Drug-induced lung disease due to topical minoxidil

A 55-year-old man presented to our institution with abnormal chest X-ray shadows. Chest computed tomography (CT) showed left-sided interlobular septal thickening; thus, we suspected lymphangitis carcinomatosis and other disorders that show similar CT findings. Bronchoscopy and laboratory and imaging studies yielded no diagnostic findings. Pulmonary shadows during follow-up spontaneously improved then worsened. Thoracoscopic lung biopsy samples showed interstitial pneumonia and granulomas but the etiology of the pulmonary lesion could not be determined. At seven years after presentation, the patient's pulmonary shadows had gradually deteriorated, and he reported using topical minoxidil. His history of minoxidil use was linked to changes in the pulmonary shadows. The diagnostic delay was due to the patient's hesitancy to report drugs obtained online and the difficulty in obtaining such a history.

Test for abnormal niacin response syndrome in schizophrenia: reclaiming the oral route

Introduction

Although there is an abnormal presentation of Niacin Response Syndrome (ANRS) in schizophrenic patients (SZ) compared to subjects with other psychiatric illnesses and with healthy individuals. However, most of the literature is based on studies that have used tests of niacin topical administration, observing, on the other hand, less scientific production of its oral administration. The objective was to determine the sensitivity of the oral niacin test as a method of detecting ASRN in EZ.

Methods

A non-randomized clinical trial was carried out. Two groups were formed, the experimental or SZ, with 21 patients diagnosed with schizophrenia according to DSM-IV-TR SZ or schizoaffective disorder, and the HC group, made up of 20 healthy controls. Both groups were exposed to an oral niacin test and clinical-semiological tools were applied to evaluate the NRS.

Results

90.5% of the SZ group presented ANRS. In contrast, no participant in the HC group presented ANRS (0%).

Conclusions

Oral niacin administration was sensitive to the detection of ASRN in schizophrenia. Likewise, ASRN could be a gradual phenomenon and its prevalence could be dose-dependent, being lower the lower the dose of oral niacin used. Further trials with larger and randomized samples will be needed.

Topical use of tranexamic acid: Are there concerns for cytotoxicity?

Tranexamic acid (TXA) has revolutionized modern blood management in orthopaedic surgery, especially in total joint arthroplasty, by significantly reducing blood loss and transfusion rates. It is an antifibrinolytic agent and a synthetic derivative of the amino acid lysine, which can inhibit the activation of plasminogen and the fibrin breakdown process. The administration of TXA can be intravenous (IV), topical, and oral. In patients where the IV administration is contraindicated, topical use is preferred. Topical administration of the drug theoretically increases concentration at the operative site with reduced systemic exposure, reduces cost, and gives the surgeon the control of the administration. According to recent studies, topical administration of TXA is not inferior compared to IV administration, in terms of safety and efficacy. However, there are concerns regarding the possible toxicity in the cartilage tissue with the topical use of TXA mainly in hemiarthroplasty operations of the hip, unilateral knee arthroplasties, total knee arthroplasties where the patella is not resurfaced, and other intraarticular procedures, like anterior cruciate ligament reconstruction. The purpose of the present review is to present all the recent updates on the use of TXA focusing on the toxicity on chondrocytes and the articular cartilage that may or may not be provoked by the topical use of TXA.

Efficacy and Safety of an Antioxidant-Enriched Medical Device for Topical Use in Adults with Eczematous Dermatitis

INTRODUCTION

Emollients reduce the severity of dermatitis-associated symptoms. Antioxidant supplementation may be helpful to control inflammatory processes and consequential skin damage. The clinical performance and safety of an emollient medical device for topical treatment enriched with antioxidant ingredients in adults with mild-to-moderate dermatitis is presented in this manuscript.

METHODS

We performed a monocenter, open-label, uncontrolled clinical trial. Participants applied the product twice a day for 28 days. No other medication or moisturizer was allowed. Changes in dermatitis severity were assessed at days 14 and 28 by study investigators. Subjects self-assessed pruritus, Dermatology Life Quality Index, and product satisfaction. At the end of the study, a global evaluation of the product was done both by patient-reported outcomes and investigators' evaluations.

RESULTS

Forty subjects were enrolled in the study (mean age 35 years). Treatment success was achieved in 87.5% of subjects (p < 0.0001) after 28 days. Mean Investigator's Global Assessment (IGA) and Eczema Area and Severity Index (EASI) scores decreased at days 14 and 28 (p < 0.0001). Subjects reported a reduction in pruritus severity and improvement of quality of life (p < 0.0001), along with satisfaction with the product. At the end of the study, skin condition improved in more than 90% of subjects. No safety issues were identified.

CONCLUSION

The medical device studied for topical use in this clinical trial is considered safe and reduces pruritus in adults with atopic and contact dermatitis.

The influence of topical use of tranexamic acid in reducing blood loss on early operation for thoracolumbar burst fracture: a randomized double-blinded controlled study

Purpose

To investigate the safety and efficacy of topical use of tranexamic acid (TXA) on early operation for thoracolumbar burst fracture (TBF).

