Quemadura genital por producto químico: reporte de caso / Genital burn by chemical product: case report

Resumen ANTECEDENTES: Las quemaduras son la forma más severa de estrés que el cuerpo puede sufrir; pueden generarse por diferentes agentes térmicos y químicos. CASO CLÍNICO: Paciente de 25 años, con dolor intenso en la región genital de 12 horas de evolución, secundario a la introducción en la vagina de una piedra de alumbre. Se le hicieron múltiples irrigaciones con solución salina al 0.9% sin obtener el resto de la piedra de alumbre. Se le aplicó sulfadiazina de plata en la cavidad vaginal cada 12 horas, óvulos vaginales de ketanserina, miconazol y metronidazol cada 8 horas, ketorolaco por vía oral 10 mg cada 8 horas. Durante su estancia hospitalaria tuvo buena evolución, con disminución de la inflamación en la zona genital, epitelización adecuada. Al tercer día se dio de alta del hospital con cita para valoración a los siete días. CONCLUSIÓN: El tratamiento de las quemaduras en el área genital, por agentes químicos, tiene como piedra angular la identificación del agente causante de la lesión que permita actuar de forma inmediata y evitar las secuelas físicas, sexuales y psicológicas mediante el lavado exhaustivo con solución o agua estéril para remover el agente causal y disminuir que continúe actuando en el sitio afectado.

Abstract BACKGROUND: Burns are the most severe form of stress that the body can suffer; they can be caused by various thermal and chemical agents. CLINICAL CASE: A 25-year-old female patient presented with severe genital pain of 12 hours' duration, secondary to the introduction of an alum stone into the vagina. She underwent several irrigations with 0.9% saline without obtaining the rest of the alum stone. She was given vaginal silver sulfadiazine every 12 hours, vaginal ketanserin, miconazole and metronidazole every 8 hours and oral ketorolac 10 mg every 8 hours. During her stay in hospital, she progressed well, with a decrease in genital inflammation and adequate epithelialisation. She was discharged on the third day with an appointment for a seven-day follow-up. CONCLUSION: The management of genital burns caused by chemical agents is based on the identification of the agent causing the lesion, which allows immediate action and prevents physical, sexual and psychological sequelae by thorough washing with sterile solution or water to remove the causative agent and reduce its continued action in the affected area.

Síntese e avaliação dos efeitos de um nanocarreador de miconazol sobre microrganismos orais / Synthesis and evaluation of the effects of a miconazole nanocarrier on oral microorganisms

A presente tese teve como objetivo geral preparar, caracterizar e avaliar os efeitos antimicrobianos de um nanocarreador de miconazol (MCZ) à base de nanopartículas magnéticas de óxido de ferro (NPsMOF) funcionalizadas com quitosana (QS). Assim, dois subprojetos (SP1 e SP2) foram desenvolvidos e apresentaram os seguintes objetivos específicos: SP1) Preparar, caracterizar e avaliar os efeitos do nanocarreador NPsMOF-QS-MCZ sobre células planctônicas e biofilmes simples e misto de Candida albicans e Candida glabrata; SP2) Avaliar o efeito do nanocarreador na composição de três diferentes modelos de biofilmes polimicrobianos patogênicos orais (gengivite, prótese total e cárie dentária). A primeira etapa do SP1 consistiu em revestir as NPsMOF com QS e carregar este core-shell com MCZ, a fim de caracterizar este nanocarreador por métodos físico-químicos. As concentrações inibitórias mínimas (CIMs) do nanocarreador foram determinadas pelo método da microdiluição em caldo, usando o índice da concentração inibitória fracionária a fim de avaliar se houve interação sinergística entre os compostos. Ainda, biofilmes simples e mistos de Candida foram formados no fundo de placas de 24 ou 96 poços por 48 h e, em seguida, tratados por 24 h com NPsMOF-QS-MCZ carreando MCZ a 31,2 e 78 µg/ml, na presença e ausência de um campo magnético externo. Os biofilmes foram avaliados quantitativamente por biomassa total, atividade metabólica, contagem de unidades formadoras de colônias (UFCs) e composição da matriz extracelular. Os dados foram analisados por ANOVA a dois fatores, seguida pelo teste de Holm-Sidak (p<0,05). Ainda, a estrutura dos biofilmes foi avaliada qualitativamente por microscopia eletrônica de varredura e microscopia confocal. Os resultados do SP1 mostraram que o nanocarreador apresentou diâmetro menor que 50 nm e valores de CIM menores do que aqueles encontrados para MCZ sozinho, com efeito sinérgico sobre C. albicans. NPsMOF-QS-MCZ a 78 µg/ml foi mais eficaz que MCZ sozinho na redução de UFCs e atividade metabólica de biofilmes misto e simples de C. albicans. A biomassa total dos biofilmes e a matriz extracelular não foram afetadas pelo nanocarreador, e a aplicação de um campo magnético externo não melhorou seu efeito antibiofilme. As imagens de microscopia confirmam que tratamentos com o nanocarreador, principalmente na maior concentração, apresentaram maior atividade antibiofilme. Com relação ao SP2, as CIMs de NPsMOF-QS-MCZ foram determinadas para diferentes espécies microbianas, e todos os biofilmes polimicrobianos foram desenvolvidos por 5 dias e tratados por 24 h com NPsMOF-QS-MCZ a 64 µg/ml. Após o tratamento, os biofilmes foram avaliados quanto à biomassa total, atividade metabólica, contagem de UFCs e análise composicional por PCR quantitativo. Microscopia eletrônica de varredura foi usada para analisar a estrutura do biofilme. As diferenças entre os grupos foram determinadas por teste t não pareado (p<0,05). Os resultados do SP2 mostraram que NPsMOF-QS-MCZ foi mais eficaz que MCZ sozinho contra a maioria das células fúngicas e bacterianas testadas. Ainda, este nanocarreador foi capaz de reduzir a atividade metabólica, biomassa total e UFCs (p<0,05) dos biofilmes, além de alterar a sua ultraestrutura. Por fim, NPsMOF-QS-MCZ afetou a composição dos três biofilmes polimicrobianos avaliados, reduzindo principalmente os números de Streptococcus spp. e alterando a prevalência das espécies nos biofilmes. Em suma, os resultados dos SP1 e SP2 permitiram concluir que o nanocarreador melhorou o efeito antimicrobiano do MCZ, dependendo da espécie e parâmetro de biofilme avaliados. O nanocarreador também mostrou potencial para interferir nas interações sinergísticas entre células fúngicas e bacterianas dentro de biofilmes polimicrobianos(AU)

