Application status and prospects of topical drug therapy in oral mucosal diseases / 口腔疾病防治

@#Oral mucosal disease is a general term for a type of disease that mainly affects the oral mucosa and surrounding soft tissues. In the treatment of oral mucosal diseases, due to the particularity of the anatomical location, the use of topical administration is relatively simple and convenient; drugs can easily accumulate in the lesions, and at the same time, they can also avoid adverse reactions caused by systemic drug delivery. Topical administration has become an important and even preferred option for the treatment of oral mucosal diseases. There are various types of topically used drugs for oral mucosal diseases, such as glucocorticoids (triamcinolone acetonide), immunomodulatory drugs (tacrolimus), antiseptic drugs (chlorhexidine), pain relievers (lidocaine) and proprietary Chinese medicines (aloe vera gel). Among these drugs, although the most widely used liquid formulations such as gargles and sprays are easy to use, they are not conducive to local retention of drugs due to the particularity of the oral environment and function. Based on this, researchers have continuously improved the dosage form of the drug, and developed a series of semi-solid pharmaceutical preparations such as gels and ointments, some of which have exerted good curative effects in clinical work. In addition, although films, patches and other solid oral mucosal topical pharmaceutical preparations have few clinical applications, they have also been widely researched and described and are expected to become the mainstream dosage form in the future. In general, with the improvement of dosage forms, topical administration is playing an increasingly important role in the treatment of oral mucosal diseases. Therefore, combined with basic research and clinical reports, this article reviews the application of topical drug delivery in the treatment of oral mucosal diseases

Effectiveness of local and topical anesthesia during gingival retraction / Eficácia da anestesia local e tópica durante a retração gingival

Objective: To compare the effectiveness of local and topical anesthesia during gingival retraction in prepared abutment teeth. Material and Methods: 72 patients desiring full mouth rehabilitation or bilateral fixed partial denture in the same arch were selected based on the inclusion criteria framed and were randomly allocated into Groups A and B of 36 each. Patients in Group A received gingival retraction with topical anesthesia and Group B received gingival retraction with infiltration anesthesia. All the patients were tested for pain, discomfort and bleeding during gingival retraction. Results: There was no significant difference in pain, discomfort and gingival bleeding (P >.05) during gingival retraction using topical and local anesthetic agents. Conclusion: Topical anesthesia was equally effective as infiltration anesthesia in managing the pain, discomfort and bleeding during gingival retraction by cord packing in prepared abutment teeth. (AU)

Objetivo: Comparar a eficácia da anestesia local e tópica durante a retração gengival previa a moldagem em dentes pilares preparados. Material e Métodos: Foram selecionados 72 pacientes indicados para reabilitação bucal total ou prótese parcial fixa bilateral na mesma arcada com base nos critérios de inclusão formulados e alocados aleatoriamente nos Grupos A e B com 36 pacientes cada. Os pacientes do Grupo A receberam retração gengival com anestesia tópica e no Grupo B receberam retração gengival com anestesia infiltrativa. Todos os pacientes foram testados para dor, desconforto e sangramento durante o procedimento. Resultados: Não houve diferença significativa na dor, desconforto e sangramento gengival (P>. 05) durante a retração gengival com anestésicos tópicos e locais. Conclusão: A anestesia tópica foi tão eficaz quanto a anestesia de infiltração no controle da dor, desconforto e sangramento durante a retração gengival com fio retrator gengival em dentes pilares preparados.(AU)

Surgical treatment of ankyloglossia using an ophthalmic topical anesthetic and a tentacannula for tongue elevation: a case report

