[Frequency of food allergy in students of human medicine of a private university]. / Frecuencia de alergia alimentaria en estudiantes de medicina humana de una universidad privada.

OBJECTIVE: Determine the frequency of total food allergy, and to Peruvian products, in Human Medicine students. METHODS: A study design is observational, descriptive and retrospective was made. Human medicine students, aged 18-25 from a private Peruvian university were included in a type of snowball sampling via electronic messaging. The sample size was calculated using the OpenEpi v3.0 program and the prevalence formula. RESULTS: We registered 355 students, with a mean age of 20.87 years (SD ± 5.01). A frequency of food allergy was also found in 9.3% of the total participants in terms of native products and common in other countries, the highest percentage are seafood 2.24%, spices and condiments 2.24%, allergy to fruits 1.4%, milk 1.4%, red meat 0.84%. CONCLUSIONS: The frequencies of self-reported food allergy produced was 9.3% by native Peruvian products and commonly consumed nationwide.

OBJECTIVO: Determinar la frecuencia de alergia alimentaria en general, y de productos de consumo común oriundos del Perú, en estudiantes de medicina humana. MÉTODOS: Estudio observacional, descriptivo y retrospectivo, al que se incluyeron estudiantes de medicina humana de 18-25 años, de una universidad privada del Perú, seleccionados mediante muestreo tipo "bola de nieve" a través de mensajería electrónica. El tamaño de la muestra se calculó con el programa OpenEpi v3.0 y la fórmula de prevalencia. RESULTADOS: Se registraron 355 estudiantes, con edad media de 20.9 años (SD ± 5,01). La frecuencia de alergia alimentaria fue de 9.3% del total de la muestra; y la frecuencia de alergia a productos de consumo común (oriundos del país) reportó: mariscos 2.24%, especias y condimentos 2.24%, frutas 1.4%, leche 1.4% y carnes rojas 0.84%. CONCLUSIONES: Existe una frecuencia de 9.3% de alergia alimentaria autorreportada, producida por productos de consumo común (oriundos del Perú) a nivel nacional.

Uso de emulsiones lipídicas en el tratamiento exitoso de un caso de intoxicación por difenhidramina / Use of lipid emulsions in the successful treatment of a case of diphenhydramine poisoning / Uso de emulsões lipídicas no sucesso do tratamento de um caso de intoxicação por difenidramina

La difenhidramina tiene efectos antihistamínico anti-H1 específico y antimuscarínico que pueden ocasionar un desenlace fatal según la dosis total ingerida. Se reporta un caso de intoxicación por difenhidramina tratado de forma exitosa con emulsiones lipídicas a pesar de ingesta de dosis letal. Se presenta el caso de un paciente de 19 años que ingresó por intoxicación por difenhidramina a dosis de 25 mg/kg (1.5 g) después del tiempo de descontaminación, con toxidrome anticolinérgico, con neurotoxicidad, cardiotoxicidad (QRS y QT prolongados) y sin respuesta al enfoque inicial, se iniciaron emulsiones lipídicas y, a su vez, se logró alta temprana por evolución clínica favorable y resolución de la prolongación del intervalo QTc y del cuadro anticolinérgico. La emulsión lipídica es una opción terapéutica para disminuir la morbimortalidad y la estancia hospitalaria por contrarrestar la cardiotoxicidad y neurotoxicidad producidas por moléculas lipofílicas como la difenhidramina.

Diphenhydramine has specific anti-H1 antihistamine and antimuscarinic effects that can be fatal depending on the total dose ingested. A case of diphenhydramine poisoning successfully treated with lipid emulsions despite ingesting a lethal dose is presented. We present the case of a 19-year-old patient who was admitted for diphenhydramine intoxication at a dose of 25 mg/kg (1.5 g) after the decontamination time, with anticholinergic toxidrome, with neurotoxicity, cardiotoxicity (prolonged QRS and QT) and without response to initial approach. Lipid emulsions were started and, in turn, early discharge was achieved due to favorable clinical evolution and resolution of the prolongation of the QTc interval and the anticholinergic symptoms. Lipid emulsion is a therapeutic option to reduce morbidity and mortality and hospital stay by counteracting cardiotoxicity and neurotoxicity produced by lipophilic molecules such as diphenhydramine.

A difenidramina tem efeitos anti-histamínicos e antimuscarínicos anti-H1 específicos que podem ser fatais dependendo da dose total ingerida. Relata-se um caso de intoxicação por difenidramina tratada com sucesso com emulsões lipídicas apesar da ingestão de uma dose letal. Apresentamos o caso de uma paciente de 19 anos que foi internada por intoxicação por difenidramina na dose de 25 mg/kg (1,5 g) após o tempo de des-contaminação, com toxina anticolinérgica, neurotoxicidade, cardiotoxicidade (QS e QT prolongados) e sem resposta na abordagem inicial, iniciaram-se emulsões lipídicas e, por sua vez, obteve-se alta precoce devido à evolução clínica favorável e resolução do prolongamento do intervalo QTc e dos sintomas anticolinérgicos. A emulsão lipídica é uma opção terapêutica para reduzir a morbimortalidade e o tempo de internação por neutralizar a cardiotoxicidade e a neurotoxicidade produzidas por moléculas lipofílicas como a difenidramina.