The present thesis aimed to prepare, characterize and evaluate the antimicrobial effects of a miconazole (MCZ) nanocarrier based on iron oxide magnetic nanoparticles (IONPs) functionalized with chitosan (CS). Thus, two subprojects (SP1 and SP2) were developed and had the following specific objectives: SP1) To prepare, characterize and evaluate the effects of the IONPs-CS-MCZ nanocarrier on planktonic cells and singleand dual-species biofilms of Candida albicans and Candida glabrata; SP2) To evaluate the effect of IONPs-CS-MCZ on the composition of three different models of oral pathogenic biofilms (gingivitis, denture and dental caries). The first step of SP1 was to coat IONPs with CS and to load this core-shell association with MCZ, in order to characterize this nanocarrier by physicochemical methods. The minimum inhibitory concentrations (MICs) of the nanocarrier were determined by the microdilution method, using the fractional inhibitory concentration index in order to assess whether there was synergistic interaction between the compounds.. In addition, single- and dual-species biofilms of Candida species were formed at the bottom of 24- or 96-well plates for 48 h and, in sequence, treated for 24 h with IONPs-CS-MCZ carrying MCZ at 31.2 and 78 µg/ml, in both the presence and absence of an external magnetic field. Biofilms were quantitatively evaluated by total biomass, metabolic activity, counting of colony forming units (CFUs) and extracellular matrix components. Data were analyzed by twoway ANOVA, followed by Holm-Sidak test (p <0.05). In addition, the structure of biofilms was qualitatively evaluated by scanning electron microscopy and confocal microscopy. The results from SP1 showed that IONPs-CS-MCZ presented diameter smaller than 50 nm, and MIC values lower than those found for MCZ alone, with synergistic effect on C. albicans. Moreover, 78 µg/ml IONPs-CS-MCZ was more effective than MCZ alone in reducing CFUs and metabolic activity of single biofilms of C. albicans and dual-species biofilms. Total biofilm biomass and extracellular matrix were not affected by the nanocarrier, and the application of an external magnetic field did not improve the nanocarrier effects. Microscopy images confirm that treatments with the nanocarrier, mainly in the highest concentration, exhibited greater antibiofilm activity. Regarding SP2, the MICs of IONPs-CS-MCZ were determined for different microbial species, and all polymicrobial biofilms were developed for 5 days and treated for 24 h with IONPs-CS-MCZ at 64 µg/ml. After treatment, the biofilms were evaluated for total biomass, metabolic activity, counting of CFUs and quantitative PCR analysis. Scanning electron microscopy was used to analyze the biofilm ultrastructure. Differences between groups were determined by unpaired t-test (p<0.05). Results from SP2 showed that IONPs-CS-MCZ was more effective than MCZ alone against most fungal and bacterial cells tested. Moreover, this nanocarrier was able to reduce the metabolic activity, total biomass and CFUs (P<0.05) of the biofilms, besides altering their ultrastructure. Finally, IONPs-CS-MCZ affected the composition of the three evaluated biofilms, mainly reducing the numbers of Streptococcus spp. and changing the prevalence of species in the biofilms. From the results obtained by SP1 and SP2, it was possible to conclude that the nanocarrier improved the antimicrobial effect of MCZ, depending on the species and biofilm parameter evaluated. Nanocarrier also showed potential to interfere in the synergistic interactions among fungal and bacterial cells within polymicrobial biofilms(AU)