Ankyloglossia is characterized by the presence of a short lingual frenum that can be inserted from the alveolar ridge to the lingual apex and, until promoting a true fusion of the tongue to the floor. A short lingual frenum can generate several problems such as phonetic disorders. Objective: To describe a surgical technique for the treatment of ankyloglossia using a topical ophthalmic anesthetic and a tentacannula for tongue elevation. Case report: A 15-year-old female was referred for lingual frenulum surgery due to speech impairment. Clinical examination revealed the presence of ankyloglossia which was both hindering the pronunciation of T, D, L phonemes and reducing tongue mobility. The surgical technique chosen was a lingual frenectomy. An ophthalmic topical anesthetic was initially applied to the lateral borders of the frenum with the patient in an upright position and in the presence of adequate aspiration. With the aid of a tentacannula the tongue was raised and the frenulum gradually released with a Goldman-Fox serrated scissor. The topical anesthetic was continuously trickled onto the surgical site during surgery. Results: No postoperative pain was reported by the patient, healing occurred normally and there was no recurrence of abnormal frenulum insertion. Conclusion: The advantages of this technique in comparison to conventional methods which use infiltrative anesthesia include less trauma and a more precise evaluation of tongue movements during surgery, because there will be better control of mobility for the patient when compared to infiltrative techniques.

Introdução: A anquiloglossia caracteriza-se pela presença de um freio lingual curto que pode inserir-se desde o rebordo alveolar até o ápice lingual e, até promover uma verdadeira fusão da língua ao assoalho. Um freio lingual curto poderá gerar vários problemas como distúrbios fonéticos. Objetivo: descrever uma técnica cirúrgica para tratamento da anquiloglossia utilizando um anestésico tópico oftálmico e uma tentacânula para elevação da língua. Relato do caso: Uma paciente com 15 anos de idade foi encaminhada para cirurgia do frênulo lingual devido ao comprometimento da fala. O exame clínico revelou a presença de anquiloglossia, dificultando a pronúncia dos fonemas T, D, L e, reduzindo a mobilidade da língua. A técnica cirúrgica escolhida foi a frenectomia lingual. Um anestésico tópico oftálmico foi aplicado inicialmente nas bordas laterais do freio com o paciente na posição vertical e na presença de aspiração adequada. Com o auxílio de uma tentacânula, a língua foi elevada e o frênulo foi gradualmente liberado com uma tesoura serrilhada Goldman-Fox. O anestésico tópico foi continuamente gotejado para o local cirúrgico durante a cirurgia. Resultados: Nenhuma dor pós-operatória foi relatada pelo paciente, a cicatrização ocorreu normalmente e não houve recorrência da inserção anormal do frênulo. Conclusão: As vantagens dessa técnica em comparação aos métodos convencionais que utilizam anestesia infiltrativa, incluem menor trauma e uma avaliação mais precisa dos movimentos da língua durante a cirurgia, pois haverá um melhor controle da mobilidade do paciente quando comparado às técnicas infiltrativas.

Application of bisphosphonates in avascular necrosis of the femoral head / 中国组织工程研究

BACKGROUND: Animal experiments have shown that bisphosphonates exhibit a preventive effect on femoral head collapse. However, clinical application of bisphosphonates remains disputed. Systematic administration of bisphosphonates has many adverse reactions. There is an increasing number of studies on local application of bisphosphonates. OBJECTIVE: To review the research progress of bisphosphonates in the treatment of avascular necrosis of the femoral head. METHODS: The first authors (GJC and MJH) searched PubMed and CNKI databases to retrieve papers regarding bisphosphonate treatment of osteonecrosis of the femoral head using the search terms “osteonecrosis of the femoral head, bisphosphonates, systemic therapy, topical therapy, osteogenesis, bone destruction, bone remodeling” in English and Chinese. Sixty-two eligible papers were included in the final analysis. RESULTS AND CONCLUSION: It remains disputed whether bisphosphonates inhibit or activate osteoblasts. Current studies have shown that low concentration of bisphosphonates can promote the proliferation of osteoblasts, while high concentration of bisphosphonates can inhibit the proliferation of osteoblasts. Long term systematic application of bisphosphonates can induce mandibular osteonecrosis and other side effects. Topical application of bisphosphonates for treatment of avascular necrosis of the femoral head is still in the experimental stage. The optimal bisphosphonate concentration and the duration of efficacy in the treatment of avascular necrosis of the femoral head have not been determined. These should be clarified by in-depth high-quality experiments prior to clinical application.

