Efetividade do metronidazol tópico e/ou sistêmico no controle do mau odor de tumores malignos fétidos: revisão sistemática

Introduction: Fetid tumors are a devastating complication of cancer and cause much discomfort and patient isolation. They usually develop themselves in the last six months of life and they are very difficult to be successfully treated. The aim of this systematic review was to analyze the evidence on the effectiveness of topical and/or systemic metronidazole for the treatment of bad odor in malignant tumor wounds. Results: Sixty-two articles were initially found, and of these, only 4 articles met the inclusion criteria. Two of them were clinical trials, being 1 double-blind, randomized and 1 non-controlled phase III studies. One study was retrospective with a 10-years data collection period and 1 was a cohort prospective study. Of these, 3 analyzed the efficacy of treating malignant tumors with a bad odor using topical metronidazole and only 1 compared the use of topical and systemic metronidazole. Discussion: A factor that contributes to the bad odor not being properly controlled is the lack of standardized protocols. Over the years, studies have tried to find affordable and effective interventions to reduce serious recurrences of bad odor in necrotic wounds. Conclusion: Both topical and systemic routes have been shown to be effective in controlling bad odor. The results of this systematic review highlight the lack of research in this area with little evidence to guide clinical practice in the treatment of these injuries. Further studies are needed to establish more effective protocols to control this distressing condition, experienced by some cancer patients.

VULVOVAGINAL CANDIDIASIS IN COMBINATION WITH BACTERIAL VAGINOSIS IN WOMEN OF REPRODUCTIVE AGE: FEATURES OF PATHOGENESIS AND TREATMENT

The aim. Reducing the recurrence of vulvovaginal candidiasis (VVC) in combination with bacterial vaginosis (BV) in women of reproductive age by studying the pathogenesis and improving the algorithm of treatment and prevention measures. Materials and methods. During the study, 150 women of reproductive age who had the same clinical manifestations of VVC and BV were selected and divided into 3 groups of 50 women: Group I was treated with an antimicrobial combination drug (miconazole with topical metronidazole), group II – the same drug in combination with probiotic (lactobacilli) in candles, group III – according to the algorithm improved by the authors. In addition, a control group was formed, which included healthy women of reproductive age. To establish the pathogenesis of VVC in combination with BV in the studied women, the concentration of cytokines and adhesion molecules in the blood before and after treatment was determined and compared with the control group. The clinical effect of different treatments was assessed at 3, 7, 10, 14 days, and the presence of relapses – 1, 3, 6 months after treatment. Results. The occurrence of a combination of VVC and BV in women of reproductive age is accompanied by a significant increase in the level of intercellular adhesion molecules (ICAM-1) and vascular cell adhesion molecules (VCAM-1) along with a statistically significant increase in proinflammatory cytokines (interleukin-6) (IL-6), interleukin-8 (IL-8)) and tumor necrosis factor (TNF) - TNF-α. As a result of the application of the algorithm improved by the authors, higher clinical efficiency and the ability to avoid recurrence of VVC in combination with BV in women of reproductive age were obtained. Conclusions. The authors' substantiated improvement of the algorithm of VVC treatment in combination with BV in women of reproductive age makes it possible to reduce the frequency of their recurrence and restore the biocenosis of the vagina to normal. In the case of this pathology there is an increase in the level of pro-inflammatory cytokines (IL-6, IL-8), TNF-α and ICAM-1 and VCAM-1.

Application of a dermatopharmacokinetic (DPK) method for bioequivalence assessment of topical metronidazole creams

Purpose: The main aim of the current research was to develop and apply a dermatopharmacokinetic (DPK) approach for the bioequivalence assessment of metronidazole (MTZ) topical cream products, indicated in the treatment of rosacea. Methods: A DPK methodology using tape stripping (TS) technique was developed by investigating the factors that may influence the TS results viz. tapes, dose durations, number of tapes to be used, pressure application, dose applied and gravimetric analysis of the tapes. An initial dose duration study was performed on 6 healthy participants to determine an appropriate application time duration using the Emax model. The SC thickness was normalised between participants using TEWL measurements. A pivotal study was conducted using both the arms of 10 healthy human participants to demonstrate the ability of the TS method for bioequivalence assessment by comparing the reference product to itself as a positive control and including products with higher and lower strengths of MTZ to serve as negative controls in order to confirm bioinequivalence. Results: Whereas the reference was found to be bioequivalent when compared to itself, the creams containing 0.56% and 0.95% MTZ (negative controls) were not bioequivalent (bioinequivalent). Furthermore, another product containing 0.75% MTZ was also assessed and was found to be bioequivalent to the reference product. In addition, the use of both forearms of each participant offered an important advantage of significantly reducing the number of human subjects required to demonstrate BE with a high statistical power of > 80%. Conclusion: The data obtained provides compelling evidence that the developed TS method has the potential to be a cost-effective surrogate alternative for lengthy and expensive clinical trials. Consequently, its application can facilitate faster development of generic products which would, in turn, lower the economic burden of healthcare.