Efecto de miconazol sobre el recuento de levaduras en candidiasis asociada a estomatitis protésica / Effect of miconazole on the yeast count in candidiasis associated with denture stomatitis

RESUMEN: Introducción: Estomatitis Subprotésica, proceso inflamatorio crónico de la mucosa adyacente a prótesis removible. 71,4% de los sujetos con esta condición es portador de Candida y la severidad se relaciona con la presencia de esta levadura. Para su tratamiento se indica antimicóticos tópicos de la familia de polienos o de azoles. El propósito del estudio fue determinar el recuento de levaduras del género Candida en adultos mayores con candidiasis oral, antes y después de ser tratados con miconazol. Materiales y métodos: Se consignaron antecedentes sistémicos y locales en 32 adultos mayores con estomatitis subprotésica. Se determinó recuento de levaduras del género Candida en saliva, antes y después del tratamiento tópico con Miconazol 2%. Se aceptaron diferencias estadísticamente significativas con un error alfa igual o menor a 0.05%. Resultados: Los recuentos de levaduras del inicio del estudio disminuyeron significativamente a los días 8 y 15 después del tratamiento (mediana 6.800, 163, 60, respectivamente). 56,2% de los individuos presentó persistencia de levaduras después del tratamiento; 21,8% de ellos con recuentos superiores a 400 UFC/ml de saliva. Conclusiones: En el 56,2% de los individuos del estudio se observó persistencia de levaduras del género Candida luego de 2 semanas de tratamiento con miconazol al 2%.

ABSTRACT: Introduction: Denture stomatitis is a chronic inflammatory process of the mucosa adjacent to removable prosthesis. 71.4% of the subjects with this condition are carriers of Candida and the severity is related to the presence of this yeast. Topical antimycotics belonging to the polyene or azole family are indicated for its treatment. Efficacy of miconazole is reported to be from 80% to 100%, although resistance is described in isolates of Candida. The purpose of the study was to determine the count of Candida in older adults with oral candidiasis, before and after being treated with miconazole. Methodology: Systemic and local antecedents were recorded in 32 elderly adults with denture stomatitis. Differences in number of the colony forming units of Candida yeast, were determined before and after topical treatment with Miconazole 2%. Statistical significances were set at a value of p < 0.05. Results: Yeast counts at the start of the study significantly decreased 8 and 15 days after treatment (median 6,800, 163, 60, respectively). 56.2% of the subjects presented persistence of yeasts after treatment; 21.8% of them with counts higher than 400 CFU / ml saliva. Conclusion: In 56.2% of the study subjects, persistence of Candida yeasts was observed after 2 weeks of treatment with 2% miconazole.

Estabilidad de la crema reformulada de nitrato de miconazol al 2 por ciento / Stability of reformulated 2 percent miconazol nitrate cream

Introducción: la Empresa Productora Roberto Escudero Díaz, llevó a cabo la reformulación de la crema de nitrato de miconazol al 2 por ciento, por incumplimiento de algunas especificaciones de calidad y contaminaciones microbiológicas de varios lotes industriales, por lo que hubo que realizar cambios mayores a la composición de la formulación registrada. Objetivo: determinar la estabilidad de la nueva formulación de nitrato de miconazol crema al 2 por ciento, para determinar su período de validez. Métodos: se realizaron los estudios según las regulaciones vigentes. Se emplearon tres lotes elaborados a escala piloto, envasados en tubos comprimibles de aluminio por 25 g. Se emplearon como métodos analíticos una técnica por cromatografía líquida de alta resolución y una por cromatografía en capa delgada previamente validadas para estos propósitos. Se consideraron dos temperaturas de almacenamiento: 30 ± 2 ºC (vida de estante) y 40 ± 2 ºC (estabilidad acelerada). Se determinaron los parámetros: propiedades organolépticas, pH, área de extensibilidad, valoración, contenido de sustancias relacionadas y/o productos de degradación, y además se evaluó la calidad de la formulación desde el punto de vista microbiológico. Resultados: desde el punto de vista químico, los lotes evaluados mostraron contenidos superiores al 98 por ciento de analito y niveles muy bajos de sustancias relacionadas, independientemente del lote y la temperatura de almacenamiento. No se detectaron manchas adicionales por cromatografía en capa delgada atribuibles a posibles productos de degradación. La...