Effect of Addition and Subtraction Therapy of Yiyiren Tang with External Application Therapy on Inflammatory Factors of Patients with Acute Gouty Arthritis and Damp-heat Obstruction Syndrome / 中国实验方剂学杂志

Objective::To observe the clinical effect of addition and subtraction therapy of Yiyiren Tang with external application therapy in the patients with acute gouty arthritis (AGA) and damp-heat obstruction syndrome, and to investigate its effect on inflammatory factors. Method::One hundred and fifty-three patients were randomly divided into control group (77 cases) and observation group (76 cases) by random number table. Patients in control group got meloxicam tablets after the meal, 1 tablet/day, 1 time/day, diclofenac sodium gel, 3 times/days. On the basis of meloxicam tablets, patients in observation group additionally received addition and subtraction therapy of Yiyiren Tang by oral and topical applications. The course of treatment was 7 days in both groups. Scores of visual analogue score of pain (VAS) were graded everyday, and the relief time and disappearance time of pain were recorded. Before and after treatment, scores of damp-heat obstruction syndrome were recorded. Levels of uric acid (UA), C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), interleukin-1 beta (IL-1β), interleukin-6 (IL-6), interleukin-8 (IL-8), tumor necrosis factor-alpha (TNF-α), serum cyclooxygenase-2 (COX-2), prostaglandin E2 (PGE2), thromboxane B2 (TXB2) and 6-keto-prostatic factor F1alpha (6-keto-PGF1α) were all detected, and the safety was evaluated. Result::The clinical efficacy in observation group was better than that in control group (Z=2.205, P<0.05). The relief time and disappearance time of pain were shorter than those in control group (P<0.01). At the 1st, 3rd, 5th and 7th day after treatment, scores of VAS were lower than those in control group (P<0.01). After treatment, the scores of main symptoms such as joint pain, tenderness, swelling and dyskinesia, scores of the secondary symptoms and the total scores of damp-heat obstruction syndrome were all lower than those in control group (P<0.01). After treatment, levels of ESR, CRP, UA, IL-1β, IL-6, IL-8, TNF-α, COX-2, PGE2 and TXB2 were all lower than those in control group (P<0.01). Conclusion::Based on the treatment of meloxicam, addition and subtraction therapy of Yiyiren Tang by oral and topical administration methods can quickly relieve and eliminate pain, alleviate the main clinical symptoms and inhibit inflammation in patients with damp-heat obstruction syndrome, showing good clinical efficacy and safety.

Pay more attention to drug-induced ocular toxicity / 中华实验眼科杂志

Medication safety is one of the primary considerations in drug therapy.With the increase of drug categories and the diversification of drug delivery routes,more and more attention has been paid to ocular adverse events caused by topical and systemic administration.Topical administration can directly induce toxicity to eye tissues.After systemic administration,especially long-term administration,the drugs may permeate blood-ocular barrier and cause toxic effects on anterior segment and posterior segment of the eye.In this article,we reviewed the reports and studies of the most commonly recognized drug-induced ocular disorders caused by different topical and systemic administration.Ophthalmologists should pay more attention to the ocular toxicity induced by both topical and systemic administration,improve the capability to distinguish drug-induced symptoms and disease itself,which helps to accurately distinguish and effetely prevent drug-induced ocular toxicity.

Evaluación de formulaciones de ketoconazol para uso tópico en leishmaniasis cutánea por Leishmania(Viannia) / Evaluation of ketoconazole formulations for topical use in cutaneous leishmaniasis caused by Leishmania (Viannia)

RESUMEN Se evaluó la efectividad de diversas formulaciones farmacéuticas de ketoconazol en modelos experimentales de leishmaniasis cutánea (LC) en ratones BALB C. Fueron preparadas formulaciones tópicas tipo gel, lipogel y crema conteniendo potenciadores de la permeación y diferentes concentraciones de ketoconazol. Se determinó la estabilidad, la toxicidad y la actividad anti-Leishmania in vitro. Además, se evaluó in vivo la efectividad de las formulaciones aplicadas tópicamente en ratones con LC infectados con Leishmania (Viannia) braziliensis. Las formulaciones tipo crema fueron evaluadas adicionalmente en ratones infectados con L. (V.) panamensis. Los sistemas evaluados mantuvieron in vitro la actividad del ketoconazol contra los parásitos; sin embargo, ninguna de las formulaciones fue efectiva en curar las lesiones de LC en los ratones. El tratamiento tópico con miltefosina (utilizado como control) curó las lesiones. Se concluye que las formulaciones que contienen ketoconazol diseñados en este estudio, no fueron efectivos contra la LC en los ratones infectados.

