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Resumo Fundamento Recentemente, foi demonstrado que o alopurinol, um inibidor da xantina oxidase, possui propriedades cardiovasculares e anti-isquêmicas e pode ser uma opção de agente antianginoso metabólico. Objetivo O objetivo do presente estudo foi avaliar o efeito antianginoso do alopurinol como terceiro medicamento para pacientes com doença arterial coronariana (DAC) estável. Métodos Trata-se de um ensaio clínico randomizado entre 2018 e 2020 incluindo pacientes com DAC que mantiveram angina apesar da otimização inicial com betabloqueadores e bloqueadores dos canais de cálcio. Os indivíduos foram randomizados 1:1 para 300 mg de alopurinol 2 vezes ao dia ou 35 mg de trimetazidina 2 vezes ao dia. O desfecho principal foi a diferença no domínio da frequência da angina do Questionário de Angina de Seattle (QAS-FA). Foram considerados estatisticamente significativos valores de probabilidade (p) < 0,05. Resultados Foram incluídos 108 pacientes na fase de randomização, com 54 (50%) no grupo alopurinol e 54 (50%) no grupo trimetazidina. Seis (5,6%) indivíduos, 3 de cada grupo, foram perdidos no seguimento para o desfecho primário. Nos grupos de alopurinol e trimetazidina, as pontuações medianas do QAS-FA foram 50 (30,0 a 70,0) e 50 (21,3 a 78,3), respectivamente. Em ambos os grupos, a pontuação do QAS-FA melhorou, mas a mediana da diferença em relação à linha de base foi menor no grupo alopurinol (10 [0 a 30] versus 20 [10 a 40]; p < 0,001), assim como a média da diferença na pontuação total do QAS (12,8 ± 17,8 versus 21,2 ± 15,9; p = 0,014). Conclusão Tanto o alopurinol quanto a trimetazidina melhoraram o controle dos sintomas de angina; no entanto, a trimetazidina apresentou um ganho maior em relação à linha de base. Registro Brasileiro de Ensaios Clínicos – Número de Registro RBR-5kh98y

Introducción: El síndrome de lisis tumoral (SLT) es una emergencia oncológica, que produce alteraciones en el metabolismo, causando manifestaciones clínicas y trastornos bioquímicos que ponen en peligro la vida del paciente. El objetivo del presente estudio fue identificar las características clínicas, de laboratorio y tratamiento del SLT, en pacientes pediátricos oncológicos, del Instituto del Cáncer SOLCA-Cuenca, en el periodo 2010 – 2020. Materiales y métodos: En este estudio se identificó las características del SLT, en pacientes pediátricos oncológicos, del Instituto del Cáncer SOLCA-Cuenca, en el periodo 2010 – 2020, a través de un estudio de tipo descriptivo-observacional. Resultados: Se incluyó 463 historias clínicas, en el cual se obtuvo que el SLT tuvo una frecuencia del 5.61%, con predominio del sexo masculino (57.7%) y con una edad media de 7 ± 1.29 años. La presentación clínica más observada fue la deshidratación con náusea, vómito y diarrea (57.7%). Las alteraciones de laboratorio más frecuentes fueron la hiperuricemia y la hipocalcemia, con un 76.9% y un 73.1% respectivamente. La Leucemia linfoblástica aguda (LLA) fue el diagnóstico oncológico con más casos (61.5%). Los pilares del tratamiento fueron la hiperhidratación y el uso de alopurinol, utilizados en el 100% y un 80.8% respectivamente. Conclusión: El SLT afectó más frecuentemente a varones, con diagnóstico de leucemia, manifestaciones clínicas digestivas y alteraciones de laboratorio (hiperuricemia e hipocalcemia). El tratamiento empleado resultó eficaz y se basó en lo recomendado por la literatura médica.

BACKGROUND: DRESS syndrome is a severe adverse reaction to a drug, which can cause multiorgan involvement when it is associated with the ingestion of allopurinol, which is a drug used in clinical practice for the treatment of hyperuricemia and gout, with a mortality rate of 10%. CLINICAL CASE: A 76-year-old female patient who, after taking allopurinol due to hyperuricemia, showed bumby, red, over raised, pruritic lesion on the body and the face. In addition, in the following 24 hours, she also presented edema and desquamation mainly in the face. With the help of complementary tests, such as leukocytosis with eosinophilia, we observed a deterioration of her renal function. However, after the suspension of the drug and the administration of corticosteroids patient improved. CONCLUSIONS: DRESS syndrome has a high risk of lethality; therefore, it is extremely important that physicians take the right steps such as the rapid suspension of drugs as well as therapeutic measurements to help minimize the risk. [ABSTRACT FROM AUTHOR]

El síndrome de DRESS (por sus siglas en inglés Drug Reaction with Eosinophilia and Systemic Symptoms) representa una farmacodermia grave con diferentes manifestaciones clínicas y paraclínicas secundarias a una reacción de hipersensibilidad farmacológica. Su incidencia exacta es desconocida pero se estima entre 1 a 1000 y 1 a 10000 casos de exposición a fármacos asociados. Se caracteriza por dermatosis generalizada extensa en conjunto con afección orgánica, linfadenopatia, eosinofilia y linfocitosis atípica. Entre los fármacos comúnmente asociados se encuentran anticomiciales aromáticos, carbamazepina, sulfonamidas y el alopurinol. Mediante el uso de la puntuación RegiSCORE es posible confirmar o descartar una sospecha de diagnóstico. El tratamiento depende de la severidad de presentación incluyendo esteroides tópicos hasta esteroide sistémico de duración variable dependiendo respuesta clínica y bioquímica. Se reporta tasas de mortalidad del 10 al 20% siendo la insuficiencia hepática la principal causa de muerte en estos pacientes. Se presenta el caso de un paciente femenino de 71 años de edad que, posterior a tratamiento con alopurinol, debuta con eritrodermia secundaria a Síndrome de DRESS.