Introduction: Roberto Escudero Diaz drug producing company is carrying out the reformulation of 2 percent miconazole nitrate cream due to non-compliance with some quality specifications and the microbiological contamination of several industrial batches, so it was required to make major changes in the registered formulation composition. Objective: to determine the stability of the new 2 percent miconazol nitrate cream formulation to verify its validity period. Methods: the studies followed the regulations in force. Three pilot-scaled batches, packed in 25 g aluminum tubes, were used. The analytical methods were high resolution liquid chromatography technique and thin layer chromatography, being both methods previously validated for these purposes. The selected storage temperatures were 30 ± 2 °C (shelf life) and 40 ± 2 ºC (accelerated stability). The estimated parameters included organoleptic properties, pH, extensibility area, titration, content of related substances and/or degradation products in addition to evaluating the quality of formulation from the microbiological viewpoint. Results: from the chemical viewpoint, the evaluated batches showed contents over 98 percent of analyte and very low levels of related substances, regardless of batch and the storage temperature. The thin layer chromatography did not detect any additional stain attributed to possible degradation products. The extensibility showed normal decrease resulting from progressive structuring of the system and the pH also lowered within the set limits. The microbiological stability of the drug was proved to be high after 12 months. Conclusions: the cream was chemically, physically and microbiologically stable at room temperature for 12 months, so this is the term suggested as the temporary validity period(AU)

Estabilidad de la crema reformulada de nitrato de miconazol al 2 % / Stability of reformulated 2 % miconazol nitrate cream

INTRODUCCIÓN: la Empresa Productora Roberto Escudero Díaz, llevó a cabo la reformulación de la crema de nitrato de miconazol al 2 por ciento, por incumplimiento de algunas especificaciones de calidad y contaminaciones microbiológicas de varios lotes industriales, por lo que hubo que realizar cambios mayores a la composición de la formulación registrada. OBJETIVO: determinar la estabilidad de la nueva formulación de nitrato de miconazol crema al 2 por ciento, para determinar su período de validez. MÉTODOS: se realizaron los estudios según las regulaciones vigentes. Se emplearon tres lotes elaborados a escala piloto, envasados en tubos comprimibles de aluminio por 25 g. Se emplearon como métodos analíticos una técnica por cromatografía líquida de alta resolución y una por cromatografía en capa delgada previamente validadas para estos propósitos. Se consideraron dos temperaturas de almacenamiento: 30 ± 2 ºC (vida de estante) y 40 ± 2 ºC (estabilidad acelerada). Se determinaron los parámetros: propiedades organolépticas, pH, área de extensibilidad, valoración, contenido de sustancias relacionadas y/o productos de degradación, y además se evaluó la calidad de la formulación desde el punto de vista microbiológico. RESULTADOS: desde el punto de vista químico, los lotes evaluados mostraron contenidos superiores al 98 por ciento de analito y niveles muy bajos de sustancias relacionadas, independientemente del lote y la temperatura de almacenamiento. No se detectaron manchas adicionales por cromatografía en capa delgada atribuibles a posibles productos de degradación. La extensibilidad mostró un decrecimiento normal debido a la estructuración progresiva del sistema, y el pH también disminuyó discretamente pero dentro de los límites propuestos. Además se comprobó la elevada estabilidad microbiológica del medicamento a los 12 meses. CONCLUSIONES: la crema es estable química, física y microbiológicamente a temperatura ambiente durante 12 meses, por lo que se propone este tiempo como período de validez provisional(AU)

INTRODUCTION: Roberto Escudero Diaz drug producing company is carrying out the reformulation of 2 percent miconazole nitrate cream due to non-compliance with some quality specifications and the microbiological contamination of several industrial batches, so it was required to make major changes in the registered formulation composition. OBJECTIVE: to determine the stability of the new 2 percent miconazol nitrate cream formulation to verify its validity period. METHODS: the studies followed the regulations in force. Three pilot-scaled batches, packed in 25 g aluminum tubes, were used. The analytical methods were high resolution liquid chromatography technique and thin layer chromatography, being both methods previously validated for these purposes. The selected storage temperatures were 30 ± 2 °C (shelf life) and 40 ± 2 ºC (accelerated stability). The estimated parameters included organoleptic properties, pH, extensibility area, titration, content of related substances and/or degradation products in addition to evaluating the quality of formulation from the microbiological viewpoint. RESULTS: from the chemical viewpoint, the evaluated batches showed contents over 98 percent of analyte and very low levels of related substances, regardless of batch and the storage temperature. The thin layer chromatography did not detect any additional stain attributed to possible degradation products. The extensibility showed normal decrease resulting from progressive structuring of the system and the pH also lowered within the set limits. The microbiological stability of the drug was proved to be high after 12 months. CONCLUSIONS: the cream was chemically, physically and microbiologically stable at room temperature for 12 months, so this is the term suggested as the temporary validity period(AU