ABSTRACT The effectiveness of various pharmaceutical formulations of ketoconazole was evaluated in experimental models of cutaneous leishmaniasis (LC) in BALB C mice. Topical gel, lipogel, and cream formulations containing permeation enhancers and different concentrations of ketoconazole were prepared. Stability, toxicity and anti-Leishmania activity were determined in vitro. In addition, the effectiveness of topically applied formulations in LC-infected mice infected with Leishmania (Viannia) braziliensis was evaluated in vivo. Cream formulations were additionally evaluated in mice infected with L. (V.) panamensis. The systems evaluated maintained in vitro the activity of ketoconazole against parasites; however, none of the formulations were effective in curing LC lesions in mice. Topical treatment with miltefosine (used as a control) cured the lesions. It is concluded that the ketoconazole-containing formulations designed in this study were not effective against LC in infected mice.

Topical Tacrolimus for the Treatment of Atopic Dermatitis with Truncal Lesion

BACKGROUND: Topical tacrolimus is an effective anti-inflammatory therapy for acute and chronic states of atopic dermatitis (AD) in both adults and children. Topical tacrolimus has particular use at sensitive areas such as the face, anogenitals, and skin folds of neck and extremities. However, many AD patients also experience aggravated symptoms on trunk. OBJECTIVE: The aim of this study was to investigate the efficacy and safety of topical tacrolimus for AD patients with truncal lesions. METHODS: AD patients with truncal lesions who were aged ≥2 years were recruited from 20 centres in Korea. They received treatment with topical tacrolimus ointment twice daily during 4 weeks. The primary end point was change of the local eczema area and severity index (EASI) of the trunk from baseline to day 28. The secondary end points were changes in the patient global assessment (PGA) score and itch visual analogue scale (VAS) score of the trunk between baseline and day 28. RESULTS: Two hundred and ninety-one patients were recruited, and 176 patients completed the full 4-week treatment course. By the end of the treatment, the mean local EASI of the trunk (2.2±4.71) was significantly decreased from that at baseline (4.71±4.03, p < 0.001). PGA (1.71±1.15) and itch VAS score of the trunk (2.61±2.19) on day 28 were also profoundly decreased compared with the baseline (2.96±1.07 and 5.15±2.47, respectively). No serious adverse events were observed during the study period. CONCLUSION: Topical tacrolimus is an effective and safe therapy for truncal lesions in AD patients.

Pay more attention to drug-induced ocular toxicity / 中华实验眼科杂志

Medication safety is one of the primary considerations in drug therapy. With the increase of drug categories and the diversification of drug delivery routes, more and more attention has been paid to ocular adverse events caused by topical and systemic administration. Topical administration can directly induce toxicity to eye tissues. After systemic administration,especially long.term administration,the drugs may permeate blood.ocular barrier and cause toxic effects on anterior segment and posterior segment of the eye. In this article,we reviewed the reports and studies of the most commonly recognized drug.induced ocular disorders caused by different topical and systemic administration. Ophthalmologists should pay more attention to the ocular toxicity induced by both topical and systemic administration, improve the capability to distinguish drug.induced symptoms and disease itself, which helps to accurately distinguish and effetely prevent drug.induced ocular toxicity.