Methods

Patients with acute TBF requiring early decompression were prospectively collected. The enrolled patients were randomly assigned to TXA and control group, in which wound surface was soaked with TXA or the same volume of normal saline for 5 min after wound incision, respectively. The total blood loss (TBL), intraoperative blood loss (IBL), postoperative blood loss (PBL), hemoglobin (HGB) levels on preoperatively (pre-op) and postoperatively, and amount of allogenic blood transfusion were recorded. Furthermore, the general information was also compared between groups.

Results

There were 39 and 37 patients enrolled in TXA and control group for final analysis. The demographics data showed no significant difference between groups (P > 0.05), but operation time and IBL were significantly decreased in TXA group (P < 0.05). Further analysis showed that HGB level was significantly higher in the TXA group at POD1, while the TBL and PBL were significantly less than those in the control group (P < 0.05), but similar to HBL (P > 0.05). The postoperative ambulation time, removal time of drainage tube, length of hospital stay, and blood transfusion rate were also significantly less in TXA group (P < 0.05). At the final follow-up, no neurological deteriorations and no TXA-related complications were observed in both groups.

Conclusion

This RCT first demonstrated that topical TXA usage after wound incision could effectively reduce IBL without increasing risk of complications, beneficial to enhanced recovery after early operation for TBF.

Electronic supplementary material

The online version of this article (10.1007/s00586-020-06626-x) contains supplementary material, which is available to authorized users.

Antibacterial and anti-inflammatory activity of bistort (Bistorta officinalis) aqueous extract and its major components. Justification of the usage of the medicinal plant material as a traditional topical agent

ETHNOPHARMACOLOGICAL RELEVANCE

Bistort rhizome (Bistorta officinalis) is a traditionally used plant material popular in Europe and Asia in the treatment of diarrhea and as a topical agent for skin conditions. It contains tannins mostly condensed flavan-3-ol derivatives. However, the in-depth phytochemical investigation of infusions from this plant materials is still lacking. Additionally, the scientific reports supporting the traditional topical application of bistort rhizome are scarce.

AIM OF THE STUDY

The major objective of the present study was to comprehensively investigate the chemical composition of infusion from subterranean parts of common bistort both using hyphenated chromatographic technique and isolation approach. Additionally, the influence of water extract on pro-inflammatory functions of human neutrophils was performed. As bacterial infections play a crucial role in the generation of skin inflammations the antimicrobial activity of the infusion and its major components was established.

MATERIAL AND METHODS

The chemical composition of the infusion was established using UHPLC-DAD-MS³ method. Major compounds which could not be identified using chromatographic analysis were isolated by column chromatography and preparative HPLC. Obtained pure phytochemicals were identified by NMR analysis. The influence of the extract and compounds on the cell viability and apoptosis was evaluated by flow cytometry. The release of pro-inflammatory cytokines after LPS stimulation was established by ELISA. Finally, the antimicrobial assays were performed by establishing MIC and MBC values using several bacterial strains.

RESULTS

The UHPLC analysis revealed the infusion contained mainly, galloyl glucose derivatives, procyanidins and chlorogenic acid. Several compounds were isolated and identified for the first time from the investigated plant material. It was shown that the infusion and its constituents influenced the release of proinflammatory cytokines such as IL-1β, TNF-α and IL-8 and also affected the viability and apoptosis of healthy cells. Both extract and isolated natural products displayed antimicrobial activity against skin pathogens.

CONCLUSIONS

The results obtained in the present study support that the infusions from common bistort influence key biological processes are crucial for skin conditions with the inflammatory background. The study justifies the traditional topical application of common bistort.

Topical vitamin D3: A randomized controlled trial (RCT)

OBJECTIVE

The intent of this study was to test the effect of Top-D, a topical Vitamin D preparation, in delivering vitamin D.

METHODS

Five hundred and fifty healthy patients, with vitamin D insufficiency and deficiency were recruited after written informed consent. Demographic data was recorded, adequate history and clinical examination was done to rule out any metabolic diseases. Complete blood picture, serum calcium, phosphorous, Parathormone and 25 Hydroxy-vitamin D3 (25OHD) was carried out before enrollment of the patients. Patients were divided randomly into two groups 350 in study group and 200 in the control group. Patients in the study group were given Top-D (Vitamin D3 gel made from proniosomal technology) to apply daily on the skin. Top-D 1 g contained 5000 IU of vitamin D3. The control group was given 1 g of Aloe vera gel to be applied every day. The two groups had no knowledge to which group they belong. After 4 months serum 25OHD was tested again.

RESULTS

Three hundred and forty five patients in study group and 192 in control group completed the study. The mean age of the patients in the both the groups was 42 years (18-80 years). The pretreatment 25OHD level in the study group was 11.03 ± 4.57 (2-12) ng/l compared to the control group 10.36 ± 4.09 (2-21) and post treatment the levels were 37.17 ± 6.04 (12-54) ng/ml and 10.51 ± 3.5 (2-19) ng/ml (p < 0.001).