Neurocriptococosis crónica en un paciente inmunocompetente / Chronic neurocryptococcosis in an immunocompetent patient

Se presenta el caso de un paciente, sin antecedentes ni evidencias de alteraciones de inmunidad, con un cuadro de meningoencefalitis crónica. Este fue ingresado en tres ocasiones con diferentes diagnósticos en un período de 10 meses. Se le realizó el diagnóstico de neurocriptococosis, y corroboró con los estudios de tinta china y cultivo micológico del líquido cefalorraquídeo; no se detectó otra localización del hongo en el paciente. El egresado curado, después del tratamiento con anfotericin B y miconazol y el seguimiento inmunológico hasta el año 2014; se le dio recientemente de alta después de 10 años, excluyéndose definitivamente la inmunosupresión adquirida.

A patient having no history or evidences of immune disorders, presented chronic meningoencephalitis. This patient was admitted three times with different diagnosis in a 10-month period. The diagnosis of neurocryptococcosis was confirmed by means of studies with India ink stain and mycological culture of cerebrospinal fluid, no other localization of fungus was found. The patient was discharged after the treatment with Amphotericin B and miconazole along with immunological follow-up to 2014; he was recently discharged after 10 years, definitely excluding an acquired immunocompetence.

Validación del método para control de la calidad del nitrato de miconazol en una nueva crema al 2 por ciento / Validation of a quality control method of a new 2 per cent miconazole nitrate cream

Objetivo: validar el método para control de la calidad del nitrato de miconazol en una nueva crema al 2 por ciento. Métodos: se realizó la validación según los parámetros exigidos para la categoría I y considerando la metodología y los criterios de aceptación vigentes en Cuba. Una vez validado, se aplicó al análisis de los tres lotes elaborados a escala piloto. Resultados: los resultados fueron satisfactorios, cumpliendo en todos los parámetros los límites establecidos. El método fue lineal, exacto y preciso en el rango de 10 a 30 mg/g y no hubo interferencias de ninguno de los componentes de la nueva formulación. Los lotes presentaron correcta dosificación, sin diferencias estadísticamente significativas entre las réplicas y los lotes analizados. Conclusiones: El método evaluado resulta válido para el objetivo con el cual se propuso(AU)

Objective: to validate a quality control method for a 2 per cent new miconazole nitrate cream. Methods: the validation was made following the category I parameters and taking into account the methodology and acceptance criteria in force in Cuba. Once validated, the analysis of the three batches was applied on pilot scale. Results: the results were satisfactory since they fulfilled all the set parameters. The method was linear, accurate and precise in the 10-30 mg/g range. there was no interference from any of the components of the new formulation. The batches presented correct dosing, without any statistically significant differences between replicas and analyzed batches. Conclusions: the evaluated method proved to be valid for the stated purpose(AU)

Validación del método para control de la calidad del nitrato de miconazol en una nueva crema al 2 % / Validation of a quality control method of a new 2 percent miconazole nitrate cream

Objetivo: validar el método para control de la calidad del nitrato de miconazol en una nueva crema al 2 por ciento. Métodos: se realizó la validación según los parámetros exigidos para la categoría I y considerando la metodología y los criterios de aceptación vigentes en Cuba. Una vez validado, se aplicó al análisis de los tres lotes elaborados a escala piloto. Resultados: los resultados fueron satisfactorios, cumpliendo en todos los parámetros los límites establecidos. El método fue lineal, exacto y preciso en el rango de 10 a 30 mg/g y no hubo interferencias de ninguno de los componentes de la nueva formulación. Los lotes presentaron correcta dosificación, sin diferencias estadísticamente significativas entre las réplicas y los lotes analizados. Conclusiones: El método evaluado resulta válido para el objetivo con el cual se propuso(AU)

Objective: to validate a quality control method for a 2 percent new miconazole nitrate cream. Methods: the validation was made following the category I parameters and taking into account the methodology and acceptance criteria in force in Cuba. Once validated, the analysis of the three batches was applied on pilot scale. Results: the results were satisfactory since they fulfilled all the set parameters. The method was linear, accurate and precise in the 10-30 mg/g range. there was no interference from any of the components of the new formulation. The batches presented correct dosing, without any statistically significant differences between replicas and analyzed batches. Conclusions: the evaluated method proved to be valid for the stated purpose(AU)

