Agranulocitosis secundaria a uso de vancomicina en pediatría. reporte de caso / Agranulocytosis secondary to vancomycin use in pediatrics. Case report

La vancomicina es un antibiótico de uso común en pacientes hospitalizados. Se han descrito múltiples efectos adversos relacionados a este fármaco, de los cuales la agranulocitosis es una entidad poco frecuente pero potencial mente grave. Este caso muestra una consecuencia médica secundaria al uso prolongado de este antibiótico, generando una neutropenia profunda posterior a 24 días de tratamiento, presentándose clínicamente con un pico febril aislado. Se asume que esta situación es consecuencia de una respuesta inmunológica inadecuada del huésped, por lo que la suspensión del agente etiológico es la clave del tratamiento. Existen pocos reportes de estos casos en la población pediátrica y debe considerarse un efecto secundario que requiere vigilancia estrecha para evitar repercusiones clínicas.

Vancomycin is a commonly used antibiotic in hospitalized patients. Multiple adverse effects related to this drug have been described, of which agranulocytosis is a rare but potentially serious entity. This case shows a medical consequence secondary to the prolonged use of this antibiotic, generating profound neutropenia after 24 days of treatment, presenting clinically with an isolated feverish peak. It is assumed that this situation is the consequence of an inadequate immunological response of the host, for which reason the suspension of the etiological agent is the key to treatment. There are few reports of these effects in the pediatric population and should be considered a side effect that requires close monitoring to avoid clinical repercussions.

Bases científicas del principio de curación homeopática en la farmacología moderna / Scientific bases of the homeopathic healing principle in modern pharmacology

La homeopatía emplea el denominado 'principio de similares' como método terapéutico ­ el cual consiste en administrar medicamentos que provocan ciertos síntomas en individuos sanos para tratar síntomas similares en individuos enfermos (similia similibus curantur) - para inducir una reacción curativa secundaria del cuerpo en contra de sus propios trastornos. Esta reacción secundaria (vital, homeostática o paradójica) del cuerpo se basa en el 'efecto de rebote' de los fármacos modernos, un tipo de evento adverso que se produce después de interrumpir varias clases de fármacos prescritos según el 'principio de los contrarios' (contraria contrariis curantur). Objetivo: La presente revisión ha buscado justificar científicamente el principio de curación homeopática frente a la farmacología clínica y experimental a través de un estudio sistemático del efecto de rebote de los fármacos modernos o reacción paradójica del cuerpo. Métodos: Empleando como referencia estudios y revisiones sobre el tema publicados a partir de 1998, actualizamos los datos añadiendo estudios recientes incluidos en la base de datos PubMed. Resultados: El efecto de rebote se produce después de interrumpir varias clases de fármacos con acción contraria a los síntomas de las enfermedades, exacerbándolos a niveles superiores a aquellos previos al tratamiento. Independientemente de la enfermedad, fármaco, dosis y duración del tratamiento, el fenómeno del rebote se manifiesta en una pequeña proporción de los individuos susceptibles. Siguiendo las premisas homeopáticas, los fármacos modernos también podrían usarse según el principio de la similitud terapéutica, empleando entonces el efecto de rebote (reacción paradójica) con propósito curativo. Conclusiones: Evidenciado por cientos de estudios que constatan la similitud de conceptos y manifestaciones, el efecto de rebote de los fármacos modernos justifica científicamente el principio de la cura homeopática. Aunque el fenómeno de rebote es un evento adverso estudiado por la farmacología moderna, no es conocido por los profesionales de la atención médica, lo cual priva a los médicos de un conocimiento indispensable para el manejo seguro de los fármacos.

Homeopathy employs the so-called 'principle of similars' as therapeutic method - which consists in administering medicines that cause certain symptoms in healthy individuals to treat similar symptoms in sick individuals (similia similibus curantur) - to induce a secondary and healing reaction by the body against its own disorders. This secondary (vital, homeostatic or paradoxical) reaction of the body is based on the 'rebound effect' of modern drugs, a type of adverse event that occurs following discontinuation of several classes of drugs prescribed according to the 'principle of contraries' (contraria contrariis curantur). Aim: The present review sought to scientifically substantiate the homeopathic healing principle vis-à-vis experimental and clinical pharmacology through a systematic study of the rebound effect of modern drugs or paradoxical reaction of the body. Methods: Employing as reference studies and revisions on the subject published since 1998, we updated the data adding recent studies included in database PubMed. Results: The rebound effect occurs after discontinuation of several classes of drugs with action contrary to the symptoms of diseases, exacerbating them to levels above the ones before treatment. Regardless of disease, drug, dose and duration of treatment, the rebound phenomenon manifests in a small proportion of susceptible individuals. Following the homeopathic premises, modern drugs might also be used according to the principle of therapeutic similitude, thus employing the rebound effect (paradoxical reaction) with curative intent. Conclusions: Evidenced by hundreds of studies that attest to the similarity of concepts and manifestations, the rebound effect of modern drugs scientifically substantiates the principle of homeopathic cure. Although the rebound phenomenon is an adverse event studied by modern pharmacology, it is not known by health care professionals, thus depriving doctors of knowledge indispensable for safe management of drugs.