Eficacia de la miel para el tratamiento de la tos aguda en niños atendidos en forma ambulatoria / Efficacy of honey for treatment of acute cough in pediatric outpatients

A partir de una consulta en la central de emergencias de un niño con tos aguda, el autor del artículo realiza una búsqueda bibliográfica para revisar la evidencia sobre el uso de la miel para aliviar este síntoma. Luego de la lectura crítica de una revisión sistemática, el autor concluye que ésta podría ser una alternativa elegible frente a los jarabes para la tos, por su perfil de seguridad y su posible beneficio en el alivio de la tos. (AU)

Based on a consultation at the emergency room of a child with acute cough, the author of this article performs a bibliographic search to review the evidence on the use of honey to alleviate this symptom. After the critical appraisal of a systematic review, the author concludes that honey could be an eligible alternative to cough syrups, due to its safety profile and its possible benefit in cough relief. (AU)

The feasibility of dexamethasone omission in weekly paclitaxel treatment for breast cancer patients.

OBJECTIVES: Patients with breast cancer who receive weekly paclitaxel therapy may experience deleterious effects associated with prophylactic dexamethasone use for 12 consecutive weeks. Approximately 90% of paclitaxel hypersensitivity reactions (HSRs) occur within the first 10 to 15 min of the first two infusions. We investigated the feasibility of dexamethasone withdrawal between weeks 3 and 12 (W3 and W12) in early stage breast cancer patients treated with weekly paclitaxel at the standard dose (80 mg/m2). METHODS: All patients received intravenous prophylaxis of dexamethasone 20 mg, ranitidine 50 mg, and diphenhydramine 50 mg in the first 2 weeks (W1 and W2) of treatment. Provided that no serious (G3/G4) HSRs events occurred, dexamethasone was omitted between W3 and W12, while ranitidine and diphenhydramine were continued. The primary end point was the incidence of any grade HSRs during the treatment period, and the secondary end points were quality of life and weight changes. RESULTS: Twenty-five patients were included in the study, and 300 infusion cycles of paclitaxel were evaluated for HSRs. The overall incidence of HSRs was 0.6% (2 events), and both of these events occurred in the first week. There were no incidents of serious HSRs or anaphylaxis and no G3 or G4 toxicities. Scores from the EORTC QLQ-C30 questionnaire did not change significantly for the global health status/quality of life scale or for the symptoms scales, although changes in scores differed significantly for the functional scales. There were no clinically relevant weight changes during the treatment period. CONCLUSIONS: Dexamethasone withdrawal from W3 to W12 in early stage breast cancer patients treated with weekly paclitaxel is feasible. The incidence of all grades of HSRs was comparable to that reported in trials with dexamethasone for 12 consecutive weeks, and no serious events (G3/G4) occurred. Studies with larger sample sizes are needed to confirm our results which are important, especially for patients for whom corticosteroids are contraindicated.

Diphenhydramine inhibits voltage-gated proton channels (Hv1) and induces acidification in leukemic Jurkat T cells- New insights into the pro-apoptotic effects of antihistaminic drugs.

An established characteristic of neoplastic cells is their metabolic reprogramming, known as the Warburg effect, with greater reliance on energetically less efficient pathways (such as glycolysis and pentose phosphate shunt) compared with oxidative phosphorylation. This results in an overproduction of acidic species that must be extruded to maintain intracellular homeostasis. We recently described that blocking the proton currents in leukemic cells mediated by Hv1 ion channels triggers a marked intracellular acidification and apoptosis induction. Moreover, histamine H1-receptor antagonists were found to induce apoptosis in tumoral cells but the mechanism is still unclear. By using Jurkat T cells, we now show how diphenhydramine inhibits Hv1 mediated currents, inducing a drop in intracellular pH and cellular viability. This provides evidence of a new target structure responsible of the known pro-apoptotic action of antihistaminic drugs.

[Effectiveness of intravenous sedation with midazolam-diphenhydramine in patients who are going to perform an magnetic resonance]. / Efectividad de la sedación intravenosa con midazolam- difenhidramina en pacientes a quienes se va a realizar una resonancia magnética (RM).