Objective: To evaluate the impact of a medical-pharmaceutical intervention strategy on patients exposed to azathioprine-allopurinol (AZA-ALO) interaction in the Community of Madrid (CM)., Material/methods: Multicentre retrospective observational study. We reviewed the database generated after an intervention carried out in the healthcare context in which Primary Care Pharmacists (PCP) review the treatment of patients with safety risks and, when there are incidents, they contact (by telephone and/or e-mail) their Family Physicians (FP) for possible resolution., Study Population: CM patients with an active clinical history in Primary Care who have been dispensed both medications (AZA-ALO) in the period April-June 2022 according to prescription billing data from the National Health System (NHS). Main variable: suppression or dose adjustment of either of the two drugs., Results: Forty-nine patients were analysed. Mean age: 65.65±11.67 years. Males; 77.6%. 8,834 patients withdrew azathioprine (28,724 packs) and 89,297 withdrew allopurinol (141,188 packs) from pharmacies, with a very low prevalence of patients at risk (<1%). The prescription was modified in 32 patients (65.31%-IC95%: 51.98%-78.63%), with allopurinol being discontinued in 65.62% and, with regard to azathioprine, the dose was reduced by 18.75% and discontinued in 9.37%. Analytical alterations compatible with adverse effects due to the interaction were recorded in 28 patients (57.1%-IC95%: 43.29%-71%), including anaemia (39.3%) and leukopenia/neutropenia (25%)., Conclusions: Coordinated intervention between pharmacists and physicians was effective, resulting in prescription modification in a significant percentage of patients, which reduced the risk of toxicity., (Copyright © 2024 The Author(s). Publicado por Elsevier España, S.L.U. All rights reserved.)

Contexto: el ácido úrico es el producto final de la degradación de las purinas en los primates, en condiciones normales es un agente antioxidante endógeno y participa en varias vías fisiológicas, sin embargo, cuando los niveles séricos de urato se incrementan, estos participan en el desarrollo de diversas enfermedades. Desde el siglo XIX se conoce de la asociación entre hiperuricemia y daño renal, aunque ninguna guía de manejo recomienda el uso de fármacos hipouricemiantes en pacientes asintomáticos, en algunos casos especiales, el manejo farmacológico beneficiará a pacientes con hiperuricemia, brindando protección al riñón y disminuyendo el riesgo de desarrollar enfermedad renal terminal. Objetivo: describir la relación entre hiperuricemia y daño renal, y analizar los casos en los que el manejo de esta condición con medicamentos resultará en un beneficio para el riñón de los pacientes. Metodología: revisión de la literatura sobre la participación de la hiperuricemia en el daño renal y análisis de los artículos revisados. Resultados: el manejo de la hiperuricemia asintomática puede proteger el riñón en algunas situaciones específicas. Conclusiones: hay situaciones específicas para la disminución de los niveles séricos de ácido úrico.

Introducción: El síndrome de DRESS es una reacción mucocutánea y visceral grave provocada por fármacos que puede llegar a provocar la muerte por la afectación de hígado y riñón. Caso Clínico: Varón de 46 años que presentó un exantema generalizado no pruriginoso, junto con fiebre, síntomas digestivos, adenopatías cervicales y sudoración nocturna coincidiendo con la toma previa de alopurinol. Tras el ingreso en el hospital se le diagnostica hepatitis aguda y deterioro de la función renal con oliguria, necesitando realización de hemodiálisis urgente. Tras un tratamiento multidisciplinar entre los servicios de nefrología, digestivo y hematología, el paciente es dado de alta con mejora de su función renal, pero continúa en seguimiento ambulatorio. Conclusiones: El alopurinol, fármaco muy utilizado en la práctica clínica, puede tener reacciones adversas muy graves, poniendo en riesgo la vida del paciente. El síndrome de DRESS, al ser muy poco frecuente, no tiene un tratamiento estandarizado. En el caso concreto de nuestro paciente, una detección temprana, junto a un tratamiento efectivo, con recambios plasmáticos con albúmina, hemodiálisis y corticoides, propiciaron una evolución favorable del paciente, con recuperación de la función renal.