La sudoración compensatoria como efecto secundario en la cirugía de la hiperhidrosis palmar primaria / Compensatory Sweating as a Side Effect of Surgical Treatment of Primary Palmar Hyperhidrosis

Introducción: La sudoración compensatoria es un efecto secundario de la simpaticotomía videotoracoscópica, que tiene una alta incidencia y puede provocar insatisfacción en los pacientes operados. Objetivo: Determinar el comportamiento de la sudoración compensatoria en los pacientes en que se les realizó una simpaticotomía videotoracoscópica por hiperhidrosis palmar. Métodos: Se realizó un estudio retrospectivo, transversal y descriptivo de 42 pacientes que tras la cirugía por hiperhidrosis palmar presentaron sudor compensatorio. Se analizó la incidencia, localización, severidad, afectación de la calidad de vida y nivel de satisfacción. Resultados: Predominó la sudoración compensatoria ligera, la localización en la espalda y el abdomen. Hubo un alto nivel de tolerancia, con solo un paciente insatisfecho y un 100 por ciento de mejoría de la calidad de vida. Conclusiones: La sudoración compensatoria no influyó negativamente en la calidad de vida de los pacientes(AU)

Introduction: Compensatory sweating is a side effect of videothoracoscopic sympathectomy. It presents high incidence and may cause dissatisfaction to operated patients. Objective: To determine the characteristics of compensatory sweating in patients who underwent videothoracoscopic sympathectomy for palmar hyperhidrosis. Methods: A retrospective, cross-sectional and descriptive study was carried out with 42 patients who presented compensatory sweating after surgery for palmar hyperhidrosis. Incidence, location, severity, change in quality of life and level of satisfaction were analyzed. Results: Light compensatory sweating predominated, with location on back and abdomen. There was a high level of tolerance, with only one dissatisfied patient and 100 percent of improvement in quality of life. Conclusions: Compensatory sweating did not influence negatively the patients' quality of life(AU)

Psicoestimulantes menores consumidos por estudiantes de la Universidad San Francisco Xavier de Chuquisaca, 2019 / Minor psychostimulants consumed by students of San Francisco Xavier de Chuquisaca University, 2019

El objetivo del estudio fue determinar el consumo de psicoestimulantes en estudiante de la Universidad San Francisco Xavier de Chuquisaca. Se recolectaron los datos mediante encuestas aplicadas a 331 estudiantes. El estudio reveló el psicoestimulante de mayor consumo con 31,88% el café y la coca cola con 26,65%, en su mayoría fueron consumidos con fines académicos. En los efectos secundarios, la sed se estableció como el más frecuente en estudiantes con 30,74%, seguido por cefalea con 27,56% y el cansancio en 14,84%. Se concluye que el café se determina como psicoestimulante menor más consumido en épocas de actividad académica y la sed como el efecto secundario más frecuente.

The objective of the study was to determine the consumption of psychostimulants in a student at the San Francisco Xavier de Chuquisaca University. The data were collected through surveys applied to 331 students. The study revealed the psychostimulant with the highest consumption with 31.88%, coffee and coca cola with 26.65%, most of which were consumed for academic purposes. Regarding side effects, thirst was established as the most frequent in students with 30.74%, followed by headache with 27.56% and fatigue in 14.84%. It is concluded that coffee is determined as the minor psychostimulant most consumed in times of academic activity and thirst as the most frequent side effect.

Trazodone-induced delirium: case report / Delirio inducido por trazodona: reporte de caso

ABSTRACT Trazodone is used as an antidepressant in doses between 150 and 600 mg. At lower doses, it is commonly used to treat insomnia. There are few case reports about confusional symptoms as an undesirable side effect of this drug. We report a case of a patient who presented with delirium after prescription of trazodone 100 mg. She required hospitalisation but, shortly after discontinuation of trazodone, the symptoms disappeared without antipsychotic medication. Seven months after the episode, the patient remains asymptomatic.

RESUMEN La trazodona se usa como antidepresivo en dosis de 150-600 mg. En dosis más bajas, se usa comúnmente para tratar el insomnio. Hay pocos reportes de caso sobre síntomas confusionales como un efecto secundario indeseable de este medicamento. Se presenta el caso de una paciente que acudió con delirio después de la prescripción de trazodona 100 mg. La paciente requirió hospitalización pero, poco después de la interrupción de la trazodona, los síntomas desaparecieron sin medicación antipsicótica. A los 7 meses del episodio, la paciente permanecía asintomática.

The effect of Niclosamide in acetic acid induce colitis: an experimental study

Ulcerative colitis is an idiopathic chronic inflammatory disease of the colon for which a lot of treatment modalities are present. However, significant side effects are associated with them, and there is a need for a search for other tretment options. This study was aimed to assess the contribution of niclosamide in experimentally established colitis in rats. Animals were categorized into 5 groups; the control group undergoes no induction of UC, colitis group in which UC was induced, and animals receive no treatment, the niclosamide group that received niclosamide and sulfasalazine group that received sulfasalazine. Each group was composed of 10 animals. After the completion of a one-month period of the experiment animals were sacrificed and the following meausres were done: the weight of the colon, determination of the area of mucosal damage by mm2, histological scoring after hematoxylin and eosin stain together with MAC score and immunohistochemistry of IL-6, TNF-alpha, MPO, MDA, CD62, and ICAM1. The results of the current study revealed that Nicosamide was able to reduce the area of mucosal damage, colon weight, histological and Mac scores and immunohistochemical scores of inflammatory and oxidative markers, significantly when contrasted to a group of colitis (P< 0.05). It has been concluded that Niclosamide was proved to have a significant effect as an adjuvant mode of therapy for colitis through its, anti-inflamatory and anti-oxidant effects (AU)