CONCLUSION

The results of this study indicate that transdermal route of vitamin D is potentially, safe and can give desired results to raise the vitamin D levels. This route is an alternate route for supplementation of vitamin D which should be utilized.

Evaluation of the in vivo leishmanicidal activity of amphotericin B emulgel: An alternative for the treatment of skin leishmaniasis

The American Cutaneous Leishmaniasis (ACL) is an infectious disease that can be fatal. The first line of treatment is pentavalent antimonies. However, due to its potential to develop resistance, Amphotericin B (AmB) started to be used as an alternative medicine. Current treatments are limited, a fact that has led to a growing interesting in developing new therapies. This study aims to evaluate the therapeutic potential in vivo of an amphotericin B + oleic acid (OA) emulgel in the treatment of cutaneous leishmaniasis in an experimental model. Strains of Leishmania major MHOM/IL/80/Friendlin of Leishmania major were used. The animals were inoculated subcutaneously. After the development of leishmanial, nodular or ulcerative lesions, the animals were divided into three groups (control, Group A and Group B) and treated twice a day for twelve days. The weight of the animals was measured and the size of the lesions was observed. A histopathological analysis was performed with skin fragments of lesions and with the spleen of animals treated with different treatments (emulgel, AmB 3% emulgel and AmB 3% plus OA 5% emulgel). It was observed that when subjected to treatment with AmB 3% emulgel during the study period using both formulations, with enhancer and without enhancer, ulcerative lesions regress gradually or even complete cure. The quantification of the average number of parasites recovered from the inoculation site was made after the treatment in each group and the differences were considered significant. The treatment with AmB 3% and OA 5% emulgel had the best in vivo therapeutic response, showing good prospects for cutaneous leishmaniasis therapy as an alternative therapy.

Plants with topical uses in the Ripollès district (Pyrenees, Catalonia, Iberian Peninsula): ethnobotanical survey and pharmacological validation in the literature

ETHNOPHARMACOLOGICAL RELEVANCE

The skin is the main structure that protects the human body from environmental factors and has, in addition, a relevant relationship to people׳s appearance and beauty. Official medicine and cosmetics have shown interest on elaborating products to protect the dermal system, yet the role of folk medicine is highly unknown in this field. Taking this into account, we performed an ethnobotanical study in a Catalan district of the eastern Pyrenees (northeast Iberian Peninsula), with the purpose of assessing popular plant knowledge and use. In this paper, we present exclusively the results on topically-used plants. Additionally, we have performed a thorough literature search in order to validate the uses of plants recorded in well-established pharmacological works.

METHODOLOGY

A number of 163 informants (57.7% women and 42.3% men, born between 1915 and 1988, with an average age of 71.6 years) were interviewed by means of 104 semi-structured interviews. Voucher specimens were collected, prepared and deposited in the BCN herbarium.

RESULTS

We collected information on the popular uses implying topical application of 115 plant taxa (three determined at generic level and 112 at specific level), belonging to 92 genera and 51 families. Taxa with use reports higher than 5% included Arnica montana subsp. montana, Hypericum perforatum, Thymus vulgaris, Lilium candidum and Tussilago farfara. The degree of reliability of the results is very high, as indicated by a big number of report uses (1676) and a very high informant consensus factor (0.93 of a maximum of 1). Topical uses of 21 plant taxa with more than 1% of use reports have been validated consulting pharmacological literature.

CONCLUSIONS

Data indicate a high degree of plant knowledge in the studied region regarding dermal conditions, cosmetics and additional affections (such as snake bite). The present study constitutes a good basis for further phytochemical and pharmacological research, which could be of interest in the design of new drugs. Furthermore, the evidence of these folk uses could be the key information in simplified procedures established by the European Union for the registration of herbal medicinal products based on traditionally used plants, reinforcing the already recognized role of ethnobotany in the mentioned applied research and development field.

Formulation of resveratrol entrapped niosomes for topical use

A new approach to the formulation of resveratrol (RSV) entrapped niosomes for topical use is proposed in this work. Niosomes were formulated with Gelot 64 (G64) as surfactant, and two skin-compatible unsaturated fatty acids (oleic and linoleic acids), commonly used in pharmaceutical formulations, as penetration enhancers. Niosomes were prepared by two different methods: a thin film hydration method with minor modifications followed by a sonication stage (TFH-S), and an ethanol injection modified method (EIM). Niosomes prepared with the EIM method were in the range of 299-402 nm, while the TFH-S method produced larger niosomes in the range of 293-496 nm. Moreover, niosomes with higher RSV entrapment efficiency (EE) and better stability were generated by the EIM method. Ex vivo transdermal experiments, carried out in Franz diffusion cells on newborn pig skin, indicated that niosomes prepared by the EIM method were more effective for RSV penetration in epidermis and dermis (EDD), with values up to 21% for both penetration enhancers tested. The EIM method, which yielded the best RSV-entrapped niosomes, seems to be the most suitable for scaling up.