Synthesis and Release of Dapsone-Alginate (DS-Alg) Conjugate / 中国药学杂志

OBJECTIVE: To synthesize and characterize dapsone-alginate acid (DS-ALG) conjugate. METHODS: Alginate (Alg) was selected as the drug carrier and valine (Val) as the linking arm to synthesize DS-Alg, which could be applied to topical administration. And the synthetic condition of DS-Alg was optimized by changing the amount of 1-(3-dimethylaminopropyl) -3-ethylcarbodiimide hydrochloride (EDC) and N-hydroxysuccinimide (NHS), while the pH of solvent was changed in the range of 4.0 to 6.0. The structures of the products were characterized by 1H-NMR, MS and FT-IR. Meanwhile, the drug release in vitro of DS-Alg was investigated in the mixture of pH 7.4, 0.05 mol•L -1 PBS and ethanol by diffusion cells. The concentration of DS or valine-dapsone in the release medium was detected by HPLC. Taking rats with local scald as model, the drug release in vivo was measured by coating the trauma with DS-Alg conjugate cream and monitoring the drug concentration in blood. RESULTS: The optimum synthetic conditions of DS-Alg were as follows: 0.277 g valine-dapsone, 0.400 g sodium alginate, 7 eq EDC, 3 eq NHS, pH of the solvent of 5.5. And during 72 h, there was no DS detected in the release medium or rat plasma. The AUC0→72 h of DS-Alg was 0. It suggested that DS immobilized by Alg with covalent bond was too stable to be released from Alg in vitro and in vivo. The DS-Alg conjugate could effectively prevent DS from entering the systemic circulation. CONCLUSION: DS-Alg conjugate is successfully synthesized. The conjugate is stable that DS cannot be released from the conjugate to the bloodstream, which can efficiently decrease the side effects of DS and has the potential for topical administration.

Determination of halometasone and its pharmacokinetics study in rabbit plasma by LC-MS/MS / 中国药理学通报

Aim TodevelopandvalidateaLC-MS/MS assay to quantify halometasone in rabbit plasma and study pharmacokinetics of halometasone after dermal topical administration of Halometasone Cream.Meth-ods Theplasmasamplewassubmittedtoliquid-liquid extraction using methyl tertiary butyl ether,with dexa-methasone as the internal standard (IS ).Chromato-graphic separations were performed on a Diamonsil C18 column(100 mm ×4. 6 mm,5 μm)with a linear gra-dient of methanol and 2 mmol · L-1 ammonium ace-tate.Halometasone and dexamethasone(IS)were ion-ized with an ESI source operated in negative ion mode, and the detected ions were m/z 503. 1→413. 0 (halo-metasone),m/z 391. 0→361. 0 (dexamethasone ). The test article could be monitored in rabbit plasma when following single dermal topical administration of Halometasone Cream at 1 g/100 cm2 to rabbits by u-singavalidatedLC-MS/MSassay.Results Calibra-tion curve was linear over the concentration range of0. 02~20 μg·L-1 in rabbit plasma.For low,medi-um,high concentration of QC solutions,the intra-and inter-day precision was in the range of 3. 72% ~7. 87%, and the accuracy was within 99. 1% to 103%. The pharmacokinetic parameters in rabbits were as follows:Tmax,Cmax,AUC0-t,T1/2 was (7. 38 ± 1. 06)h,(1. 16 ±0. 527)μg·L-1,(18. 8 ±7. 23)h·μg·L-1 ,(13. 8 ±3. 70)h,respectively.Conclusions ThisLC-MS/MSanalysismethodhashighsensitivi-ty,and sample processing method is simple,which has been rigorously validated.The method could be suc-cessfully applied to the pharmacokinetic study of halo-metasone after skin administration of Halometasone Cream to rabbits.

Meta-analysis of Clinical Effects of Topical Administration of Phenytoin on Wound Healing / 中国药师

Objective:To evaluate the clinical effects of topical administration of phenytoin ( PHT) on wound healing. Methods:The clinical trials on PHT topically used for wound healing were collected from Cocharne Library and PubMed ( from database establish-ment to May, 2016. Meta-analysis was performed using RevMan 5. 0 software and Stata 12. 0 software. Results:A total of 15 stud-ies involving 1 048 patients were included. Topical PHT treatment was significantly associated with complete healing rate (OR=3. 28, 95%CI:1. 23-8. 75, P=0. 02), production rate of health granulation tissue (OR=2. 18,95%CI:1. 33-3. 59, P=0. 002) and aver-age percentage reduction of wound surface size (SMD=1. 77, 95%CI:0. 53-3. 02, P<0. 000 01). However, heterogeneity existed in complete healing rate and average percentage reduction of wound surface size among the studies. Meta-regression analysis showed that wound types (P=0. 02) and treatment periods(P=0. 08) were associated with the heterogeneity of complete healing rate outcomes, and mean age was associated with the heterogeneity of average percentage reduction of wound surface size(P=0. 07). Conclusion:Meta-analysis suggests that topical PHT treatment has significant positive clinical effect on wound healing. There is heterogeneity among the studies, so topical PHT treatment still should be applied in clinical practice prudently.