INTRODUCTION: The requirement of the anesthesiologist for patient care outside the surgical area is constantly increasing. It is an activity that encompasses the different degrees of monitoring, sedation, and anesthesia. OBJECTIVE: To compare the safety and efficacy of midazolam midazolam-diphenhydramine against magnetic resonance with level of sedation on the Ramsay scale. MATERIALS AND METHODS: We performed a study in the Instituto Mexicano del Seguro Social Obregon, Sonora, of patients scheduled for cranial magnetic resonance imaging with sedation, during October and December 2013, comparing two groups: midazolam/diphenhydramine against midazolam groups. RESULTS: We included 68 patients, 34 in the experimental group (midazolam-diphenhydramine) versus 34 controls (midazolam). The Ramsay scale showed, in the experimental group, an increased sedation effect resulting in one Ramsay 1, at 10 minutes 2.8 2.8 20 minutes and 30 minutes 2.0. In the control group the basal Ramsay was 1, 2.1 to 10 minutes, 20 minutes and 2.1 to 2.0 at 30 minutes (p = 0.0001). The analysis of heart rate, respiratory, and baseline oxygen saturation, at 10, 20 and 30 minutes, was p = 0.0001 for both groups. CONCLUSION: The combination of diphenhydramine with intravenous midazolam is safe, with the degree of sedation being better compared with use of midazolam alone, resulting in less failure of sedation during magnetic resonance imaging.

Simultaneous determination of three species with a single-injection step using batch injection analysis with multiple pulse amperometric detection.

In this work, the possibility of simultaneous determination of three compounds with a single-injection step using batch injection analysis with multiple pulse amperometric detection (BIA-MPA) is demonstrated for the first time. A sequence of three potential pulses (+1.25 V, +1.60 V, and +1.80 V) was applied with the acquisition of three separate amperograms. 8-Chlorotheophylline was detected selectively at +1.25 V, both 8-chlorotheophylline and pyridoxine at +1.60V and 8-chlorotheophylline, pyridoxine, and diphenhydramine at +1.80 V. Subtraction between the currents detected at the three amperograms (with the help of correction factors) was used for the selective determination of pyridoxine and diphenhydramine. The proposed method is simple, inexpensive, fast (60 injections h(-1)), and present selectivity for the determination of the three compounds in pharmaceutical samples, with results similar to those obtained by HPLC (95% confidence level).

Tortícolis aguda en la práctica neuropediátrica / Acute torticollis in neuro-pediatric practice

Objetivos: Delinear un algoritmo de actuación ante un niño o adolescente con tortícolis aguda, para facilitar la asistencia médica adecuada y oportuna.Desarrollo: La atención de un niño o adolescente con tortícolis aguda, requiere que el médico considere un grupo de trastornos con diferentes pronósticos. Previamente debe poseer una estrategia diagnóstica que le permita llegar a conclusiones de una manera rápida y a la vez, correcta. Se presenta una propuesta para la asistencia de estos pacientes. Los principios se organizan de manera que en primer lugar se establezcan las características evolutivas del evento. Luego la inclusión en grupos con características comunes que permitanrealizar un acercamiento a un conjunto de enfermedades. Por último, se incluyen las sugerencias de los exámenes a indicar en caso desospecha de un trastorno en específico o incluso cuando no hay una orientación suficientemente clara de lo que ocurre.Conclusiones: El algoritmo de actuación delineado ante un niño o adolescente con tortícolis aguda puede facilitar la acción adecuada y oportuna, aunque constituye solo una orientación. Con la experiencia y los conocimientos de cada profesional, dicho algoritmo puede sermodificado ante las múltiples situaciones que pueden presentarse en un paciente pediátrico con tortícolis aguda(AU)

Objective: To delineate an algorithm of actuation designed for the attention to children and adolescents with acute torticollis and to offer them an efficient and opportune medical assistance.Development: The attention of children and adolescents with acute torticollis requires that the physician may consider a group of disorders with different outcomes. Previously he should have a strategy for diagnosis that it may let him to arrive to quick and correct conclusions.Here is presented a proposition about the assistance to patients with acute torticollis. The principles are organized and in the first line are considered evolution characteristic of events. Next, is important the inclusion of patients in groups with common characteristics that allow to carry out an approach to a cluster of illnesses. Lastly, should be included some suggestions about key investigations in occasion ofsuspicion of one specific disorder or even when there is not sufficient clear orientation of what happens.Conclusions: The delineated algorithm of actuation in children and adolescents with acute torticollis may to facilitate the correct and opportune action although this proposition only constitutes an orientation. With the professional experience and knowledge, the algorithm may be modified according different situations during the attention of one pediatric patient affected by acute torticollis(AU)

Modulatory effects of taurine on jejunal contractility

Taurine (2-aminoethanesulfonic acid) is widely distributed in animal tissues and has diverse pharmacological effects. However, the role of taurine in modulating smooth muscle contractility is still controversial. We propose that taurine (5-80 mM) can exert bidirectional modulation on the contractility of isolated rat jejunal segments. Different low and high contractile states were induced in isolated jejunal segments of rats to observe the effects of taurine and the associated mechanisms. Taurine induced stimulatory effects on the contractility of isolated rat jejunal segments at 3 different low contractile states, and inhibitory effects at 3 different high contractile states. Bidirectional modulation was not observed in the presence of verapamil or tetrodotoxin, suggesting that taurine-induced bidirectional modulation is Ca2+ dependent and requires the presence of the enteric nervous system. The stimulatory effects of taurine on the contractility of isolated jejunal segments was blocked by atropine but not by diphenhydramine or by cimetidine, suggesting that muscarinic-linked activation was involved in the stimulatory effects when isolated jejunal segments were in a low contractile state. The inhibitory effects of taurine on the contractility of isolated jejunal segments were blocked by propranolol and L-NG-nitroarginine but not by phentolamine, suggesting that adrenergic β receptors and a nitric oxide relaxing mechanism were involved when isolated jejunal segments were in high contractile states. No bidirectional effects of taurine on myosin phosphorylation were observed. The contractile states of jejunal segments determine taurine-induced stimulatory or inhibitory effects, which are associated with muscarinic receptors and adrenergic β receptors, and a nitric oxide associated relaxing mechanism.