Early diagnosis and treatment of latent tuberculosis infection / Diagnóstico y tratamiento temprano de la infección de tuberculosis latente

Latent tuberculosis infection is a major health problem worldwide. People with latent tuberculosis infection have a lifetime risk of developing active tuberculosis approximately 5 % to 10%. Patients with latent tuberculosis infection were infected with Mycobacterium tuberculosis. Therefore, early diagnosis and treatment of a latent tuberculosis infection are very important. Patients with latent tuberculosis infection do not have the symptoms, signs, radiographic, and bacteriological evidence of active tuberculosis. Consequently, these patients are not contagious to others. Patients with latent tuberculosis infection usually have a positive tuberculin skin test or interferon-gamma release assays test. Systematic testing is recommended for all patients that are at risk for latent tuberculosis infection. The treatment of latent tuberculosis is recommended for patients that are at increased risk for developing active tuberculosis. The medications recommended to treat latent tuberculosis infection are isoniazid, rifampin, and a combination of isoniazidand rifapentine, and isoniazid and rifampin combination regimens. The most common side effect of these medications is hepatotoxicity. Therefore, patient monitoring during treatment should occur every month to evaluate medications side effects and adherence to medications. Post-treatment patient follow-up is very important, but serial or repeats chest radiography is not recommended.

La infección de tuberculosis latente es un gran problema de salud a nivel mundial. Las personas con infección de tuberculosis latente tienen un riesgo de desarrollar tuberculosis activa en aproximadamente 5 % a 10 % en toda su vida. Pacientes con infección de tuberculosis latente fueron infectados con Mycobacterium tuberculosis, por lo tanto, diagnóstico y tratamiento temprano de la infección de tuberculosis latente es muy importante. Pacientes con infección de tuberculosis latente son asintomáticos, no tienen signos físicos o radiográficos anormales, y no tienen evidencia bacteriológica de tuberculosis activa. Consecuentemente, estos pacientes no son contagiosos a otras personas. Pacientes con infección de tuberculosis latente usualmente son positivos para las pruebas de la tuberculina o Interferon-Gamma Release Assays. Pruebas sistemáticas son recomendadas para todos los pacientes que están en riesgo de presentar infección de tuberculosis latente. El tratamiento de tuberculosis latente es recomendado para los pacientes que tienen un elevado riesgo de desarrollar tuberculosis activa. Los medicamentos recomendados para el tratamiento de la infección de tuberculosis latente son isoniacida, rifampicina, y una combinación de isoniacida y rifapentin, y la combinación de isoniacida y rifampicina. El efecto secundario más común de estos medicamentos es hepatotoxicidad. Por lo tanto, la monitorización de estos pacientes durante el tratamiento debería ser cada mes, para evaluar efectos secundarios de los medicamentos y la adherencia al tratamiento. Es muy importante dar seguimiento después del tratamiento, pero hacer radiografías repetidas de pulmones no es recomendado.

Hepatitis aguda recurrente inducida por albendazol / Recurrent albendazole-induced acute hepatitis

Resumen El albendazol es un medicamento usado para tratar infecciones por helmintos y usualmente presenta pocos o ningún efecto secundario. A pesar de que hay un incremento transitorio de enzimas hepáticas luego de su uso, existe poca evidencia en la literatura en la que se reporte lesión hepática luego de automedicación con albendazol. En este informe, el paciente se presentó con hepatitis aguda luego de automedicarse con albendazol. El paciente cuenta además con una historia de episodios similares después de haber usado el fármaco. Se evaluada la causalidad con el método de evaluación de causalidad de Roussel Uclaf del Concejo para Organizaciones Internacionales de Ciencias Médicas, cuyo resultado fue un puntaje de 10, lo que indicó una alta probabilidad de lesión hepática inducida por albendazol al cabo de realizarse una investigación rigurosa y de excluir otras posibles causas de la condición física del paciente. En conclusión, aunque es ideal agilizar el proceso para combatir a los helmintos, es necesario intensificar la necesidad de monitorizaciones de calidad para evitar reacciones adversas como la hepatitis inducida por medicamentos. Asimismo, la automedicación de cualquier medicamento debe ser siempre evitada.

Abstract Albendazole is used to treat helminth infections and usually has minimal or no side effects. A transient increase in liver enzymes is common following its use, but little evidence of albendazole-induced liver damage has been reported in the literature. This study presents a patient who developed acute hepatitis following self-medication with albendazole. The patient also had a history of similar episodes in the past after using the drug. After a thorough investigation and exclusion of all other causes of the patient's clinical condition, the Roussel Uclaf Causality Assessment Method of the Council for International Organizations of Medical Sciences scale yielded a score of 10 points, indicating a high probability of albendazole-induced liver damage. In conclusion, expediting the process of combating helminths is ideal, but quality monitoring is required to avoid adverse reactions such as drug-induced hepatitis. Moreover, self-medication with any drug should always be discouraged.