Evaluación de métodos cromatográficos para la estabilidad química del nitrato de miconazol en una nueva crema / Assessment of chromatographic methods for the chemical stability of a new miconazol nitrate cream

Objetivo: evaluar los métodos cromatográficos para la estabilidad química del nitrato de miconazol en una nueva crema al 2 por ciento. Métodos: en primer lugar se aplicaron diferentes condiciones degradativas al nitrato de miconazol materia prima a fin de obtener los posibles productos de degradación del fármaco y evaluarlos por un método diseñado por cromatografía en capa delgada, el cual se validó para identificar productos de degradación en la crema. Se evaluó el desempeño del método oficial informado en la Farmacopea Británica 2010 por cromatografía líquida de alta resolución para la valoración del nitrato de miconazol en la crema, analizando su selectividad frente a los posibles productos de degradación. Ambos métodos cromatográficos fueron aplicados al análisis de muestras de crema procedentes de los tres lotes pilotos sometidos a estrés térmico durante 30 días. Resultados: ambos métodos mostraron elevada selectividad frente a los excipientes y los productos de degradación del fármaco. Se obtuvo degradación del nitrato de miconazol frente a hidrólisis ácida, termólisis y fotólisis y el límite de detección fue de 1 µg para cromatografía en capa delgada. No se mostró degradación del analito según los resultados cualitativos y cuantitativos en ninguno de los tres lotes analizados. Conclusiones: los métodos utilizados son válidos para el objetivo con el cual se proponen, por lo que pueden emplearse en el estudio de estabilidad química de las cremas de nitrato de miconazol al 2 por ciento(AU)

Objective: to assess the chromatographic methods for the chemical stability of a new 2 percent miconazol nitrate cream. Methods: various degradation conditions were firstly used in the raw material miconazole nitrate in order to obtain the possible degradation products of this drug and to evaluate them by thin layer chromatography-based method, which was validated to identify the degradation products in the new cream. The performance of the official method based on high resolution liquid chromatography and reported in British Pharmacopeia 2010 was evaluated, and its selectivity against the possible degradation products were also analyzed. Both chromatographic methods were applied to the analysis of cream samples from the three pilot batches under heat stress for 30 days. Results: the two methods showed high selectivity against excipients and degradation products of the drug. Miconazol nitrate was degraded against acid hydrolysis, thermolysis and photolysis, being the detection limit of 1 µg for the thin layer chromatography. No degradation of the analyte was observed in any of the three analyzed batches according to the qualitative and quantitative results. Conclusions: these methods are valid for the submitted objective, so they may be used in the chemical stability study of 2 percent miconazol nitrate creams(AU)

Evaluación de métodos cromatográficos para la estabilidad química del nitrato de miconazol en una nueva crema / Assessment of chromatographic methods for the chemical stability of a new miconazol nitrate cream

Objetivo: evaluar los métodos cromatográficos para la estabilidad química del nitrato de miconazol en una nueva crema al 2 por ciento. Métodos: en primer lugar se aplicaron diferentes condiciones degradativas al nitrato de miconazol materia prima a fin de obtener los posibles productos de degradación del fármaco y evaluarlos por un método diseñado por cromatografía en capa delgada, el cual se validó para identificar productos de degradación en la crema. Se evaluó el desempeño del método oficial informado en la Farmacopea Británica 2010 por cromatografía líquida de alta resolución para la valoración del nitrato de miconazol en la crema, analizando su selectividad frente a los posibles productos de degradación. Ambos métodos cromatográficos fueron aplicados al análisis de muestras de crema procedentes de los tres lotes pilotos sometidos a estrés térmico durante 30 días. Resultados: ambos métodos mostraron elevada selectividad frente a los excipientes y los productos de degradación del fármaco. Se obtuvo degradación del nitrato de miconazol frente a hidrólisis ácida, termólisis y fotólisis y el límite de detección fue de 1 µg para cromatografía en capa delgada. No se mostró degradación del analito según los resultados cualitativos y cuantitativos en ninguno de los tres lotes analizados. Conclusiones: los métodos utilizados son válidos para el objetivo con el cual se proponen, por lo que pueden emplearse en el estudio de estabilidad química de las cremas de nitrato de miconazol al 2 por ciento