Resumo: A gota é uma comorbidade comum em pacientes transplantados renais, afetando entre 2% e 13% dos indivíduos. A doença se caracteriza por artrite aguda recidivante ou crônica, resultante da precipitação de cristais de urato monossódico na sinóvia e no tecido periarticular. Fatores como distúrbios metabólicos preexistentes e o uso de medicamentos como diuréticos, tiazídicos e imunossupressores podem estar associados ao desenvolvimento da gota. Relato de caso: Apresentamos o caso de um paciente masculino de 62 anos com histórico de refluxo vesicoureteral, que realizou hemodiálise por um ano e transplante renal aos 30 anos sem complicações. Há dois anos, o paciente relatou dor e hiperemia no hálux esquerdo, inicialmente atribuída à presença de hálux valgo. Em junho de 2024, ele apresentou quadro de dor, edema e rubor no hálux e nas regiões maleolar e plantar do membro inferior direito, impossibilitando a locomoção. Após uma semana, o paciente procurou atendimento no HUPE, onde foi internado e recebeu o diagnóstico de gota. Na admissão, foi constatada hiperuricemia sem repercussões osteoarticulares, como erosão em saca bocada. Não houve manifestação de artrite em outras articulações ou repercussões extra-articulares. O tratamento iniciado incluiu colchicina e aumento da dose de prednisona em cascata, com boa resposta clínica. O paciente recebeu alta hospitalar com orientação para terapia redutora de urato monossódico (TRU) com alopurinol no ambulatório e uso de colchicina profilática por 3 a 6 meses. Discussão: Hiperuricemia e gota são comorbidades frequentes em pacientes pós-transplante renal, principalmente associadas ao uso de imunossupressores. Estes medicamentos podem induzir o aumento da reabsorção e inibir a secreção tubular de ácido úrico, levando ao acúmulo de urato sérico (US). O padrão clínico da gota em pacientes pós-transplante é similar ao de pacientes não transplantados, porém com curso mais agressivo e acometimento de articulações proximais. Manifestações extra-articulares também são mais frequentes, como tofo, entesite gotosa e tenossinovite plantar e de tornozelo. O tratamento de primeira linha para a gota em pacientes transplantados renais consiste no uso de alopurinol como TRU, iniciado em dose baixa (=100 mg/dia) com ajustes seriados de acordo com os níveis de US, buscando atingir um alvo terapêutico de <6 mg/dL. Recomenda-se o uso de anti-inflamatórios não esteroides (AINEs) para terapia profilática por 3 a 6 meses, com preferência pela colchicina, porém com cautela devido ao risco de mioneuropatia. AINEs também podem ser utilizados como alternativa, mas com atenção aos seus efeitos sobre a hemodinâmica renal. Corticoides, já utilizados na maioria dos pacientes transplantados, podem ter sua dose aumentada durante crises de gota. [ABSTRACT FROM AUTHOR]

Copyright of Enfermería Nefrológica is the property of Sociedad Espanola de Enfermeria Nefrologica and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Dermatoses perfurantes são patologias cutâneas papulonodulares que se caracterizam pela extrusão transepitelial de componentes da matriz extracelular da derme, por inflamação ou degeneração. Quando são secundárias as doenças sistêmicas são chamadas Doenças Perfurantes Adquiridas. Nossa carta tem como objetivo relatar caso de dermatose perfurante adquirida secundária a insuficiência renal crônica dialítica. O tratamento com Alopurinol se mostrou eficaz neste caso. O Alopurinol atuaria como antioxidante, reduzindo a reação inflamatória nos tecidos e consequentes danos nas fibras colágenas.

Cardiovascular diseases are aggravated by various factors, including chronic use of certain medications. There are worldwide reported cases of sudden strokes or myocardial infarction in previously non-ischemic patients while using medications for other chronic diseases, such as diabetes, gout, hypertension, and endocrine diseases. The mechanism is quite complicated, and the underlying causes were obscure. In line with this reported toxicity are patients with hyperuricemia on uric acid lowering therapy. The goal of the present investigation was to assess the cardiotoxic effect of allopurinol based on the levels of troponin that were quantified by fully automated COBAS technique in apparently healthy renal stone patients. To do so, serum samples were collected from these patients at baseline (before starting allopurinol therapy), and at the end of the course of the therapy. The troponin level was significantly elevated after allopurinol therapy compared to baseline. The study concluded that allopurinol could have a significant cardiotoxic effect in heart tissues and should be used cautiously in patients with preexisting ischemic cardiac diseases. [ABSTRACT FROM AUTHOR]

La gota es una artritis inflamatoria causada por la acumulación excesiva de cristales de urato monosódico a nivel tisular, predominando la afectación articular. Sus manifestaciones clínicas son variadas, condicionando usualmente un curso crónico de la enfermedad. El diagnóstico se realiza mediante el conjunto de hallazgos clínicos, bioquímicos e imagenológicos. El tratamiento se basa en medidas no farmacológicas y farmacológicas, dentro de los que se describen los inhibidores de xantina oxidasa y los uricosuricos. Se describe un caso de un paciente masculino con artritis gotosa de difícil manejo e hiperuricemia refractaria.

BACKGROUND: Drug hypersensitivity syndrome, also known as DRESS syndrome (drug reaction with eosinophilia and systemic symptoms), is an adverse reaction to medications and is life-threatening; dermatological manifestations are diverse and can cause significant multisystemic compromise. Diagnosis is a challenge due to the polymorphous rash of skin lesions, fever and multiorgan commitment. Treatment consists on the immediate withdrawal of the suspicious drug; systemic corticosteroids are the gold standard, depending on the severity, intravenous immunoglobulin or other immunosuppressive drugs can be added. CLINICAL CASE: A 37-year-old female patient, who three weeks after consumption of allopurinol had a generalized and symmetrical dermatosis, consisting of numerous macules that converged with each other to form a morbilliform pattern, with some skin-colored isolated spaces, also some papules that form erythematous-edematous plaques with ill-defined and blurred edges of apparently acute evolution. It was accompanied by itching, dry cough, fever, and adenomegalies. Laboratory tests showed eosinophilia and impaired kidney function. Histopathological study corresponded to interface dermatitis consistent with reactional dermatitis. CONCLUSIONS: It is important to know the clinical manifestations of DRESS syndrome, in order to have its early recognition and timely treatment, since although complete recovery is the usual course, mortality of up to 20-30% has been reported. [ABSTRACT FROM AUTHOR]