Fundamentação científica do princípio de cura homeopático na farmacologia moderna / Scientific basis of the homeopathic healing principle in modern pharmacology

INTRODUÇÃO: O modelo homeopático de tratamento utiliza o ‘princípio dos semelhantes’ como método terapêutico, administrando medicamentos que causam determinados sintomas em indivíduos sadios para tratar sintomas semelhantes em indivíduos doentes (similia similibus curantur), com o intuito de despertar uma reação secundária e curativa do organismo contra os seus próprios distúrbios. Essa reação secundária (vital, homeostática ou paradoxal) do organismo está embasada no ‘efeito rebote’ dos fármacos modernos, evento adverso observado após a descontinuação de diversas classes de drogas que utilizam o ‘princípio dos contrários’ (contraria contrariis curantur) como método terapêutico...

INTRODUCTION: Homeopathy employs the so-called ‘principle of similars’as therapeutic method, which consists in administering medicines thatcause certain symptoms in healthy individuals to treat similar symptomsin sick individuals (similia similibus curantur) to arouse a secondaryand healing reaction by the body against its own disorders. Thissecondary (vital, homeostatic or paradoxical) reaction of the body isbased on the ‘rebound effect’ of modern drugs, a type of adverseevent that occurs following discontinuation of several classes of drugsprescribed according to the ‘principle of contraries’ (contraria contrariiscurantur)....

Scientific basis of the homeopathic healing principle in modern harmacology

BACKGROUND: Homeopathy employs the so-called ‘principle of similars’ as therapeutic method - which consists in administering medicines that cause certain symptoms in healthy individuals to treat similar symptoms in sick individuals (similia similibus curantur) - to induce a secondary and healing reaction by the body against its own disorders. This secondary (vital, homeostatic or paradoxical) reaction of the body is based on the ‘rebound effect’ of modern drugs, a type of adverse event that occurs following discontinuation of several classes of drugs prescribed according to the ‘principle of contraries’ (contraria contrariis curantur). AIM: The present review sought to scientifically substantiate the homeopathic healing principle vis-à-vis experimental and clinical pharmacology through a systematic study of the rebound effect of modern drugs or paradoxical reaction of the body. METHODS: Employing as reference studies and revisions on the subject published since 1998, we updated the data adding recent studies included in database PubMed. RESULTS: The rebound effect occurs after discontinuation of several classes of drugs with action contrary to the symptoms of diseases, exacerbating them to levels above the ones before treatment. [...]. Following the homeopathic premises, modern drugs might also be used according to the principle oftherapeutic similitude, thus employing the rebound effect (paradoxical reaction) with curative intent. CONCLUSIONS: Evidenced by hundreds of studies that attest to the similarityof concepts and manifestations, the rebound effect of modern drugs scientifically substantiates the principle of homeopathic cure. Although the rebound phenomenon is anadverse event studied by modern pharmacology, it is not known by health care professionals, thus depriving doctors of knowledge indispensable for safe management of drugs.

Fundamentação científica do princípio de cura homeopático na farmacologia moderna / Scientific basis of the principle of homeopathic cure in modern pharmacology

Introdução: O modelo homeopático de tratamento utiliza o ‘princípio dos semelhantes’ como método terapêutico, administrando medicamentos que causam determinados sintomas em indivíduos sadios para tratar sintomas semelhantes em indivíduos doentes (similia similibus curantur), com o intuito de despertar uma reação secundária e curativa do organismo contra os seus próprios distúrbios. Essa reação secundária (vital, homeostática ou paradoxal) do organismo está embasada no ‘efeito rebote’ dos fármacos modernos, evento adverso observado após a descontinuação de diversas classes de drogas que utilizam o ‘princípio dos contrários’ (contraria contrariis curantur) como métodoterapêutico. Objetivo: Esta revisão visa fundamentar cientificamente o princípio de cura homeopático perante a farmacologia clínica e experimental, através do estudo sistemático do efeito rebote dos fármacos modernos ou reação paradoxal do organismo. Métodos: Empregando como fonte de referência os estudos e revisões sobre o tema que vimos publicando desde 1998, atualizamos os dados acrescentando pesquisas recentes citadasna base de dados PubMed. Resultados: O efeito rebote ocorre após a descontinuação de inúmeras classes de fármacos com ação terapêutica contrária aos sintomas das doenças, exacerbando-os a níveis superiores aos anteriores do tratamento. Independente da doença, da droga, da dose e da duração do tratamento, o fenômeno rebote se manifesta numa pequena proporção de indivíduos suscetíveis. Seguindo as premissas homeopáticas, osfármacos modernos também podem ser utilizados segundo o princípio da similitude terapêutica, empregando o efeito rebote (reação paradoxal) de forma curativa Conclusões: [...] Embora o fenômeno rebote seja um evento adversoestudado pela farmacologia moderna, ele não é conhecido pelos profissionais da saúde, privando a classe médica de um saber indispensável ao manejo seguro dos fármacos. (AU)