Objective: to assess the chromatographic methods for the chemical stability of a new 2 percent miconazol nitrate cream. Methods: various degradation conditions were firstly used in the raw material miconazole nitrate in order to obtain the possible degradation products of this drug and to evaluate them by thin layer chromatography-based method, which was validated to identify the degradation products in the new cream. The performance of the official method based on high resolution liquid chromatography and reported in British Pharmacopeia 2010 was evaluated, and its selectivity against the possible degradation products were also analyzed. Both chromatographic methods were applied to the analysis of cream samples from the three pilot batches under heat stress for 30 days. Results: the two methods showed high selectivity against excipients and degradation products of the drug. Miconazol nitrate was degraded against acid hydrolysis, thermolysis and photolysis, being the detection limit of 1 µg for the thin layer chromatography. No degradation of the analyte was observed in any of the three analyzed batches according to the qualitative and quantitative results. Conclusions: these methods are valid for the submitted objective, so they may be used in the chemical stability study of 2 percent miconazol nitrate creams

Eficacia, tolerancia y seguridad de una combinación de metronidazol, miconazol, centella asiática, polimixina y neomicina en cápsula blanda para uso vaginal en el tratamiento de la vaginosis bacteriana / Efficacy, tolerability, and safety of a combination including metronidazole, miconazole, Gotu kola, polymixin, and neomycin in soft vaginal capsules for the treatment of bacterial vaginosis

Introducción: La vaginosis bacteriana (VB) es un síndrome polimicrobiano, en la cual la flora dominante de lactobacilos normales es sustituida por una flora polimicrobiana. La prevalencia de VB en Perú varía entre 27 y 43,7%. El Centro de Control y Prevención de Enfermedades (DCD) sugiere el tratamiento de VB en mujeres sintomáticas con metronidazol oral/gel o clindamicina crema. Se planteó en el presente estudio evaluar la eficacia, tolerancia y seguridad de la combinación de metronidazol, miconazol, centella asiática, polimixina y neomicina en cápsula blanda para el tratamiento de VB. Material y Métodos: El presente estudio de tipo abierto, observacional, prospectivo, permitió evaluar la eficacia, tolerancia y seguridad en la aplicación de la combinación de metronidazol, miconazol, centella asiática, polimixina y neomicina en cápsula blanda. Resultados: Se incluyó a 61 pacientes con edad promedio de 29.28 años (rango 18-48) de las cuales 93,4% tenía historia previa de flujo vaginal anormal. Se realizaron dos visitas durante el estudio, la primera para diagnóstico e inicio de tratamiento y la segunda de control post tratamiento. Tres pacientes no tuvieron segunda visita y 8 no tenían registrada toda la información para definir la respuesta terapéutica. La segunda visita se realizó a los 21 días en promedio. Los principales signos y síntomas en la primera visita de diagnóstico fueron flujo vaginal (100,0%), disconfort vaginal (85,2%), dispareunia (70,5%) y dolor abdominal bajo (57,4%), las cuales disminuyeron en forma significativa (p<0,05) a la segunda visita post tratamiento. La prueba de aminas resultó positiva en el 93,4% de los casos en la primera visita y en el 15,5% de los casos en la segunda visita (p<0,05). De la población inicial de estudio, solo 53 mujeres son evaluables para eficacia terapéutica...

Introduction: Bacterial vaginosis (BV) is a polymicrobial syndrome, in which the normal dominant flora consisting in Lactobacillus is replaced by polymicrobial flora. The prevalence of BV in Peru varies between 27 and 43.7%. The Centers for Disease Control and Prevention suggest therapy for BV in symptomatic women should include oral/gel metronidazole or clindamycin cream. We proposed in this study to evaluate the efficacy, tolerability and safety of the combination of metronidazole, miconazole, Gotu kola (Centella asiatica), polymixin, and neomycin in soft capsules, for the treatment of BV. Material and Methods: This investigation was an open, observational, and prospective study, which allowed us to evaluate the efficacy, tolerability and safety of the aforementioned combined therapy administered in soft capsules. Results: The study included 61 patients with a mean age of 29.28 years (range, 18-48) and 93.4% had a history of abnormal vaginal discharge. Two visits took place during the study, the first for making the diagnosis and initiating therapy, and the second was the post-treatment control. Three patients did not have a second visit and 8 did not record all the information required to define the therapeutic response. The second visit took place after 21 days on average. The main signs and symptoms at the first visit were vaginal discharge at diagnosis (100.0%), vaginal discomfort (85.2%), dyspareunia (70.5%) and lower abdominal pain (57.4%), which were significantly reduced (p <0.05) in the second visit after treatment. The amine test was positive in 93.4% of cases in the first visit and in 15.5% of cases in the second visit (p <0.05). From the initial population in the study, only 53 women are evaluable for efficacy. An overall response rate in 44 women (83.02%) was achieved with the soft capsule combination treatment. Adverse events were reported in only one case...

