Combination of mifepristone and misoprostol vs misoprostol monotherapy for treatment of second-trimester pregnancy loss.

OBJECTIVE: Our main goal was to evaluate whether a treatment protocol based on the combination of mifepristone and misoprostol for second-trimester foetal loss was more effective than misoprostol monotherapy. METHODS: This was an observational, retrospective, cross-sectional two-centre study of women receiving treatment for second-trimester pregnancy loss. Patients were recruited in two centres that used different treatment protocols: combined mifepristone-misoprostol treatment or misoprostol monotherapy. RESULTS: A total of 99 patients were included in the study: 41 in the mifepristone-misoprostol combined treatment group and 58 in the misoprostol monotherapy group. The combined treatment group had shorter times to expulsion and shorter hospitalisations, as well as higher rates of hospital discharge within 24 h and complete abortion within the first 6 h and 12 h. There were no differences regarding secondary effects and complication rates. CONCLUSION: A combination of mifepristone and misoprostol appears to be a feasible option for the treatment of second-trimester pregnancy loss.

Insulina tópica en el tratamiento de úlcera corneal refractaria en un paciente no diabético: a propósito de un caso / Insulin eye drops for treating corneal ulcer in a non-diabetic patient: regarding a case

Las úlceras corneales se incluyen dentro de un grupo heterogéneo de lesiones oculares, las cuales pueden ser de gravedad variable. Cuando los pacientes no responden al tratamiento, incluyendo incluso el trasplante corneal, se crea la necesidad de explorar otras alternativas. Presentamos el caso de un paciente que sufrió una salpicadura ocular del contenido de una batería de automóvil por accidente. Esta lesión corneal, fue refractaria al tratamiento farmacológico e incluso quirúrgico. Tras cuatro años de persistencia de la úlcera corneal, se inició un tratamiento tópico con insulina 50 UI/ml. Se observó mejoría de forma evidente y actualmente el paciente ha recuperado completamente el epitelio corneal. Hoy en día, las evidencias disponibles del uso tópico de la insulina para el tratamiento de las úlceras corneales se centran en pacientes diabéticos. En los pacientes no diabéticos, la evidencia se limita a una serie de casos de úlceras neurotróficas corneales y al caso de un paciente que presentó un defecto epitelial persistente después de la resección de un neurinoma. Este caso, presenta la experiencia de uso de una formulación magistral de insulina oftálmica con eficacia y ausencia de toxicidad en un paciente no diabético con una úlcera corneal post-cáustica resistente al resto de tratamientos

Corneal ulcers are included in a heterogeneous group of eye injuries. When patients do not respond to treatment, including even corneal transplant, other alternatives need to be explored.We present a case of a patient who suffered an accidental spillage from the contents of a car battery. This corneal lesion was refractory to both surgical and pharmacological treatment. After four years of a persistent ulcer, insulin topical treatment 50 IU/mL was started. Improvement began to be observed and currently the patient has completely recovered the corneal epithelium. Nowadays, evidence of the topical insulin use for the treatment of corneal ulcers is higher in diabetic patients. In non-diabetic patients, evidence is restricted to a series of cases of neurotrophic corneal ulcers and a case report of a patient who presented a persistent epithelial defect after resection of a neurinoma. This case presents the experience of using an insulin drop formulation with effectiveness and absence of toxicity in a patient non-diabetic with a post-caustic corneal ulcer

Insulin eye drops for treating corneal ulcer in a non-diabetic patient: regarding a case.

Corneal ulcers are included in a heterogeneous group of eye injuries. When  patients do not respond to treatment, including even corneal transplant, other  alternatives need to be explored.We present a case of a patient who suffered an accidental spillage from the  contents of a car battery. This corneal lesion was refractory to both surgical and  pharmacological treatment. After four years of a persistent ulcer, insulin topical  treatment 50 IU/mL was started. Improvement began to be observed and  currently the patient has completely recovered the corneal epithelium.Nowadays, evidence of the topical insulin use for the treatment of corneal ulcers  is higher in diabetic patients. In non-diabetic patients, evidence is restricted to a series of cases of neurotrophic corneal ulcers and a case report of a patient who  presented a persistent epithelial defect after resection of a neurinoma. This case  presents the experience of using an insulin drop formulation with effectiveness  and absence of toxicity in a patient nondiabetic with a post-caustic corneal ulcer.