Introduction: Homeopathy employs the so-called ‘principle of similars’ as therapeutic method, which consists in administering medicines that cause certain symptoms in healthy individuals to treat similar symptoms in sick individuals (similia similibus curantur)to arouse a secondary and healing reaction by the body against its own disorders. This secondary (vital, homeostatic or paradoxical) reaction of the body is based on the ‘rebound effect’ of modern drugs, a type of adverse event that occurs following discontinuation of several classes of drugs prescribed according to the ‘principle of contraries’ (contraria contrariis curantur). Aim: The present review sought to scientifically substantiate the homeopathic healing principle vis-à-vis experimental and clinical pharmacology through a systematic study of the rebound effect of modern drugs or paradoxical reaction of the body. Methods: Employing as reference the studies and revisions on the subject that we have published since 1998, we updated the data adding recent studies cited in database PubMed. Results: The rebound effect occurs after discontinuation of several classes of drugs with contrary action to the symptoms of diseases, exacerbating them to levels above the ones present before treatment. Regardless of disease, drug, dose and duration of treatment, the rebound phenomenon manifests in a small proportion of susceptible individuals.[...] Conclusions: Evidenced in hundreds of studies that attest to the similarity of concepts and manifestations, the rebound effect of modern drugs scientifically substantiates the principle of homeopathic cure. Although the rebound phenomenon is an adverse event studied by modern pharmacology, it is not known by healthcare professionals, thus depriving doctors of knowledge indispensable for a safe management of drugs. (AU)

Scientific basis of the homeopathic healing principle in modern harmacology

Background: Homeopathy employs the so-called ‘principle of similars’ as therapeutic method - which consists in administering medicines that cause certain symptoms in healthy individuals to treat similar symptoms in sick individuals (similia similibus curantur) - to induce a secondary and healing reaction by the body against its own disorders. This secondary (vital, homeostatic or paradoxical) reaction of the body is based on the ‘rebound effect’ of modern drugs, a type of adverse event that occurs following discontinuation of several classes of drugs prescribed according to the ‘principle of contraries’ (contraria contrariis curantur). Aim: The present review sought to scientifically substantiate the homeopathic healing principle vis-à-vis experimental and clinical pharmacology through a systematic study of the rebound effect of modern drugs or paradoxical reaction of the body. Methods: Employing as reference studies and revisions on the subject published since 1998, we updated the data adding recent studies included in database PubMed. Results: The rebound effect occurs after discontinuation of several classes of drugs with action contrary to the symptoms of diseases, exacerbating them to levels above the ones before treatment. [...]. Following the homeopathic premises, modern drugs might also be used according to the principle oftherapeutic similitude, thus employing the rebound effect (paradoxical reaction) with curative intent. Conclusions: Evidenced by hundreds of studies that attest to the similarityof concepts and manifestations, the rebound effect of modern drugs scientifically substantiates the principle of homeopathic cure. Although the rebound phenomenon is anadverse event studied by modern pharmacology, it is not known by health care professionals, thus depriving doctors of knowledge indispensable for safe management ofdrugs. (AU)

Fundamentação científica do princípio de cura homeopático na farmacologia moderna / Scientific basis of the homeopathic healing principle in modern harmacology

Introdução: O modelo homeopático de tratamento utiliza o ‘princípio dos semelhantes’ como método terapêutico, administrando medicamentos que causam determinados sintomas em indivíduos sadios para tratar sintomas semelhantes em indivíduos doentes (similia similibus curantur), com o intuito de despertar uma reação secundária e curativa do organismo contra os seus próprios distúrbios. Essa reação secundária (vital, homeostática ou paradoxal) do organismo está embasada no ‘efeito rebote’ dos fármacos modernos, evento adverso observado após a descontinuação de diversas classes de drogas que utilizam o ‘princípio dos contrários’ (contraria contrariis curantur) como métodoterapêutico. Objetivo: Esta revisão visa fundamentar cientificamente o princípio de cura homeopático perante a farmacologia clínica e experimental, através do estudo sistemático do efeito rebote dos fármacos modernos ou reação paradoxal do organismo. Métodos: Empregando como fonte de referência os estudos e revisões sobre o tema que vimos publicando desde 1998, atualizamos os dados acrescentando pesquisas recentes citadasna base de dados PubMed. Resultados: O efeito rebote ocorre após a descontinuação de inúmeras classes de fármacos com ação terapêutica contrária aos sintomas das doenças, exacerbando-os a níveis superiores aos anteriores do tratamento. Independente da doença, da droga, da dose e da duração do tratamento, o fenômeno rebote se manifesta numa pequena proporção de indivíduos suscetíveis. Seguindo as premissas homeopáticas, osfármacos modernos também podem ser utilizados segundo o princípio da similitude terapêutica, empregando o efeito rebote (reação paradoxal) de forma curativa Conclusões: [...] Embora o fenômeno rebote seja um evento adversoestudado pela farmacologia moderna, ele não é conhecido pelos profissionais da saúde, privando a classe médica de um saber indispensável ao manejo seguro dos fármacos. (AU)

Secondary myeloid neoplasms: bone marrow cytogenetic and histological features may be relevant to prognosis