Gout is a disease caused by the chronic deposition of monosodium urate crystals. Its clinical presentation as an acute, self-limiting arthritis and the belief that it is a banal, self-inflicted disease have led to its poor management. Despite advances in the knowledge of the disease and the simplicity of its management, no more than 30% of patients are well treated. In Spain, the prevalence of gout is 2.5% and its incidence is increasing. In the following article we will review the pathogenesis of gout and hyperuricaemia, highlighting the greater weight of genetics and renal function over diet. We will look at the consequences of crystal deposition. Gout, in addition to its joint presentation and renal involvement, has been shown to be an independent cardiovascular risk factor. Hypouricemic therapy is the most important treatment, as it is the one that dissolves the crystals and cures the disease. This requires the sustained achievement of uricemia levels below 6mg/dl. We will also review preventive and flares treatment, as well as the role of patient education in terms of both lifestyle and dietary habits and adherence to pharmacological treatment., (Copyright © 2023 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España, S.L.U. All rights reserved.)

BACKGROUND: Secondary skin reactions to medications are estimated in 3 to 7% in hospital emergency services. The term photosensitivity in its broadest sense refers to any alteration induced by the absorption of non-ionizing energy. CLINICAL CASE: A 50-year-old male patient with hyperuricemia of one month of diagnosis under treatment with allopurinol 300 mg/day, which began his dermatosis one month after sun exposure for working hours of approximately 6-8 hours, with vesicles and blisters on his face, subsequent spread to the upper extremities and trunk, associated with itching of intensity 9/10 and poor general condition. Patient warranted hospitalization due to acute kidney injury and severity of his dermatosis. Management was started with general skin care, intravenous hydrocortisone at 100 mg every 6 hours, drying promotions with a colloid bath and due to antibiotic ceftriaxone 1 g/day meliceric crusts; in addition to fluid therapy by internal medicine. Patient had favorable response. CONCLUSIONS: Photosensitizing drugs can be administered topically and/or systemically and cause a phototoxic or photoallergic reaction in some cases with high morbidity and mortality. [ABSTRACT FROM AUTHOR]

Arterial hypertension is a public health problem that affects approximately 25% of the world’s adult population. The association between hypertension and hyperuricemia has been shown on epidemiological and experimental studies. However, it is unclear whether lowering serum uric acid might lower blood pressure. This Cochrane systematic review - a revised edition of a previously published one - intended as primary objective to evaluate the effect of hypouricemic drugs in patients with primary hypertension or prehypertension. The secondary objectives were to evaluate the efficacy and safety of hypouricemic drugs. A systematic search until February 2016 on controlled, randomized or quasi-randomized trials comparing the effect of hypouricemic drug versus placebo in hypertensive or prehypertensive patients was performed on the following databases: The Cochrane Hypertension Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL), Medline, Embase, The World Health Organization International Clinical Trials Registry Platform, e ClinicalTrials.gov. LILACS database up to March 2016 was also searched and the authors of relevant studies were contacted. There were 349 identified papers, 21 were preselected and three randomized clinical trials (211 patients) were included in the qualitative analysis and in the meta-analysis. Two of the trials were conducted exclusively on adolescents. The authors conclude that hypouricemic drugs are not effective in lowering blood pressure in patients with hyperuricemia and primary prehypertension or hypertension. However, this strategy might be more effective in the specific population of adolescents with prehypertension or mild primary hypertension recently diagnosed. Hypouricemic drugs effectively reduce serum uric acid level and withdrawals of therapy due to adverse effects were not superior in the treated group, comparing to placebo; however, one patient withdrew due to a severe cutaneous reaction.

DRESS syndrome is a severe and idiosyncratic reaction of hypersensitivity to drugs, characterized by rash, fever, lymphadenopathy, hematological alterations and systemic compromise, the heterogeneity of the clinical presentation represents a diagnostic challenge for the clinician, a high clinical suspicion is required and the need to rule out a wide spectrum of differential diagnoses. Cutaneous reactions associated with drugs can be potentially fatal, early diagnosis can modify the patient's prognosis. We describe the clinical case and treatment of a 15-year-old male patient with chronic renal failure who was hospitalized for generalized morbilliform lesions associated with fever, lymphadenopathy, splenomegaly and eosinophilia. Complementary studies ruled out infectious, autoimmune and neoplastic processes; the antecedent of recent intake of allopurinol together with clinical and laboratory data allowed to establish a definitive diagnosis of DRESS syndrome. Patient received topical and systemic corticosteroids, clinical manifestations reverted from the second week of hospitalization. We emphasize the importance of identifying risk factors associated with the development of this syndrome. [ABSTRACT FROM AUTHOR]