Comparison of mean pain score using topical and oral metronidazole in post milligan morgan hemorrhoidectomy patient; A randomized controlled trial

Background and Objectives: Milligan Morgan Hemorrhoidectomy is one of the most commonly performed surgeries. Post-operative pain is the major cause of morbidity in post hemorrhoidectomy patients. Metronidazole has an established role in relieving post hemorrhoidectomy pain. The objective was to evaluate the pain score by using topical and oral metronidazole in post Milligan Morgan hemorrhoidectomy patients. Methods: A prospective randomized controlled trail was done in surgical departments of Akbar Niazi Teaching Hospital, Islamabad. A total of 166 consecutive patients with 3rd and 4th degree hemorrhoids were presenting in surgical OPD and who underwent Milligan Morgan hemorrhoidectomy between July 2018 and December 2018 were included in the study. Patients allocated in two groups, Group-A received topical metronidazole 10% post hemorrhoidectomy for seven days and Group-B were given oral metronidazole 400mg for 07 days. Analgesics were given on patient’s requirement. Patients post hemorrhoidectomy pain was recorded by using VSA scale at baseline (1st day) and on 7th post-operative day. Data analysis was done by using SPSS 21. Pain calculated by compared in terms of mean, standard deviation between groups and independent sample T test was used. Association between demographic details like gender and ages of the patients with pain scale on 7th day was measured and chi-square distribution was used. Results: Total 166 patients were included in this study. The mean ages of the patients were 44.07±10.62 years with minimum 20 and maximum 60 years. Out of 166 patients, female were 55 (33.1%) and male were 111 (66.9%). Results showed significantly lower pain in patients using topical metronidazole as compared to oral metronidazole (p=0.001). Association of pain with respect to ages was insignificant (p=0.202) whereas between genders inside the groups showed significant difference (p=0.028). Conclusion: These results showed that topical metronidazole significantly reduces pain in post hemorrhoidectomy patients as compared to oral metronidazole overall and even when data stratified among age, gender and type of hemorrhoids. doi: https://doi.org/10.12669/pjms.36.5.1796 How to cite this:Abbas ST, Raza A, Chaudhry I, Hameed T, Hasham N, Arshad N. Comparison of mean pain score using topical and oral metronidazole in post milligan morgan hemorrhoidectomy patient; A randomized controlled trial. Pak J Med Sci. 2020;36(5):---------. doi: https://doi.org/10.12669/pjms.36.5.1796 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Granulomatous Periorificial Dermatitis in an Adult: A case report with review of literature

Granulomatous periorificial dermatitis (GPD) is a benign, self-limiting eruption that is considered a clinical variant of periorificial dermatitis, also known as perioral dermatitis. It presents primarily in prepubertal children as monomorphic scaly papules over perioral, paranasal and periorbital areas of the face with rare occurrence in adults. We report a 36-year-old Omani male patient who presented to the Dermatology Clinic at Bahla Polyclinic, Bahla, Oman, in 2018 with a papular eruption over his face for the previous six months. Based on clinical and histopathological findings the patient was diagnosed with GPD with sarcoid-like histology. He was treated effectively with oral doxycycline and topical metronidazole. This report provides a review of the literature on GPD and summarises all reported cases in adults to date.Keywords: Perioral Dermatitis; Dermatitis; Granulomas; Case Report; Oman.

Efficacy of metronidazole and miconazole vaginal co-formulation for bacterial vaginosis and vulvovaginal candidiasis

Recurrent vulvovaginal infections being an epidemiological and clinical issue also have social and psychological implications. As a result, the development of the effective diagnostic strategies and therapeutic approaches to female genital infections is important. This paper reviews the most common vulvovaginal infections, i.e., bacterial vaginosis and vulvovaginal candidiasis. Topical metronidazole and miconazole vaginal dosage forms prescribed for these relevant obstetrical gynecological disorders are highlighted. Although numerous domestic and foreign publications on the clinical efficacy of this combination are available, dose reductions and the minimum therapeutically effective doses for bacterial vaginosis, vulvovaginal candidiasis, and mixed vaginitis are still challenging entities. The data on the efficacy of a novel dosage form, Gynocaps® vaginal capsules, containing low doses of miconazole (100 mg) and metronidazole (100 mg) are addressed. The treatment has resulted in microbiological cleaning, the normalization of vaginal WBC count, and the improvement of vaginal florocenosis. In addition, easy-to-use vaginal capsules ensure treatment adherence.KEYWORDS: bacterial vaginosis, vulvovaginal candidiasis, metronidazole, miconazole nitrate, vaginal capsules.FOR CITATION: Markova E.A. Efficacy of metronidazole and miconazole vaginal co-formulation for bacterial vaginosis and vulvovaginal candidiasis. Russian Journal of Woman and Child Health. 2020;3(3):205–210. DOI: 10.32364/2618-8430-2020-3-3-205-210.