Abstract Background: Secondary myeloid neoplasms comprise a group of diseases arising after chemotherapy, radiation, immunosuppressive therapy or from aplastic anemia. Few studies have addressed prognostic factors in these neoplasms. Method: Forty-two patients diagnosed from 1987 to 2008 with secondary myeloid neoplasms were retrospectively evaluated concerning clinical, biochemical, peripheral blood, bone marrow aspirate, biopsy, and immunohistochemistry and cytogenetic features at diagnosis as prognostic factors. The International Prognostic Scoring System was applied. Statistical analysis employed the Kaplan–Meier method, log-rank and Fisher's exact test. Results: Twenty-three patients (54.8%) were male and the median age was 53.5 years (range: 4–88 years) at diagnosis of secondary myeloid neoplasms. Previous diseases included hematologic malignancies, solid tumors, aplastic anemia, autoimmune diseases and conditions requiring solid organ transplantations. One third of patients (33%) were submitted to chemotherapy alone, 2% to radiotherapy, 26% to both modalities and 28% to immunosuppressive agents. Five patients (11.9%) had undergone autologous hematopoietic stem cell transplantation. The median latency between the primary disease and secondary myeloid neoplasms was 85 months (range: 23–221 months). Eight patients were submitted to allogeneic hematopoietic stem cell transplantation to treat secondary myeloid neoplasms. Important changes in bone marrow were detected mainly by biopsy, immunohistochemistry and cytogenetics. The presence of clusters of CD117+ cells and p53+ cells were associated with low survival. p53 was associated to a higher risk according to the International Prognostic Scoring System. High prevalence of clonal abnormalities (84.3%) and thrombocytopenia (78.6%) were independent factors for poor survival. Conclusion: This study demonstrated that cytogenetics, bone marrow biopsy and immunohistochemistry are very important prognostic tools in secondary myeloid neoplasms.

Potentized estrogen in homeopathic treatment of endometriosis-associated pelvic pain: A 24-week, randomized, double-blind, placebo-controlled study

OBJECTIVE: To evaluate the efficacy and safety of potentized estrogen compared to placebo in homeopathic treatment of endometriosis-associated pelvic pain (EAPP). Study design: The present was a 24-week, randomized, double-blind, placebocontrolled trial that included 50 women aged 18-45 years old with diagnosis of deeply infiltrating endometriosis based on magnetic resonance imaging or transvaginal ultrasound after bowel preparation, and score ≥ 5 on a visual analogue scale (VAS: range 0 to 10 points) for endometriosis-associated pelvic pain. Potentized estrogen (12cH, 18cH and 24cH) or placebo was administered twice daily per oral route. The primary outcome measure was change in the severity of EAPP global and partial scores (VAS) from baseline to week 24, determined as the difference in the mean score of five modalities of chronic pelvic pain (dysmenorrhea, deep dyspareunia, non-cyclic pelvic pain, cyclic bowel pain and/or cyclic urinary pain). The secondary outcome measures were mean score difference for quality of life assessed with SF-36 Health Survey Questionnaire, depression symptoms on Beck Depression Inventory (BDI), and anxiety symptoms on Beck Anxiety Inventory (BAI). RESULTS: The EAPP global score (VAS: range 0 to 50 points) decreased by 12.82 (p< 0.001) in the group treated with potentized estrogen from baseline to week 24. Group that used potentized estrogen also exhibited partial score (VAS: range 0 to 10 points) reduction in three EAPP modalities: dysmenorrhea (3.28; p< 0.001), non-cyclic pelvic pain (2.71; p= 0.009), and cyclic bowel pain (3.40; p< 0.001). Placebo group did not show any significant changes in EAPP global or partial scores. [...] CONCLUSIONS: Potentized estrogen (12cH, 18cH and 24cH) at a dose of 3 drops twice daily for 24 weeks was significantly more effective than placebo for reducing endometriosis-associated pelvic pain. Trial registration: ClinicalTrials.gov Identifier: https://clinicaltrials.gov/show/NCT02427386.

Estrogênio potencializado no tratamento homeopático da dor pélvica associada à endometriose: Um estudo de 24 semanas, randomizado, duplocego e placebo-controlado / Estrogen potentiated in the homeopathic treatment of endometriosis-associated pelvic pain: A 24-week, randomized, double-blind, placebo-controlled study

Objetivo: Avaliar a eficácia e a segurança do estrogênio potencializado em comparação com o placebo no tratamento homeopático da dor pélvica associada à endometriose (DPAE). Desenho do estudo: Ensaio randomizado, duplo-cego e placebocontrolado de 24 semanas de duração, que incluiu 50 mulheres com idade entre 18-45 anos de idade, diagnóstico de endometriose infiltrativa profunda com base em ressonância magnética nuclear ou ultrassonografia transvaginal após preparo intestinal e escore ≥ 5 na escala analógica visual (EAV: intervalo de 0 a 10 pontos) para DPAE. Estrogênio potencializado (12cH, 18cH e 24cH) ou placebo foi administrado 2 vezes ao dia por via oral. A medida de desfecho primário foi a mudança na severidade da DPAE com base no escore global e parcial (EAV) entre as semanas 0-24, determinado pela diferença entre a pontuação média de 5 modalidades de dor pélvica crônica (dismenorreia, dispareunia de profundidade, dor pélvica acíclica, dor intestinal cíclica e/ou dor urinária cíclica). Os desfechos secundários foram: diferença nos escores médios para qualidade de vida (SF-36), sintomas de depressão (Inventário de Depressão de Beck, IDB) e sintomas de ansiedade (Inventário de Ansiedade de Beck, IAB). [...]O grupo placebo não mostrou qualquer melhora significativa nesses desfechos secundários. Esses resultados demonstraram a superioridade do estrogênio potencializado em comparação ao placebo. Alguns efeitos adversos foram associados com o estrogênio dinamizado. Conclusões: Estrogênio potencializado (12cH, 18cH e 24cH) na dose de 3 gotas 2 vezes ao dia durante 24 semanas foi significativamente mais eficaz que o placebo na redução da dor pélvica associada à endometriose.Registro do estudo: ClinicalTrials.gov Identificador: NCT02427386. (AU)