A 45-year-old Caucasian female was admitted to the Emergency Department with a diffuse maculo-papular erythematous and pruritic rash that developed over the last four days. In addition, she developed oral mucocutaneous painful hemorrhagic blisters and hemorrhagic crustations over the eyelids. She was medicated with allopurinol 300mg once a day for the first time about 10 days ago for asymptomatic hyperuricemia. About three days prior to presentation she became feeling photophobia, conjunctival itching, pain on swallowing, myalgias and fever. She had no prior history of a similar reaction or allergies. Upon examination, she was febrile and there were widespread, irregularly shaped erythematous and purpuric macules with blistering on more than 20% of the body surface area (BSA), including palms and soles and mucous membrane of mouth, anal canal and vagina. Nikolsky's sign was positive. Laboratory evaluation had mild leucocytosis without other relevant changes. A skin biopsy revealed keratinocyte necrosis of full-thickness of the epidermis with dermo-epidermal detachment and a scant, perivascular and inflammatory infiltrate of mononuclear cells in the superficial dermis (Image 1). The temporal association of allopurinol use and subsequent rash in addition of histologic and clinical findings suggested the diagnosis of allopurinol-Induced Stevens-Johnson Syndrome / Toxic Epidermal Necrolysis (SJS/TEN) overlap syndrome. As per the Naranjo Adverse Drug Reaction Probability Scale, the score of 5 indicated a probable adverse drug reaction. Allopurinol was withdrawn immediately. Patient was monitored closely in an isolation room with nutritional and intravenous fluid therapy, oral hygiene, analgesia and daily observation by Ophthalmology. Dressings, topical antibacterial agents and emollients were used to cover cleansed wounds. Despite controversial, corticosteroid therapy was initiated with gradual diminished and healed up of lesions in about 20 days (Image 2). SJS and TEN are rare but potentially life-threatening and severe mucocutaneous reactions, characterized by extensive necrosis and detachment of the epidermis. (1) SJS/TEN overlap described patients with skin detachment of 10%-30% of BSA. Medications are the leading trigger of SJS/TEN and allopurinol is the drug most commonly associated.(2) Diagnosis is clinical and confirmed with skin biopsy. Identification and removal of the precipitating agents should be done as early as possible and aggressive supportive measures should be taken to avoid mortality and morbidity.(3) Patients must not be exposed to the trigger drug, avoid sunlight during healing and moisturise their skin.

Antecedentes: los felinos son huéspedes incidentales de Leishmania spp. con altas prevalencias en regiones endémicas. En el Tolima se ha determinado la prevalencia de Leishmania spp. en caninos y humanos‚ mostrando al municipio de Ibagué como una región endémica de leishmaniasis. Sin embargo‚ en Colombia no existen estudios enfocados a la detección de la leishmaniasis felina (LeF). Objetivo: reportar la fase clínica‚ el uso de técnicas moleculares en el diagnóstico y la terapéutica asociada a un caso de LeF en el área rural de IbaguéTolima. Anamnesis: felino macho con linfadenomegalia‚ conjuntivitis hemorrágica bilateral‚ y lesiones cutáneas nodulares en la barbilla y el carpo derecho. Metodología: se tomaron muestras de sangre‚ conjuntiva ocular y tejido nodular del felino. Se llevaron a cabo exámenes de hematología‚ bioquímica sérica‚ citología‚ y ultrasonografía abdominal. La detección molecular de Leishmania spp. se realizó con la amplificación del gen 16s del ARNr mediante PCR en tiempo real (qPCR)‚ y la caracterización a partir de la amplificación de un fragmento de 498 pb del ITS-1 y un fragmento de 234 pb del gen hsp70-C mediante PCR punto-final y secuenciación Sanger. Tratamiento: se le suministró alopurinol [10 mg/kg] cada 24 h durante 6 meses y miltefosina [2 mg/kg] cada 24 h durante 28 días consecutivos con un refuerzo a los dos meses. Resultados: se evidenciaron alteraciones de la ecogenicidad tanto en corteza como médula renal‚ nefrocalcinosis cortical‚ esplenopatía heterogénea difusa‚ y colangitis‚ así como leucocitosis‚ linfocitosis‚ trombocitopenia‚ neutrofilia‚ monocitosis‚ hipergammaglobulinemia y aumento de la GGT‚ y formas basofílicas. A partir del qPCR se estimó una carga de 6162787 copias/µL (Ct = 27‚16) en la biopsia nodular‚ y mediante la PCR punto final y secuenciación Sanger se determinó la especie como L. infantum. Conclusión: a conocimiento de los autores‚ este es el primer reporte de LeF en Colombia. El uso conjunto del examen clínico‚ la citología y las pruebas moleculares permitieron un diagnóstico rápido y sensible de la infección con L. infantum. El tratamiento generó una mejoría clínica en el paciente. [ABSTRACT FROM AUTHOR]

Copyright of Revista Veterinaria is the property of Universidad Nacional del Nordeste and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Uric acid is the end product of purine metabolism, ultimately converted to uric acid. There is no universal definition of hyperuricemia, in practice, the cutoff point is from 6.8mg/dL in plasma. The relationship between hyperuricemia and hypertension has been demonstrated in many experimental studies. Experimental studies have shown a linear enpositive correlation between blood pressure and uric acid levels, as well as a decrease in blood pressure figures with therapy with allopurinol. Numerous mechanisms have been identified through which hyperuricemia can cause hypertension: reduction of endothelial nitric oxide levels, stimulation of oxidative stress, expression in smooth muscle cells of the vascular endothelium of URAT-1 receptor, activation of the renin-angiotensin axis, stimulation of vascular smooth muscle proliferation also favors the development of renal microvascular disease. Recent evidence has provided new insight into the multiple mechanisms through which UA would play a major role both in systemic arterial hypertension and in multiple metabolic alterations; however, large-scale, well-designed clinical studies are needed, which prove more conclusively these theories, before considering therapies focused on the management of asymptomatic hyperuricemia in daily clinical practice. [ABSTRACT FROM AUTHOR]

