR-BSI were similar in the two groups.

Papilomatosis reticulada y confluente de Gougerot-Carteaud: un caso con excelente respuesta a minociclina / Confluent and reticulated Gougerot-Carteaud papillomatosis: a case report of an excellent response to minocycline

La papilomatosis reticulada y confluente de Gougerot-Carteaud es una dermatosis poco frecuente que por lo general afecta a individuos jóvenes, especialmente a mujeres de fototipos oscuros. Es asintomática y se presenta como placas pigmentadas con textura papilomatosa que confluyen formando placas reticuladas de mayor tamaño en el cuello y zonas intertriginosas. La causa es desconocida, aunque se ha implicado una queratinización anormal, y en ocasiones se puede asociar a Malassezia sp. Su evolución es crónica con remisiones y exacerbaciones. Por el momento no se dispone de un tratamiento específico. Se presenta un caso tratado de manera efectiva con minociclina que no presentó recidiva tras seis meses de seguimiento.

Confluent and reticulated Gougerot-Carteaud papillomatosis is an uncommon dermatological condition that affects adolescents, especially young women with dark skin types. It presents itself as asymptomatic pigmented patches with a papillomatous texture that coalesce to form reticular plaques localized in the neck and intertriginous areas. The cause of this disease is unknown, although an abnormal keratinization has been implicated and sometimes has been associated with Malassezia sp. It has a chronic course with remissions and exacerbations. Several therapies have been used unsuccessfully to eradicate it but nowadays there is no specific treatment. We report a case treated efficiently with minocycline without recurrence at 6 months follow-up.

Estudo terapêutico comparando a associação de rifampicina, ofloxacina e minociclina com a associação rifampicina, clofazimina e dapsona em pacientes com hanseníase multibacilar / Therapeutic study comparing the association rifampin, ofloxacinand minocycline, with the association rifampin, clofazimine anddapsone in multibacillary leprosy patients

Foram comparados dois esquemas terapêuticos em pacientes com hanseníase multibacilar. O grupo controle com 14 pacientes recebeu o tratamento convencional.O grupo teste com 12 pacientes recebeu a associação de rifampicina 600 mg, ofloxacina 400 mg,e minociclina 100 mg, uma vez por mês, durante dois anos. Na avaliação inicial foram realizados exames clínicos, baciloscópicos e histológicos. A baciloscopia e a biópsia foram repetidas no final do primeiro e segundo ano de tratamento. As avaliações clínicas realizadas mensalmente. Todos pacientes apresentavam lesões cutâneas, que os caracterizavam como virchovianos ou peri-virchovianos. No grupo controle, o índice baciloscópico antes do tratamento variou de 2 a 4,8 e no grupo teste de 1,6 a 4,8. Histologicamente apresentavam quadro de hanseníase virchoviana ativa, exceto um paciente do grupo teste. Ao final do primeiro ano de tratamento estavam todos clinicamente melhorados,o índice baciloscópico diminuído e quadro histológico regressivo. Essa tendência se mantinha e ao final do segundo ano todos estavam clinicamente, baciloscopicamente e histologicamente ainda melhores. Análise estatística mostrou não haver diferença significante entre os grupos, sendo os esquemas equivalentes. No grupo controle todos apresentaram pigmentação cutânea devido a clofazimina. Os resultados deste estudo demonstraram que o esquema com rifampicina, ofloxacinae minociclina, teve eficácia e segurança equivalente a poliquimioterapia convencional para multibacilar. Além disso, não causa pigmentação cutânea, pode ser totalmente supervisionado, podendo ser utilizado como esquema alternativo

Two therapeutic schemes in multibacillary leprosy patients were compared. The control group with 14 patients received the conventional treatment (MDT-MB). The test group with 12 patients, received the association rifampin 600 mg, ofloxacin 400 mg and minocycline 100 mg (ROM), administrated under supervision once a month, during two years. Initial evaluations include clinical, bacilloscopic and histological exams. The bacilloscopy and the biopsy were repeated at the end of first and second year of treatment. Clinical evaluations were performed monthly. All patients presented skin lesions characteristic of the lepromatous type. In the control group, the bacterial index (BI) before treatment ranged from 2 to 4.8 and in the test group it ranged from 1.6 to 4.8. Histological picture resembled active lepromatous leprosy, except one patient from the test group. At the end of the first year of treatment all patients showed clinical improvement, decreased BI and regressive histological picture. This tendency was maintained and at a final evaluation at the end of the second year all patients showed improvement on clinical, bacilloscopic and histological evaluations. Statistical analysis showed no significant differences between the groups, therefore, the two schemes were similar. In the control group all patients presented skin pigmentation after clofazimine intake. The results demonstrated that monthly administration of ROM is as efficacious and safe as MDT-MB. Besides, it doesn’t cause skin pigmentation, it can be given under supervision and can be used as alternative scheme.