A simple HPLC method for the determination of halcinonide in lipid nanoparticles: development, validation, encapsulation efficiency, and in vitro drug permeation

ABSTRACT Halcinonide is a high-potency topical glucocorticoid used for skin inflammation treatments that presents toxic systemic effects. A simple and quick analytical method to quantify the amount of halcinonide encapsulated into lipid nanoparticles, such as polymeric lipid-core nanoparticles and solid lipid nanoparticles, was developed and validated regarding the drug's encapsulation efficiency and in vitro permeation. The development and validation of the analytical method were carried out using the high performance liquid chromatography with the UV detection at 239 nm. The validation parameters were specificity, linearity, precision and accuracy, limits of detection and quantitation, and robustness. The method presented an isocratic flow rate of 1.0 mL.min-1, a mobile phase methanol:water (85:15 v/v), and a retention time of 4.21 min. The method was validated according to international and national regulations. The halcinonide encapsulation efficiency in nanoparticles was greater than 99% and the in vitro drug permeation study showed that less than 9% of the drug permeated through the membrane, indicating a nanoparticle reservoir effect, which can reduce the halcinonide's toxic systemic effects. These studies demonstrated the applicability of the developed and validated analytical method to quantify halcinonide in lipid nanoparticles.

Epinephrine-induced lactic acidosis in orthognathic surgery: a report of two cases

Submucosal infiltration and the topical application of epinephrine as a vasoconstrictor produce excellent hemostasis during surgery. The hemodynamic effects of epinephrine have been documented in numerous studies. However, its metabolic effects (especially during surgery) have been seldom recognized clinically. We report two cases of significant metabolic effects (including lactic acidosis and hyperglycemia) as well as hemodynamic effects in healthy patients undergoing orthognathic surgery with general anesthesia. Epinephrine can induce glycolysis and pyruvate generation, which result in lactic acidosis, via β2-adrenergic receptors. Therefore, careful perioperative observation for changes in plasma lactate and glucose levels along with intensive monitoring of vital signs should be carried out when epinephrine is excessively used as a vasoconstrictor during surgery.

Effect of Using Local Intrawound Vancomycin Powder in Addition to Intravenous Antibiotics in Posterior Lumbar Surgery: Midterm Result in a Single-Center Study

OBJECTIVE: We conducted this study to report the efficacy of local application of vancomycin powder in the setting of surgical site infection (SSI) of posterior lumbar surgical procedures and to figure out risk factors of SSIs. METHODS: From February 2013 to December 2013, SSI rates following 275 posterior lumbar surgeries of which intrawound vancomycin powder was used in combination with intravenous antibiotics (Vanco group) were assessed. Compared with 296 posterior lumbar procedures with intravenous antibiotic only group from February 2012 to December 2012 (non-Vanco group), various infection rates were assessed. Univariate and multivariate analysis to figure out risk factors of infection among Vanco group were done. RESULTS: Statistically significant reduction of SSI in Vanco group (5.5%) from non-Vanco group (10.5%) was confirmed (p=0.028). Mean follow-up period was 8 months. Rate of acute staphylococcal SSIs reduced statistically significantly to 4% compared to 7.4% of non-Vanco group (p=0.041). Deep staphylococcal infection decreased to 2 compared to 8 and deep methicillin-resistant Staphylococcus aureus infection also decreased to 1 compared to 5 in non-Vanco group. No systemic complication was observed. Statistically significant risk factors associated with SSI were diabetes mellitus, history of cardiovascular disease, length of hospital stay, number of instrumented level and history of previous surgery. CONCLUSION: In this series of 571 patients, intrawound vancomycin powder usage resulted in significant decrease in SSI rates in our posterior lumbar surgical procedures. Patients at high risk of infection are highly recommended as a candidate for this technique.