Acquired reactive perforating collagenosis is a perforating dermatosis usually associated with different systemic diseases, mainly diabetes mellitus and/or chronic renal insufficiency. Different therapies have been tried but treatment is not standardized yet and remains a challenge. In the last few years, allopurinol has been reported as a good therapeutic option for acquired reactive perforating collagenosis. We describe the case of a 73-year-old man affected by acquired reactive perforating collagenosis associated with diabetes type 1 and chronic renal failure with secondary hyperparathyroidism. The patient was successfully treated with allopurinol 100mg once/day p.o..A colagenose reativa perfurante adquirida pertence ao grupo das dermatoses perfurantes e frequentemente está associada com diferentes doenças sistêmicas, principalmente diabetes mellitus e/ou insuficiência renal crônica. Diferentes terapêuticas têm sido utilizadas, mas o tratamento ainda é um desafio, pois não existe tratamento padronizado. Nos últimos anos, alopurinol tem sido relatado como uma boa opção terapêutica para colagenose reativa perfurante adquirida. Relatamos o caso de um paciente masculino, com 73 anos de idade, portador de colagenose reativa perfurante adquirida em associação com diabetes tipo 1 e falência renal crônica com hiperparatireoidismo secundário. O paciente foi eficazmente tratado com alopurinol na dose 100mg/dia, via oral.

Objetivo. Evaluar el efecto protector contra la lesión por isquemia-reperfusión intestinal del pretratamiento con alopurinol en ratas. Materiales y métodos. Se llevó a cabo un experimento controlado en animales. Un grupo de 10 ratas Wistar de características morfométricas comparables se mantuvo en bioterio bajo condiciones controladas por tres días. A cinco animales se les administró 50 mg/kg diarios de alopurinol por vía oral durante los tres días y, una dosis adicional, antes de inducir isquemia intestinal por ligadura quirúrgica durante 60 minutos seguida de 60 minutos de reperfusión. El otro grupo de cinco ratas no recibió el medicamento. Se hizo el análisis histológico de la mucosa intestinal al final del experimento por medio de la clasificación de Chou y se tomaron hemocultivos de la cavidad cardiaca. Resultados. Se encontraron hemocultivos positivos en 20 % de los animales pretratados con alopurinol, en comparación con el 100 % de las ratas control (pObjective: To evaluate the protective effect of pretreatment with allopurinol in an intestinal ischemia-reperfusion injury rat model. Materials and methods: A controlled animal trial was conducted; 10 Wistar rats were kept under controlled conditions for three days. One group (n=5) received allopurinol 50 mg/kg per day for the 3-day period and an additional dose immediately prior to surgical mesenteric artery clamping (60 minutes) and reperfusion (60 minutes). The other group (n=5) did not receive the medication. Hystologic analysis of intestinal mucosa by means of Chou grading system was performed, and blood cultures from the heart were withdrawn. Results: Positive blood cultures were found in 20% of the allopurinol group as compared with 100% in the control group (p

O controle de qualidade de matérias-primas é imprescindível, pois visa assegurar a qualidade do produto acabado. O objetivo do trabalho foi avaliar a qualidade físico-química e farmacotécnica de matérias-primas de alopurinol, fármaco utilizado para a prevenção e o tratamento de crises de gota, amplamente prescrito e produzido por indústrias e farmácias magistrais. As amostras (A, B, C e D) de alopurinol oriundas de diferentes fornecedores foram submetidas a ensaios farmacopeicos (características organolépticas; solubilidade; ensaios de identificação: teste de precipitação e varredura no UV; ensaios de pureza: limpidez de solução, perda por dessecação, cinzas sulfatadas; doseamento), análise térmica (DSC, TG), análise granulométrica e determinação das propriedades de fluxo (ângulo de repouso, densidade bruta e de compactação, fator de Hausner, índice de compressibilidade e compactabilidade). As amostras foram aprovadas em todos os ensaios farmacopeicos. Nas curvas de DSC, o ponto de fusão foi de cerca de 380 °C para todas as amostras e, após a fusão houve a degradação, confirmada pelas curvas TG, com uma perda de massa de aproximadamente 100 %. A partir da distribuição granulométrica as amostras A e B foram classificadas como pós finos e as C e D como finíssimos. Os valores de ângulo de repouso caracterizaram as amostras A, B, C e D como de fluxo fraco e, o fator de Hausner e índice de compressibilidade caracterizaram as amostras como amostras de fluxo bastante deficiente. Os ensaios demonstraram-se úteis para avaliar a qualidade das amostras. A adição de adjuvantes apropriados durante o preparo das formulações de alopurinol é essencial para melhoramento do fluxo.