Modulatory effects of taurine on jejunal contractility.

Taurine (2-aminoethanesulfonic acid) is widely distributed in animal tissues and has diverse pharmacological effects. However, the role of taurine in modulating smooth muscle contractility is still controversial. We propose that taurine (5-80 mM) can exert bidirectional modulation on the contractility of isolated rat jejunal segments. Different low and high contractile states were induced in isolated jejunal segments of rats to observe the effects of taurine and the associated mechanisms. Taurine induced stimulatory effects on the contractility of isolated rat jejunal segments at 3 different low contractile states, and inhibitory effects at 3 different high contractile states. Bidirectional modulation was not observed in the presence of verapamil or tetrodotoxin, suggesting that taurine-induced bidirectional modulation is Ca(2+) dependent and requires the presence of the enteric nervous system. The stimulatory effects of taurine on the contractility of isolated jejunal segments was blocked by atropine but not by diphenhydramine or by cimetidine, suggesting that muscarinic-linked activation was involved in the stimulatory effects when isolated jejunal segments were in a low contractile state. The inhibitory effects of taurine on the contractility of isolated jejunal segments were blocked by propranolol and L-NG-nitroarginine but not by phentolamine, suggesting that adrenergic ß receptors and a nitric oxide relaxing mechanism were involved when isolated jejunal segments were in high contractile states. No bidirectional effects of taurine on myosin phosphorylation were observed. The contractile states of jejunal segments determine taurine-induced stimulatory or inhibitory effects, which are associated with muscarinic receptors and adrenergic ß receptors, and a nitric oxide associated relaxing mechanism.

[Anaphylaxis secondary to prick-to-prick tests to foods and its risk factors]. / Anafilaxia secundaria a pruebas cutáneas prick-to-prick para alimentos y sus factores de riesgo.

The diagnosis of food allergy requires a proper anamnesis and diagnostic testing with skin prick tests with fresh foods and/or standardized allergen, or specific IgE tests. The risk of systemic reactions is of 15-23 per 100,000 skin tests performed by prick method, specifically anaphylaxis at 0.02%. This paper reports the case of four patients, who while performing prick to prick test with fresh food presented anaphylactic reaction. Implicated foods were fruits of the Rosaceae, Anacardiaceae and Caricaceae families. The severity of anaphylaxis was: two patients with grade 4, one patient grade 2 and one grade 3, all with appropriate response to drug treatment. The risk factors identified were: female sex, personal history of atopy, previous systemic reaction to Hymenoptera venom, prior anaphylaxis to prick tests to aeroallergens. We found that a history of positive skin test for Betulla v, can be a risk factor for anaphylaxis in patients with oral syndrome. During testing prick to prick with food anaphylaxis can occur, so it should be made with aerial red team on hand. The history of positivity Betulla v is an additional risk factor in these patients.

El diagnóstico de alergia alimentaria requiere una anamnesis adecuada y la realización de pruebas diagnósticas, las pruebas cutáneas con alimentos en fresco, con alergenos estandarizados, o con ambos; las pruebas de IgE específica para alimentos son útiles. El riesgo de reacciones sistémicas por pruebas cutáneas por punción es de 15 a 23 por cada 100,000 y el de anafilaxia es de 0.02%. Comunicamos el caso de cuatro pacientes que sufrieron anafilaxia durante la realización de prueba Prick-to-Prick con alimentos frescos. Los alimentos implicados fueron frutas de las familias Rosaceae, Anacardiaceae y Caricaceae. En dos pacientes la anafilaxia fue de grado 4, en una grado 2 y en otra grado 3, todas con adecuada respuesta al tratamiento farmacológico. Los factores de riesgo fueron: sexo femenino, antecedente personal de atopia, reacción sistémica previa a veneno de himenópteros y anafilaxia previa con pruebas por punción para aeroalergenos. Las cuatro pacientes tuvieron síndrome de alergia oral y 50% tenía antecedente de prueba por punción positiva a betuláceas. Durante la realización de pruebas Prick-to-Prick para alimentos los pacientes pueden presentar anafilaxia, por lo que deben realizarse en un área que cuente con equipo rojo. El antecedente de síndrome de alergia oral se observó en todos los casos y la mitad de las pacientes tuvieron positividad a betuláceas, estos antecedentes pueden ser factores de riesgo adicional de anafilaxia dura te la realización de pruebas Prick-to-Prick para alimentos.