Avaliação clínica e laboratorial do gel da Uncaria tomentosa (Unha de Gato) sobre candidose oral / Clinical and laboratorial evaluation of Uncaria tomentosa (Cat's Claw) gel on oral candidiasis

Na odontologia, a fitoterapia já vem sendo utilizada com sucesso há vários anos. Trata-se de um meio terapêutico que apresenta como vantagem sobre as medicações alopáticas o fato de apresentar reações adversas mínimas. A Uncaria tomentosa é uma planta indígena da floresta Amazônica e de outras áreas tropicais da América do Sul e Central. Tem aplicação no tratamento de diversas patologias, entre elas a candidose. Este trabalho avalia clínico e laboratorialmente a ação do gel da Uncaria tomentosa em pacientes portadores de candidose na cavidade oral. Foram selecionados 20 pacientes que apresentaram clínico e laboratorialmente infecção pelo Candida. Os mesmos foram divididos em 2 grupos. O grupo-teste (Uncaria tomentosa/Imuno-Max Gel), composto por 10 pacientes, foi orientado a utilizar o gel da Uncaria tomentosa, sobre as lesões na cavidade oral, 3x ao dia por um período de 14 dias. O grupo-controle (Miconazol/Daktarin Gel) utilizou a medicação da mesma forma prescrita para o grupo-teste. Após o período de tratamento, os pacientes retornaram para nova avaliação clínica e laboratorial. A Uncaria tomentosa mostrou ser um fitofármaco promissor na odontologia, apresentando vantagem sobre o miconazol de não ter provocado reações adversas nos pacientes, uma vez que, 40 por cento dos pacientes do grupo-controle, apresentaram reações indesejáveis.

In dentistry, the phytotherapy is already being used successfully for some years now. It is about a promising therapeutical way in the pharmaceutical field, having as advantage on pharmacotherapy medications the fact to present minimum adverse reactions. The Uncaria tomentosa is an aboriginal plant of the Amazonian forest and other tropical areas of the South and Central America. It has application in the treatment of several pathologies, including candidiasis. This work evaluates, clinical and laboratorial, the action of the Uncaria tomentosa gel in the oral cavity candidiasis patients. Twenty patients which presented clinical and laboratorial signs of Candida infection were selected. They were divided in 2 groups. The test-group (Uncaria tomentosa/IMUNO-MAX Gel), with 10 patients, was told to use the Uncaria tomentosa gel, on the oral cavity injuries, 3 times a day for a period of 14 days. The control-group (Miconazol/DAKTARIN Gel) used the prescribed medication in the same way of the test-group. After the treatment period, the patients returned for a new clinical and laboratorial evaluation. The Uncaria tomentosa showed to be a promising phytotherapeutical medication in dentistry, in the field of the anti-fungi treatment, presenting as advantage on the Miconazol not causing adverse reactions in the patients, once 40 percent of the control-group patients showed undesirable reactions.

Diseño de una formulación antimicótica

Se desarrolló una formulación con nitrato de miconazol al 2 % en una crema hidrosoluble apropiada, la cual cumple con los requerimientos físicos, químicos, microbiológicos y biológicos para este tipo de forma farmacéutica. Se comprobó que el producto debe ser envasado en frascos de vidrio ámbar o en tubos de aluminio laqueado, además de presentar una estabilidad física adecuada durante 3 años. El contenido del principio activo se mantuvo dentro de los límites establecidos hasta los 16 meses. También se demostró la actividad antimicótica de la preparación y su efectividad terapéutica.

A formulation with miconazole nitrate 2 % is developed in an appropiate hydrosoluble cream, which meets all the physical, chemical, microbiologic and biologic requirements for this type of pharmaceutical form. It was proved that the product should be put into amber glass flasks or into lacquered aluminum tubes. besides having an adecuate physical stability during three years. The content of the active principle was kept within the established limits up to the 16 months. The antifungal activity of the preparation as well as its therapeutic effectiveness were also demonstrated.

The epidemiology of pseudallescheriasis complicating transplantation: Nosocomial and community-acquired infection.

The epidemiology of two cases of pseudallescheriasis in organ transplant patients are described and the disease in that population is reviewed. Disseminated hospital-acquired infection occurred in a liver transplant recipient and was fatal despite therapy with miconazole. A heart transplant recipient developed localized disease following soil contamination of soft tissue trauma which was cured with surgical resection and miconazole therapy. Itraconazole showed in vitro activity against Pseudallescheria boydii and should be evaluated in pseudallescheriasis. P. boydii infections are important complications of transplantation and should be considered in the differential diagnosis of community-acquired as well as nosocomial fungal infections in this population.