Allopurinol is a commonly used drug in the treatment of chronic gout or hyperuricaemia associated with treatment of diuretic conditions. One of the major problems with the drug is that it is practically insoluble in water, which results in poor bioavailability after oral administration. In the present study, solid dispersions of allopurinol were prepared by solvent evaporation, kneading method, co-precipitation method, co-grinding method and closed melting methods to increase its water solubility. Hydrophilic carriers such as polyvinylpyrrolidone, polyethylene glycol 6000 were used in the ratio of 1:1, 1:2 and 1:4 (drug to carrier ratio). The aqueous solubility of allopurinol was favored by the presence of both polymers. These new formulations were characterized in the liquid state by phase solubility studies and in the solid state by differential scanning calorimetry, powder X-ray diffraction, UV and Fourier Transform Infrared spectroscopy. Solid state characterizations indicated that allopurinol was present as an amorphous material and entrapped in polymer matrix. In contrast to the very slow dissolution rate of pure allopurinol, the dispersion of the drug in the polymers considerably enhanced the dissolution rate. Solid dispersion prepared with polyvinylpyrrolidone showed highest improvement in wettability and dissolution rate of allopurinol. Mathematical modeling of in vitro dissolution data indicated the best fitting with Korsemeyer-Peppas model and the drug release kinetics primarily as Non-Fickian diffusion. Therefore, the present study showed that polyvinylpyrrolidone and polyethylene glycol 6000 have a significant solubilizing effect on allopurinol.Alopurinol é fármaco comumente utilizado no tratamento de gota crônica ou hiperuricemia associada com o tratamento em condições diuréticas. Um dos maiores problemas com o fármaco é que este é praticamente insolúvel em água, o que resulta em baixa biodisponibilidade na administração oral. No presente estudo, dispersões sólidas de alopurinol foram preparadas pela evaporação do solvente, pelos métodos de amassamento, de coprecipitação, de comoagem e fusão fechada para aumentar sua solubilidade em água. Transportadores hidrofílicos, como polivinilpirrolidona, polietilenoglicol 6000 foram utilizados nas proporções de 1:1. 1:2 e 1:4 (fármaco: transportador). A solubilidade aquosa do alopurinol foi favorecida pela presença de ambos os polímeros. Estas novas formulações forma caracterizadas no estado líquido pelos estudos de solubilidade de fase e no estado sólido pela calorimetria diferencial de varredura, difração de Raio-X, espectroscopia de UV e de IV com transformada de Fourier. As caracterizações do estado sólido indicaram que o alopurinol estava presente como material amorfo e embebido em matriz polimérica. Ao contrário da velocidade de dissolução lenta do alopurinol puro, a dispersão do fármaco nos polímeros aumentou consideravelmente a taxa de dissolução. A dispersão sólida preparada com polivinilpirrolidona mostrou as maiores melhorias na molhabilidade e taxa de dissolução do alopurinol. A modelagem matemática dos dados da dissolução in vitro indicou o melhor ajuste ao modelo de Korsemeyer-Peppas e a cinética de liberação do fármaco primariamente como difusão não-Fickiana. Assim, o presente estudo mostrou que a polivinilpirrolidona e o polietilenoglicol 6000 têm efeito significativo na solubilização do alopurinol.

PURPOSE: To investigate the duration of apoptosis caused by ischemia-reperfusion in the intestine in a new double jejunum-segment model, and to analyze the protective effects of allopurinol or ischemic preconditioning (IPC). METHODS: In Experiment I for harvesting the double jejunum-segment model after laparotomy a 30-cm-long jejunum part was selected on mongrel dogs (n=24). End-to-end anastomoses were performed at both ends and in the middle of the jejunum part, creating two equal segments. In one segment ischemia was induced by occluding the supplying vessels, the other segment served as control. Tissue samples for detecting apoptosis were taken at 30th minutes, 1st, 2nd, 4th, 6th, 8th, 12th and 24th hours of reperfusion. In Experiment II using the same model the 4-hour reperfusion time period, allopurinol (50 mg/kg) pre-treated and IPC (3 cycles of 5x1) groups (n=5 per each) were also investigated. RESULTS: In Experiment I the greatest apoptotic activity was detected at the 4th and 6th hour of reperfusion (14.2 ± 1.31 and 16.3 ± 1.05 per visual field at 40x magnification). In Experiment II Using the 4-hour reperfusion time period allopurinol pre-treatment increased the apoptotic activity (10.72 ± 0.47 per 50 intestinal villi) approximately two-fold than the IPC (6.72 ± 0.46 per 50 intestinal villi) did (pOBJETIVO: Investigar a duração da apoptose causada pela isquemia-reperfusão no intestino em um novo modelo de duplo segmento de jejuno e analisar os efeitos protetores do alopurinol ou precondicionamento isquêmico (IPC). MÉTODOS: No experimento I para obter o modelo do duplo segmento de jejuno, após a laparotomia, uma parte de 30cm de comprimento de jejuno foi selecionada em cães mestiços (n=24). Anatomoses T-T foram realizadas em ambas as extremidades no meio do segmento de jejuno, criando dois segmentos iguais. Em um segmento foi induzida isquemia por oclusão dos vasos que o irrigavam e o outro segmento foi usado como controle. Amostras de tecido para detecção da apoptose foram obtidos aos 30 minutos, 1h, 2h, 4h, 6h, 8h, 12h e 24 horas de reperfusão. No experimento II usando o mesmo modelo, no tempo de reperfusão de 4 horas, foram investigados dois outros grupos (n=5 cada) usando precondicionamento com alopurinol (50 mg/kg) e IPC (3 ciclos de 5x1). RESULTADOS: No experimento I a maior atividade de apoptose detectada foi às 4h e 6h de reperfusão (14,2 ± 1,31 e 16,3 ± 1,05 no campo visual de 40x). No experimento II usando o período de 4horas de reperfusão o pré-tratamento com alopurinol aumentou a atividade apoptótica (10,72 ± 0,47) aproximadamente 2 vezes mais do que o IPC (6,72 ± 0,46) (p