Efectividad del tratamiento con una composición tópica en el proceso de cicatrización de las úlceras por presión / Effectiveness of topical composition treatment in the healing of pressure ulcers

Resumen:

Introducción: el tratamiento de las heridas crónicas y en especial el de las úlceras por presión (UPP) constituye uno de los más complejos e importantes problemas asistenciales en el ámbito hospitalario. Objetivo: evaluar la efectividad del tratamiento con y sin una composición tópica en el proceso de cicatrización de las UPP.

Metodología: estudio de intervención, con muestreo probabilístico estratificado según el estadio de las UPP. Se incluyeron 12 pacientes, con seguimiento de 16 UPP; aleatoriamente se seleccionaron ocho para el grupo de estudio con la aplicación de la composición tópica y ocho para el grupo control. En ambos grupos se realizó el procedimiento de curación con base en una guía de práctica clínica. El seguimiento del proceso de cicatrización en ambos grupos fue semanal y la efectividad de la curación se estimó con la escala RESVECH V. 1.0. El análisis de datos se hizo con el estadístico SPSS, versión 20. Resultados: el 75 % de los pacientes fueron hombres, que en promedio tuvieron 64.1 ± 11.1 años de edad. El 37 % de las UPP se clasificó en estadio II, el 25 % en estadio III y el 38 % en estadio IV. La efectividad del procedimiento de curación se determinó en días de intervención. En el grupo experimental fue de 9.1 ± 3.3 y en el grupo control fue de 13 ± 2.3 días de intervención; la diferencia entre las medias fue significativa, t (14) = 2.155, p < 0.05, dos colas.

Conclusiones: la curación con la composición tópica es una alternativa de tratamiento para este tipo de lesiones.

Abstract:

Introduction: The treatment of chronic wounds and especially of pressure ulcers (PU) is one of the most complex and important health care problems in hospitals.

Objective: To evaluate the effectiveness of a treatment with and without a topical composition in the PU healing process.

Methodology: Intervention study, with a probability sampling stratified according to the stage of PU. Twelve patients were included, with a follow-up of 16 PU; eight were randomly selected for the study group with the application of the topical composition and eight for the control group. In both groups the healing process was done on the basis of a clinical practice guideline. The monitoring of the healing process in both groups was done weekly and the effectiveness of healing was calculated with the RESVECH V. 1.0 scale (Results expected from the assessment and healing progress of wounds). The statistical analysis was performed with SPSS, version 20. Results: 75 % of the patients were men, who on average were 64.1 ± 11.1 years old. Of all the PU, 37 % were classified as stage II, 25 % as stage III and 38 % as stage IV. The effectiveness of the healing process was established in the days of intervention, the experimental group was 9.1 ± 3.3 and in the control group was 13 ± 2.3 days of intervention, the difference between the means was significant, r (14) = 2.155 , p < 0.05, two-tailed.

Conclusions: healing with topical composition is an alternative treatment for PU.

Formulation and Characterization of Ketoprofen Emulgels.

The present study was intended to formulate the ketoprofen emulgels using different viscosity grades of hydroxypropyl methylcellulose and carbopol as gelling agents. All the prepared emulgels were shown acceptable physical properties concerning colour, homogeneity, consistency, and pH value. Emulgels containing hydroxypropyl methylcellulose were poor in clarity when compared to carbopol formulations. The influence of the type of gelling agent on the drug release from the prepared emulgels was investigated and carbopol 934 showed good results not only in the drug release but also in physical evaluation parameters. From the drug release studies, F3 formulation showed 98.46±2.05% drug release in 8 h with good clarity and physical appearance. The T10% and T80% values of best formulation F3 was found to be 0.9 h and 6.6 h respectively. The T10% and T80% was higher for formulations with carbopol in low concentration when compared to hydroxypropyl methylcellulose K 4M and K 15M in high concentrations, indicating better controlled release. FTIR studies proved the compatibility between drug and carbopol. From the stability studies, similarity index value between dissolution profiles of F3 formulation before and after storage was found to be 87.16. Hence the development of ketoprofen emulgels is a suitable way for topical administration.