Objective: To evaluate the efficacy and safety of potentized estrogen compared to placebo in homeopathic treatment of endometriosis-associated pelvic pain (EAPP). Study design: The present was a 24-week, randomized, double-blind, placebocontrolled trial that included 50 women aged 18-45 years old with diagnosis of deeply infiltrating endometriosis based on magnetic resonance imaging or transvaginal ultrasound after bowel preparation, and score ≥ 5 on a visual analogue scale (VAS: range 0 to 10 points) for endometriosis-associated pelvic pain. Potentized estrogen (12cH, 18cH and 24cH) or placebo was administered twice daily per oral route. The primary outcome measure was change in the severity of EAPP global and partial scores (VAS) from baseline to week 24, determined as the difference in the mean score of five modalities of chronic pelvic pain (dysmenorrhea, deep dyspareunia, non-cyclic pelvic pain, cyclic bowel pain and/or cyclic urinary pain). The secondary outcome measures were mean score difference for quality of life assessed with SF-36 Health Survey Questionnaire, depression symptoms on Beck Depression Inventory (BDI), and anxiety symptoms on Beck Anxiety Inventory (BAI). [...] Placebo group did not show any significant changes in EAPP global or partial scores. In addition, the potentized estrogen group showed significant improvement in three of eight SF-36 domains (bodily pain, vitality and mental health) and depression symptoms (BDI). Placebo group showed no significant improvement in this regard. These results demonstrate superiority of potentized estrogen over placebo. Few adverse events were associated with potentized estrogen. Conclusions: Potentized estrogen (12cH, 18cH and 24cH) at a dose of 3 drops twice daily for 24 weeks was significantly more effective than placebo for reducing endometriosis-associated pelvic pain. Trial registration: ClinicalTrials.gov Identifier: NCT02427386. (AU)fier: NCT02427386. (AU)

Potentized estrogen in homeopathic treatment of endometriosis-associatedpelvic pain: A 24-week, randomized, double-blind, placebo-controlled study

Objective: To evaluate the efficacy and safety of potentized estrogen compared to placebo in homeopathic treatment of endometriosis-associated pelvic pain (EAPP). Study design: The present was a 24-week, randomized, double-blind, placebocontrolled trial that included 50 women aged 18-45 years old with diagnosis of deeply infiltrating endometriosis based on magnetic resonance imaging or transvaginal ultrasound after bowel preparation, and score ≥ 5 on a visual analogue scale (VAS: range 0 to 10 points) for endometriosis-associated pelvic pain. Potentized estrogen (12cH, 18cH and 24cH) or placebo was administered twice daily per oral route. The primary outcome measure was change in the severity of EAPP global and partial scores (VAS) from baseline to week 24, determined as the difference in the mean score of five modalities of chronic pelvic pain (dysmenorrhea, deep dyspareunia, non-cyclic pelvic pain, cyclic bowel pain and/or cyclic urinary pain). The secondary outcome measures were mean score difference for quality of life assessed with SF-36 Health Survey Questionnaire, depression symptoms on Beck Depression Inventory (BDI), and anxiety symptoms on Beck Anxiety Inventory (BAI). Results: The EAPP global score (VAS: range 0 to 50 points) decreased by 12.82 (p< 0.001) in the group treated with potentized estrogen from baseline to week 24. Group that used potentized estrogen also exhibited partial score (VAS: range 0 to 10 points) reduction in three EAPP modalities: dysmenorrhea (3.28; p< 0.001), non-cyclic pelvic pain (2.71; p= 0.009), and cyclic bowel pain (3.40; p< 0.001). Placebo group did not show any significant changes in EAPP global or partial scores. [...] Conclusions: Potentized estrogen (12cH, 18cH and 24cH) at a dose of 3 drops twice daily for 24 weeks was significantly more effective than placebo for reducing endometriosis-associated pelvic pain. Trial registration: ClinicalTrials.gov Identifier: https://clinicaltrials.gov/show/NCT02427386. (AU)

Estrogênio potencializado no tratamento homeopático da dor pélvica associada à endometriose: Um estudo de 24 semanas, randomizado, duplocego e placebo-controlado / Potentized estrogen in homeopathic treatment of endometriosis-associatedpelvic pain: A 24-week, randomized, double-blind, placebo-controlled study