Las úlceras corneales se incluyen dentro de un grupo heterogéneo de lesiones  oculares, las cuales pueden ser de gravedad variable. Cuando los pacientes no  responden al tratamiento, incluyendo incluso el trasplante corneal, se crea la  necesidad de explorar otras alternativas.Presentamos el caso de un paciente que sufrió una salpicadura ocular del  contenido de una batería de automóvil por accidente. Esta lesión corneal, fue  refractaria al tratamiento farmacológico e incluso quirúrgico. Tras cuatro años de persistencia de la úlcera corneal, se inició un tratamiento tópico con insulina 50  UI/ml. Se observó mejoría de forma evidente y actualmente el paciente ha  recuperado completamente el epitelio corneal.Hoy en día, las evidencias disponibles del uso tópico de la insulina para el  tratamiento de las úlceras corneales se centran en pacientes diabéticos. En los  pacientes no diabéticos, la evidencia se limita a una serie de casos de úlceras  neurotróficas corneales y al caso de un paciente que presentó un defecto  epitelial persistente después de la resección de un neurinoma. Este caso,  presenta la experiencia de uso de una formulación magistral de insulina  oftálmica con eficacia y ausencia de toxicidad en un paciente no diabético con  una úlcera corneal post-cáustica resistente al resto de tratamientos.

Therapeutic drug monitoring of infliximab in spondyloarthritis. A review of the literature.

Available evidence indicates that a therapeutic drug monitoring strategy leads to major cost savings related to the anti-tumour necrosis factor-α therapy in both inflammatory bowel disease and rheumatoid arthritis (RA) patients, with no negative impact on efficacy. However, although the systematic use of therapeutic drug monitoring could potentially be beneficial and economically acceptable to drug dose optimization, it is not justifiable for all drugs. Infliximab (IFX) is a chimeric monoclonal immunoglobulin G1 targeting tumour necrosis factor. It has been approved for the treatment of immuno-inflammatory diseases, including RA, ankylosing spondylitis, psoriatic arthritis, Crohn's disease and ulcerative colitis. IFX's pharmacokinetics is highly variable and influences clinical response in chronic inflammatory diseases. Clinical response increases with IFX trough concentrations in RA, ankylosing spondylitis, inflammatory bowel disease and psoriatic patients. Target concentrations predictive of good clinical response were proposed in RA, Crohn's disease and ulcerative colitis. The purpose of this article is to review the current literature surrounding IFX serum concentrations and their related parameters with disease activity in patients with spondyloarthritis. Gathering information about the efficacy of IFX in patients with spondyloarthritis and relating IFX serum concentrations to disease activity were the main goals of this study.

Adherence and preference of intravenous zoledronic acid for osteoporosis versus other bisphosphonates.

OBJECTIVE: To evaluate adherence as well as patient preference and satisfaction of once-yearly intravenous zoledronic acid versus other bisphosphonates treatments. METHODS: In accordance with the PRISMA guidelines, a systematic literature search was conducted in PubMed, Cochrane Library and EMBASE databases, over the date range of 2000-2016. Following the PICO (Population, Interventions, Comparator, Outcomes) elements, eligibility criteria included: (1) participants: adults over 18 with osteoporosis and adults who were at high risk of developing low bone density as a result of chronic use of glucocorticoids; (2) intervention: adherence or patient preference/satisfaction of once-yearly zoledronic acid treatment; (3) comparator: other bisphosphonates; (4) outcome: data about adherence, persistence, compliance, preference and satisfaction criteria. Specific exclusion criteria were also applied. RESULTS: Adherence to zoledronate is only quantified in one study showing that mean proportion of days covered for zoledronic acid was greater than for ibandronate users. Three studies showed 100% of compliance to zoledronate treatment and only one study showed zoledronic acid provided the highest persistence rates. Once-yearly intravenous infusion of zoledronic acid was clearly preferred. Only one article indicated preference for schedules that were once monthly or less frequent and other preference results practically equal between once-yearly intravenous infusion or weekly oral. Although there is little evidence, adherence to osteoporosis treatment is improved with annual intravenous zoledronate regimen. Moreover, patients appear to have preference for less frequent dosing. Switching from oral to intravenous therapy, based on the opportunities offered by an integrated health management area, may allow obtaining better outcomes in adherence to osteoporosis treatment.

Emergence of Inflammatory Bowel Disease During Treatment With Secukinumab.

Secukinumab is an anti-IL 17A monoclonal antibody currently licensed for the treatment of plaque psoriasis, psoriatic arthritis, and ankylosing spondylitis. However, although inflammatory bowel disease is a disorder with related immune characteristics, secukinumab has not proved to be effective in these diseases. In fact, negative results in a clinical trial designed to assess the efficacy of secukinumab in patients with Crohn's disease have been published. On the other hand, the drug fact sheet states that secukinumab should be used with caution in patients with inflammatory bowel disease. Although the drug has shown to worsen these pathologies, there are no published data of cases in which the patient is first diagnosed with inflammatory bowel disease during secukinumab treatment. We present two cases of emergence of inflammatory bowel disease in patients with plaque psoriasis and ankylosing spondylitis, treated with secukinumab.