Evaluation of microcrystalline cellulose II (MCCII) as an alternative extrusion-spheronization aid.

Microcrystalline cellulose II (MCCII) is a different allomorph of MCC that can be used as a filler and a disintegrant for direct compression. MCCII was studied as new pelletization aid with the aim to prepare pellets with a faster drug release than MCCI-based pellets. MCCII-based pellets showed an immediate diphenydramineHCl release profile comparable to that of Benadryl and a faster griseofulvin release than MCCI-based pellets. MCCII offers potential to use as an alternative pelletization aid.

Comparação do tratamento homeopático e convencional numa epidemia de conjuntivite / Comparación del tratamiento homeopático y convencional en una epidemia de conjuntivitis / Comparison between homeopathic and conventional treatment in a conjunctivitis epidemic

Objetivo: Comparar os resultados dos tratamentos homeopático e convencional na epidemia de conjuntivite viral em 1997 em Ranchuelo, VC, Cuba. Materiais e métodos: Estudo retrospectivo de 67 pacientes diagnosticados e hospitalizados durante uma epidemia de conjuntivite viral que aconteceu entre julho e setembro de 1997 na área de saúde de Ranchuelo, divididos em dois grupos; um grupo de 47 pacientes foi submetido a tratamento convencional, e em segundo grupo de 20 pacientes a tratamento homeopático. Resultados: Comprovou-se que o tratamento homeopático induziu a cura em menor tempo, o tratamento convencional requereu quase o dobro do tempo. Além do mais, o tratamento homeopático teve custo menor que o convencional, que foi mais do dobro. Conclusões: Foi demostrada a ação benéfica do tratamento homeopático no controle da epidemia, enquanto que a cura aconteceu num tempo mais breve e com menos custo que o tratamento convencional.

Aim: To compare results of homeopathic and conventional treatment in a conjunctivitis epidemic in 1997 in Ranchuelo, VC, Cuba. Materials and methods: Retrospective study comprising 67 patients diagnosed and hospitalized during a viral conjunctivitis epidemic between July and September 1997 in Ranchuelo health district divided in two groups; one group comprising 47 patients was given conventional treatment, and a second group comprising 20 patients was given homeopathic treatment. Results: Homeopathic treatment elicited faster healing, since conventional treatment required almost twice as long. Moreover, cost of homeopathic treatment was lowed compared to conventional treatment, the latter was more than twice as expensive. Conclusions: Homeopathic treatment proved beneficial to control this epidemic since healing was faster and less expensive than conventional treatment.

Objetivo: Comparar los resultados de los tratamientos homeopático y convencional sobre la epidemia de conjuntivitis viral del año 1997 en Ranchuelo, VC, Cuba. Material y métodos: Se trata de un estudio retrospectivo de un total de 67 pacientes que se diagnosticaron y se ingresaron durante la epidemia de conjuntivitis viral que se produjo en los meses de julio a septiembre de 1997 en el área de salud de Ranchuelo, conformados en dos grupos, un primer grupo de 47 pacientes tratados con medicamentos convencionales y un segundo grupo de 20 pacientes tratados con medicamentos homeopáticos, Resultados: Se comprobó que el tratamiento homeopático produjo la curación en menor tiempo, necesitando el otro tratamiento casi el doble del tiempo y además, que el tratamiento homeopático demostró ser más barato que el convencional, siendo el costo de éste último más del doble. Conclusiones: Quedó demostrada la buena acción del medicamento homeopático sobre la epidemia, con la curación que se produjo en mucho menos tiempo y con menos costo que con los otros medicamentos.

Comparação do tratamento homeopático e convencional numa epidemia de conjuntivite / Comparación del tratamiento homeopático y convencional en una epidemia de conjuntivitis / Comparison between homeopathic and conventional treatment in a conjunctivitis epidemic

Objetivo: Comparar os resultados dos tratamentos homeopático e convencional na epidemia de conjuntivite viral em 1997 em Ranchuelo, VC, Cuba. Materiais e métodos: Estudo retrospectivo de 67 pacientes diagnosticados e hospitalizados durante uma epidemia de conjuntivite viral que aconteceu entre julho e setembro de 1997 na área de saúde de Ranchuelo, divididos em dois grupos; um grupo de 47 pacientes foi submetido a tratamento convencional, e em segundo grupo de 20 pacientes a tratamento homeopático. Resultados: Comprovou-se que o tratamento homeopático induziu a cura em menor tempo, o tratamento convencional requereu quase o dobro do tempo. Além do mais, o tratamento homeopático teve custo menor que o convencional, que foi mais do dobro. Conclusões: Foi demostrada a ação benéfica do tratamento homeopático no controle da epidemia, enquanto que a cura aconteceu num tempo mais breve e com menos custo que o tratamento convencional.(AU)