Objetivo: Avaliar a eficácia e a segurança do estrogênio potencializado em comparação com o placebo no tratamento homeopático da dor pélvica associada à endometriose (DPAE). Desenho do estudo: Ensaio randomizado, duplo-cego e placebocontrolado de 24 semanas de duração, que incluiu 50 mulheres com idade entre 18-45 anos de idade, diagnóstico de endometriose infiltrativa profunda com base em ressonância magnética nuclear ou ultrassonografia transvaginal após preparo intestinal e escore ≥ 5 na escala analógica visual (EAV: intervalo de 0 a 10 pontos) para DPAE. Estrogênio potencializado (12cH, 18cH e 24cH) ou placebo foi administrado 2 vezes ao dia por via oral. A medida de desfecho primário foi a mudança na severidade da DPAE com base no escore global e parcial (EAV) entre as semanas 0-24, determinado pela diferença entre a pontuação média de 5 modalidades de dor pélvica crônica (dismenorreia, dispareunia de profundidade, dor pélvica acíclica, dor intestinal cíclica e/ou dor urinária cíclica). Os desfechos secundários foram: diferença nos escores médios para qualidade de vida (SF-36), sintomas de depressão (Inventário de Depressão de Beck, IDB) e sintomas de ansiedade (Inventário de Ansiedade de Beck, IAB). [...]O grupo placebo não mostrou qualquer melhora significativa nesses desfechos secundários. Esses resultados demonstraram a superioridade do estrogênio potencializado em comparação ao placebo. Alguns efeitos adversos foram associados com o estrogênio dinamizado. Conclusões: Estrogênio potencializado (12cH, 18cH e 24cH) na dose de 3 gotas 2 vezes ao dia durante 24 semanas foi significativamente mais eficaz que o placebo na redução da dor pélvica associada à endometriose.Registro do estudo: ClinicalTrials.gov Identificador: NCT02427386. (AU)

‘Paradoxical pharmacology’: therapeutic strategy used by the ‘homeopathic pharmacology’ for more than two centuries

Using the empirical or phenomenological research method by observing the effects of drugs in the human physiology, Samuel Hahnemann proposed the homeopathic treatment. He synthesized modern pharmacodynamic in the ‘primary action’ of the drugs and in the consequent and opposite ‘secondary action’ or ‘vital reaction’ of the organism. Noting that drugs with ‘contrary’ primary action to the symptoms of the diseases caused worsening of the symptoms after its withdrawal, as a result of secondary action of the organism, Hahnemann proposed using this vital reaction (secondary action) in a curative way, administering to sick individuals the drugs that caused‘similar’ symptoms in healthy individuals (therapeutic use of the similitude principle). According to the clinical and experimental pharmacology, this secondary action (vital reaction) of the organism is observed in the ‘rebound effect’ or ‘paradoxical reaction’ of several classes of drugs, which is the scientific basis of the ‘homeopathic pharmacology’. In the last decade, exponents of modern pharmacology have suggested the therapeutic use of the paradoxical reaction(‘paradoxical pharmacology’), proposing the use of drugs that cause an exacerbation of the disease in the short term to treat these same diseases in the long-term. In this review, we compare the various aspects between the ‘homeopathic pharmacology’ and the ‘paradoxical pharmacology’, reinforcing the validity of homeopathic assumptions and expanding the knowledge to optimize both proposals.(AU)

Similia similibus curentur: o princípio de cura homeopático fundamentado na farmacologia moderna / Similia similibus curentur: the homeopathic healing principle based on modern pharmacology

O modelo homeopático de tratamento das doenças utiliza o ‘princípio da semelhança’ como método terapêutico, empregando medicamentos que causam determinados sintomas em indivíduos sadios para tratar sintomas semelhantes em indivíduos doentes (similia similibus curentur), com o intuito de estimular uma reação curativa do organismo contra os seus próprios distúrbios. Esta reação secundária (vital, homeostática ou paradoxal) do organismo está fundamentada no estudo do ‘efeito rebote’ dos fármacos modernos, evento adverso que pode causar transtornos graves após a descontinuação de diversas classes de tratamentos convencionais que utilizam o ‘princípio dos contrários’ como prática terapêutica (contraria contrariis curentur). Embora o fenômeno rebote seja um evento adverso estudado pela farmacologia moderna, ele é desconhecido pelos profissionais da saúde, privando a classe médica de um conhecimento necessário e fundamental ao manejo seguro dos fármacos. Apesar de se expressar numa pequena proporção de indivíduos suscetíveis, o efeito rebote assume importância epidemiológica em vista do enorme consumo de medicamentos pela população e da falta de esclarecimentos sobre o fenômeno. Este artigo apresenta uma revisão atualizada sobre o efeito rebote das drogas, relacionando-o ao princípio de cura homeopático.

The homeopathic model of treatment of diseases uses the ‘principle of similarity’ as therapeutic method, employing drugs that cause certain symptoms in healthy individuals to treat similar symptoms in sick individuals (similia similibus curentur), seeking to stimulate a healing reaction of the organism against its own disorders. This secondary (vital, homeostatic or paradoxical) reaction of the organism is based on the study of the ‘rebound effect’ of modern drugs, iatrogenic event that can cause serious disorders after the discontinuation of several classes of conventional treatments that use the ‘principle of contraries’ as therapeutic practice (contraria contrariis curentur). Although the rebound phenomenon is an adverse event studied by modern pharmacology, it is unknown by health professionals, depriving the medical class of a necessary and fundamental knowledge to the safe management of drugs. Despite expressing itself in a small proportion of susceptible individuals, the rebound effect assumes epidemiological importance in view of the enormous consumption of drugs by the population and the lack of clarity on the phenomenon. This article presents an updated review on the rebound effect of drugs, relating it to the homeopathic healing principle.