Comparing the effects of cryotherapy with nitrous oxide gas versus topical corticosteroids in the treatment of oral lichen planus.

Background: Oral lichen planus (OLP) is a chronic inflammatory disease of the oral mucosa with treatment challenges for clinicians. Aims: The objective of this study is to compare the effects of cryotherapy as a new modality with topical corticosteroids as a conventional therapy in the treatment of OLP. Materials and Methods: Thirty patients with bilateral OLP lesions were selected. From each patient a lesion on one side was chosen randomly for a single session of cryotherapy with nitrous oxide gas and the lesion on the other side received triamcinolone acetonide 0.1% ointment in orabase. Treatment outcome was measured by means of an appearance score, pain score (visual analogue scale), and severity of lesions before treatment and after 2, 4 and 6 weeks of treatment. Statistical Analysis Used: Paired samples t‑test and Wilcoxon test. Results: In both methods of treatment sign score, pain score and severity of lesions was significantly reduced in all follow‑up sessions (P < 0.05). But the treatment outcome and relapse was not significantly different between the two treatment methods (P > 0.05). Conclusion: Cryotherapy with nitrous oxide gas is as effective as topical triamcinolone acetonide in the treatment of OLP with no systemic side effects and needs less patient compliance. It can be considered as an alternative or adjuvant therapy in OLP patients to reduce the use of treatments with adverse effects.

Tratamento tópico das doenças anorretais / Topical treatment of anorectal diseases

O tratamento das doenças anorretais, como a doença hemorroidária e as fissuras anais, é essencialmente clínico para a maioria dos pacientes, estando as alternativas cirúrgicas reservadas para doença avançada. Modificações no estilo de vida são fundamentais na prevenção e no tratamento das doenças anorretais e incluem aumento do consumo de fibras e ingestão de líquidos para evitar a obstipação intestinal, associado a higienização adequada da região anal. Medicamentos tópicos promovem rápido alívio dos sintomas e são amplamente utilizados na prática clínica. A associação do anestésico cinchocaína com o policresuleno, um agente com propriedades pró-coagulantes e vasoconstritoras, promove alívio dos sintomas associados à doença hemorroidária, à fissura anal, ao prurido local e no pós-operatório de cirurgias proctológicas, sendo uma opção terapêutica efetiva e segura para o tratamento conservador das afecções anorretais.

Analgesic effects of Evodia extract cream and its mechanisms in mice / 中国药学杂志

OBJECTIVE: To study the analgesic effects of Evodia extract cream and its mechanisms. METHODS: Kunming mice were used as model animals, and hot plate test and formalin test were adopted in analgesia experiments. ELISA test was used to detect the contents of CGRP and PGE2. In addition, the tissue section technique was used to investigate the extent of inflammation cell infiltration in the area of pain. RESULTS: Evodia extract cream with a drug loading ranging from 0.1% to 0.4% could relieve pain induced by noxious heat (P < 0.05), and demonstrated significant analgesic effects in the mice formalin test (P < 0.05) in a dose-dependent manner. RESULTS: from ELISA test showed that Evodia extract cream with a drug loading of 0.2% significantly decreased the expression of CGRP in the pain zone of skin (P < 0.05) 3 min after subcutaneous injection of formalin (0.2% EE), and the expression of CGRP showed significant reduction over time (P < 0.05). But Evodia extract cream with a drug loading ranging from 0.1% to 0.4% had no significant effects on the contents of CGRP and PGE2 in plasma or the content of PGE2 in mice skin. Histological section RESULTS: indicated that the content of inflammation cell infiltration induced by formalin was decreased significantly after topical administration of Evodia extract cream with a drug loading ranging from 0.1% to 0.4% (P < 0.05). CONCLUSION: Topical administration of Evodia extract cream has significant dose-dependent analgesic effects. These findings suggest that the analgesic mechanism of Evodia extract cream is most likely related with exhausting the CGRP and interdicting its conduction and coordinating with anti-inflammatory effect.