Aim: To compare results of homeopathic and conventional treatment in a conjunctivitis epidemic in 1997 in Ranchuelo, VC, Cuba. Materials and methods: Retrospective study comprising 67 patients diagnosed and hospitalized during a viral conjunctivitis epidemic between July and September 1997 in Ranchuelo health district divided in two groups; one group comprising 47 patients was given conventional treatment, and a second group comprising 20 patients was given homeopathic treatment. Results: Homeopathic treatment elicited faster healing, since conventional treatment required almost twice as long. Moreover, cost of homeopathic treatment was lowed compared to conventional treatment, the latter was more than twice as expensive. Conclusions: Homeopathic treatment proved beneficial to control this epidemic since healing was faster and less expensive than conventional treatment.(AU)

Objetivo: Comparar los resultados de los tratamientos homeopático y convencional sobre la epidemia de conjuntivitis viral del año 1997 en Ranchuelo, VC, Cuba. Material y métodos: Se trata de un estudio retrospectivo de un total de 67 pacientes que se diagnosticaron y se ingresaron durante la epidemia de conjuntivitis viral que se produjo en los meses de julio a septiembre de 1997 en el área de salud de Ranchuelo, conformados en dos grupos, un primer grupo de 47 pacientes tratados con medicamentos convencionales y un segundo grupo de 20 pacientes tratados con medicamentos homeopáticos, Resultados: Se comprobó que el tratamiento homeopático produjo la curación en menor tiempo, necesitando el otro tratamiento casi el doble del tiempo y además, que el tratamiento homeopático demostró ser más barato que el convencional, siendo el costo de éste último más del doble. Conclusiones: Quedó demostrada la buena acción del medicamento homeopático sobre la epidemia, con la curación que se produjo en mucho menos tiempo y con menos costo que con los otros medicamentos.(AU)

Hemodynamic effects of atracurium and cisatracurium and the use of diphenhydramine and cimetidine.

BACKGROUND AND OBJECTIVES: Since atracurium can cause hypotension in humans, the hemodynamic effects of atracurium and cisatracurium as well as the hemodynamic protection of diphenhydramine and cimetidine were investigated in rats. METHODS: 1) Wistar rats were anesthetized with sodium pentobarbital and prepared according to Brown et al. to evaluate different doses of atracurium and cisatracurium in the reduction of T4/T1 equal or greater than 95%. 2) Assessment of the hemodynamic changes caused by the intravenous administration of atracurium and cisatracurium by monitoring the blood pressure in the carotid artery and the electrocardiogram of rats. 3) Observation of the hemodynamic protection of prior treatment with the intravenous administration of diphenhydramine (2 mg.kg(-1)) and/or cimetidine (4 mg.kg(-1)). STATISTICAL ANALYSIS: Student t test and ANOVA. RESULTS: Doses of 1 mg.kg(-1) and 0.25 mg.kg(-1) of atracurium and cisatracurium respectively did not change the mean arterial pressure (MAP). Doses of 4 mg.kg(-1) of atracurium and cisatracurium decreased MAP to 62.8 +/- 4.5% and 82.5 +/- 2.3% respectively when compared to control levels. When the rats were pre-treated with diphenhydramine and cimetidine, diastolic pressure was reduced to 95.4% +/- 2.5%. With cimetidine, diastolic pressure was reduced to 82.7 +/- 8.4% when compared to the control group. The effects on systolic and diastolic blood pressure were reflected in the levels of MAP. CONCLUSIONS: The isolated administration of diphenhydramine and cimetidine did not prevent the reduction in mean arterial pressure induced by atracurium. However, the association of both drugs was able to prevent the hemodynamic effects of atracurium. The doses of cisatracurium used in this study did not cause a reduction in blood pressure significant enough to justify the use of the preventive measures used in the atracurium groups.

Efeitos hemodinâmicos do atracúrio e do cisatracúrio e o uso de difenidramina e cimetidina / Hemodynamic effects of atracurium and cisatracurium and the use of diphenhydramine and cimetidine / Efectos hemodinámicos del atracurio y del cisatracurio y el uso de la difenidramina y la cimetidina

Justificativa e objetivos: Haja visto que atracúrio pode causar hipotensão arterial no homem, investigaram-se os efeitos hemodinâmicos promovidos pelo atracúrio e pelo cisatracúrio e a proteção hemodinâmica conferida pela difenidramina e cimetidina em ratos. Método: 1) Ratos Wistar anestesiados com pentobarbital sódico e preparados de acordo com Brown e col. para avaliar doses de atracúrio e cisatracúrio para redução de T4/T1 da sequência de quatro estímulos maior ou igual a 95 por cento. 2) Avaliação das alterações hemodinâmicas de atracúrio e cisatracúrio por injeção venosa, medindo-se a pressão arterial sistêmica da artéria carótida e eletrocardiograma de ratos. 3) Observação de proteção hemodinâmica pelo tratamento prévio com difenidramina (2 mg.kg-1) e/ou cimetidina (4 mg.kg-1) por injeção venosa. Análise estatística: teste t de Student, ANOVA. Resultados: O atracúrio e o cisatracúrio não modificaram a pressão arterial média (PAM) nas doses de 1 mg.kg-1 e 0,25 mg.kg-1, respectivamente. Doses de 4 mg.kg-1 promoveram diminuição da PAM de 62,8 ± 4,5 por cento do controle para o atracúrio, e de 82,5 ± 2,3 por cento do controle para o cisatracúrio. Com difenidramina e cimetidina, a pressão sistólica diminuiu 95,4 ± 2,5 por cento do controle. Com cimetidina, pressão diastólica diminuiu 82,7 ± 8,4 por cento do controle. O efeito conjunto sobre as pressões sistólica e diastólica refletiu-se nos valores observados da PAM. Conclusões: A difenidramina e a cimetidina, isoladamente, não impediram a diminuição da pressão arterial média induzida pelo atracúrio. No entanto, associação destes dois fármacos foi eficaz na prevenção dos efeitos hemodinâmicos induzidos pelo atracúrio. O cisatracúrio nas doses do experimento não promoveu diminuição da pressão arterial que justificasse as medidas preventivas aplicadas nos grupos onde se utilizou o atracúrio.

Background and objectives: Since atracurium can cause hypotension in humans, the hemodynamic effects of atracurium and cisatracurium as well as the hemodynamic protection of diphenhydramine and cimetidine were investigated in rats. Methods: 1) Wistar rats were anesthetized with sodium pentobarbital and prepared according to Brown et al. to evaluate different doses of atracurium and cisatracurium in the reduction of T4/T1 equal or greater than 95 percent. 2) Assessment of the hemodynamic changes caused by the intravenous administration of atracurium and cisatracurium by monitoring the blood pressure in the carotid artery and the electrocardiogram of rats. 3) Observation of the hemodynamic protection of prior treatment with the intravenous administration of diphenhydramine (2 mg.kg-1) and/or cimetidine (4 mg.kg-1). Statistical analysis: Student t test and ANOVA. Results: Doses of 1 mg.kg-1 and 0.25 mg.kg-1 of atracurium and cisatracurium respectively did not change the mean arterial pressure (MAP). Doses of 4 mg.kg-1 of atracurium and cisatracurium decreased MAP to 62.8 ± 4.5 percent and 82.5 ± 2.3 percent respectively when compared to control levels. When the rats were pre-treated with diphenhydramine and cimetidine, diastolic pressure was reduced to 95.4 percent ± 2.5 percent. With cimetidine, diastolic pressure was reduced to 82.7 ± 8.4 percent when compared to the control group. The effects on systolic and diastolic blood pressure were reflected in the levels of MAP. Conclusions: The isolated administration of diphenhydramine and cimetidine did not prevent the reduction in mean arterial pressure induced by atracurium. However, the association of both drugs was able to prevent the hemodynamic effects of atracurium. The doses of cisatracurium used in this study did not cause a reduction in blood pressure significant enough to justify the use of the preventive measures used in the atracurium groups.

Justificativa y objetivos: Habida cuenta de que el atracurio puede causar hipotensión arterial en el hombre, se investigaron los efectos hemodinámicos promovidos por el atracurio y por el cisatracurio, y la protección hemodinámica dada por la difenidramina y la cimetidina en ratones. Método: 1) Ratones Wistar anestesiados con pentobarbital sódico y preparados de acuerdo con Brown y col. para evaluar las dosis de atracurio y cisatracurio para la reducción de T4/T1 de la secuencia de cuatro estímulos mayor o igual al 95 por ciento. 2) Evaluación de las alteraciones hemodinámicas del atracurio y el cisatracurio por inyección venosa, midiendo la presión arterial sistémica de la arteria carótida y electrocardiograma de ratones. 3) Observación de la protección hemodinámica por el tratamiento previo con difenidramina (2 mg.kg-1) y/o cimetidina (4 mg.kg-1) por inyección venosa. Análisis estadístico: test t de Student, ANOVA. Resultados: El atracurio y el cisatracurio no modificaron la presión arterial promedio (PAP) en las dosis de 1 mg.kg-1 y 0,25 mg.kg-1, respectivamente. Las dosis de 4 mg.kg-1 disminuyeron la PAP de 62,8 ± 4,5 por ciento del control para el atracurio, y de 82,5 ± 2,3 por ciento del control para el cisatracurio. Con la difenidramina y la cimetidina, la presión sistólica se redujo a 95,4 ± 2,5 por ciento del control. Con la cimetidina, la presión diastólica disminuyó 82,7 ± 8,4 por ciento del control. El efecto con-junto sobre las presiones sistólica y diastólica se reflejó en los valores observados de la PAP. Conclusiones: La difenidramina y la cimetidina, aisladamente, no impidieron la disminución de la presión arterial promedio inducida por el atracurio. Sin embargo, la asociación de esos de los fármacos fue eficaz en la prevención de los efectos hemodinámicos inducidos por el atracurio. El cisatracurio, en las dosis del experimento, no promovió una disminución de la presión arterial que justificase las medidas preventivas...

Antiemetic medications in children with presumed infectious gastroenteritis--pharmacoepidemiology in Europe and Northern America.

OBJECTIVE: To investigate the prescription pattern of antiemetic medications in 0- to 9-year-old children with infectious gastroenteritis in several industrialized countries during 2005. STUDY DESIGN: We retrospectively retrieved data from 4 national and international databases (IMS MIDAS, IMS disease analyzer, WIdO databases). RESULTS: Between 2% and 23% of children with gastroenteritis (International Classification of Diseases code A08.X or A09) received prescriptions for antiemetic medications (United States, 23%; 95% CI, 15-31; Germany, 17%; 95% CI, 15-20; France, 17%; 95% CI, 14-19; Spain, 15%; 95% CI, 10-19; Italy, 11%; 95% CI, 7-16; Canada, 3%; 95% CI, 0-16; United Kingdom, 2%; 95% CI, 1-2). The antihistamines dimenhydrinate and diphenhydramine were most frequently used in Germany and Canada, whereas promethazine was prescribed preferentially in the United States. In France, Spain, and Italy, the dopamine receptor antagonist domperidone was preferred as antiemetic treatment. Ondansetron was used in a minor proportion of antiemetic prescriptions (Germany, Canada, Spain, and Italy, 0%; United States, 3%; United Kingdom, 6%). CONCLUSION: Antiemetic drugs are frequently used in children with gastroenteritis. In different industrialized countries, prescription of antiemetic medication varies considerably. Ondansetron, the only drug with evidence-based antiemetic efficacy, plays a minor role among antiemetic prescriptions.

Acrodermatitis enteropática / Acrodermatitis enteropathica

La acrodermatitis enteropática es una rara patología de herenciaautosómica recesiva ocasionada por una deficiente absorcióndel zinc de la dieta. Se caracteriza por la tríada de alopecía,diarrea y dermatitis acral y periorificial. Se presenta una paciente de 11 meses de edad con síntomas característicos cuyo diagnóstico fue confirmado por bajos niveles plasmáticos de zinc (37,7 µg%). Se realizó tratamiento consulfato de zinc a dosis de 5 mg/kg/día con evolución claramente favorable.

Acrodermatitis enteropathica is a rare autosomal recesive disorder, caused by impaired absorption of zinc dietary intake. It is characterized by a triad of alopecia, diarrhea and acral and periorificial dermatitis. We report an 11 month-old girl with tipical symptoms in whom the diagnosis was confirmed by decreased plasma zinc level (37,7 µg%). The patient was given zinc sulfate 5 mg/kg/day and showed marked improvement.

Acrodermatitis enteropática / Acrodermatitis enteropathica

La acrodermatitis enteropática es una rara patología de herenciaautosómica recesiva ocasionada por una deficiente absorcióndel zinc de la dieta. Se caracteriza por la tríada de alopecía,diarrea y dermatitis acral y periorificial. Se presenta una paciente de 11 meses de edad con síntomas característicos cuyo diagnóstico fue confirmado por bajos niveles plasmáticos de zinc (37,7 Ag%). Se realizó tratamiento consulfato de zinc a dosis de 5 mg/kg/día con evolución claramente favorable.(AU)

Acrodermatitis enteropathica is a rare autosomal recesive disorder, caused by impaired absorption of zinc dietary intake. It is characterized by a triad of alopecia, diarrhea and acral and periorificial dermatitis. We report an 11 month-old girl with tipical symptoms in whom the diagnosis was confirmed by decreased plasma zinc level (37,7 Ag%). The patient was given zinc sulfate 5 mg/kg/day and showed marked improvement.(AU)

Fingerprint analysis and synthetic adulterant search in Hedera helix formulations by capillary electrophoresis.

A high-performance capillary electrophoretic (CE) method has been developed for obtaining electropherograms of various extracts and the commercial formulation (fingerprints) of Hedera helix L used in Argentina as a cough's treatment. Also, a capillary zone electrophoresis (CZE) method was developed for the search, identification and determination of some possible adulterants. These likely adulterants are common synthetic drugs used in respiratory diseases (antitussive, decongestant and bronchodilator agents). Under optimum conditions, the analytes (ephedrine, codeine, diphenhydramine and constituents of H. helix formulations) were separated within less than 10 min in 20 mM sodium tetraborate buffer (pH 9.0). The present procedure was validated with respect to selectivity, linearity range, limits of detection (LOD) and quantification (LOQ), precision (repeatability and intermediate precision), solution stability and accuracy; the results obtained were satisfactory. Good linearity was obtained over two orders of magnitude and detection limits (S/N = 3) were better than 1.2 microg ml(-1) for all analytes. The CE methodology was successfully applied to the search and subsequent determination of ephedrine, codeine and diphenhydramine in H. helix extracts and its phytopharmaceutical products.