CONTEXT: Exposure of hepatocytes to pathological conditions in a microenvironment of hypoxia and reoxygenation is very frequent in hepatic diseases. Several substances present perspectives for cytoprotective action on hepatocyte submitted to reoxygenation after hypoxia and simple hypoxia. OBJECTIVE: We research therapeutic options for hepatocytes submitted to hypoxia and hypoxia + reoxygenation injury. METHODS: Primary culture of rat hepatocytes was submitted to hypoxia (2 hours) plus reoxygenation (2 hours) and simple hypoxia (4 hours) in the presence or the absence of cytoprotectors. The hepatocyte lesion was evaluated by functional criteria through percentage of lactate dehydrogenase released and cell viability. The effects of the cytoprotectors prostaglandin E1 3 ηg/mL, superoxide dismutase 80 μg/mL, allopurinol 20 μM and verapamil 10-4 M were studied in this model of injury. RESULTS: Reoxygenation after hypoxia induced more significant lesion in cultured hepatocytes compared to simple hypoxia, detected by analysis of functional criteria. There was a significant reduction of percentage of lactate dehydrogenase released and a significant increase of percentage of cell viability in the hypoxia + reoxygenation + cytoprotectors groups compared to hypoxia + reoxygenation groups. Prostaglandin E1, superoxide dismutase and verapamil also protected the group submitted to simple hypoxia, when evaluated by functional criteria. CONCLUSIONS: We conclude that reoxygenation after hypoxia significantly increased the lesion of cultured rat hepatocytes when compared to simple hypoxia. Prostaglandin E1, superoxide dismutase, allopurinol and verapamil acted as cytoprotectors to the rat cultured hepatocytes submitted to hypoxia + reoxygenation in vitro. The substances prostaglandin E1, superoxide dismutase and verapamil protected hepatocytes submitted to simple hypoxia on the basis of all the criteria studied in this experimental model.CONTEXTO: A exposição dos hepatócitos a condições patológicas em que ocorram microambientes de hipóxia e reoxigenação são muito frequentes em doenças hepáticas. Várias substâncias apresentam perspectivas de ação citoprotetora para hepatócitos submetidos a reoxigenação após hipóxia e hipóxia simples. OBJETIVO: Pesquisaram-se opções terapêuticas para o dano dos hepatócitos submetidos a hipóxia e hipóxia + reoxigenação. MÉTODOS: Hepatócitos de rato em cultura primária foram submetidos a hipóxia (2 horas) mais reoxigenação (2 horas) e hipóxia simples (4 horas), na presença ou ausência dos citoprotetores. A lesão dos hepatócitos foi avaliada por critérios funcionais através da percentagem liberada de desidrogenase láctica e da viabilidade celular. Os efeitos dos citoprotetores prostaglandina E1 3 ηg/mL, superóxido dismutase 80 μg/mL, alopurinol 20 μM e verapamil 10-4M, foram estudados neste modelo de injúria celular. RESULTADOS: A reoxigenação após hipóxia induziu lesão mais significativa nos hepatócitos cultivados comparado com hipóxia simples, conforme demonstrado pela análise dos critérios funcionais. Houve significativa redução da porcentagem liberada de desidrogenase láctica e aumento significativo da percentagem de viabilidade celular nos grupos hipóxia + reoxigenação + citoprotetores em comparação com o grupo hipóxia + reoxigenação. Prostaglandina E1, superóxido dismutase e verapamil também protegeram o grupo hipóxia simples, quando avaliado pelos critérios funcionais. CONCLUSÕES: Conclui-se que a reoxigenação após hipóxia aumentou significativamente a lesão dos hepatócitos de rato cultivados, em comparação com a hipóxia simples. Prostaglandina E1, superóxido dismutase, alopurinol e verapamil foram citoprotetores para os hepatócitos de rato submetidos a hipóxia + reoxigenação in vitro. As substâncias prostaglandina E1, superóxido dismutase e verapamil protegeram os hepatócitos submetidos a hipóxia simples com base em todos os critérios estudados neste modelo experimental.

Copyright of Revista Veterinaria is the property of Universidad Nacional del Nordeste and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Patients in treatment with allopurinol are in risk of having life threatening adverse reactions particularly at the beginning of the treatment. Two percent of the patients prescribed with this drug have associated severe cutaneous adverse reactions. We present two cases of allopurinol hypersensitivity syndrome in mexican patients in which asymptomatic hyperuricemia was the indication to its use. The general physician and the specialist must be alert of this syndrome that causes elevate morbidity and mortality. [ABSTRACT FROM AUTHOR]

OBJETIVO: Estudar o efeito do alopurinol no fenômeno de isquemia-reperfusão em testículos de ratos. MÉTODOS: Foram utilizados 80 ratos Wistar, adultos, distribuídos em 4 grupos: controle sem alopurinol, controle com alopurinol, torção do cordão espermático sem alopurinol e torção do cordão espermático com alopurinol. Os testículos foram retirados após 60 dias do ato operatório e processados para exame histológico à microscopia óptica, onde os túbulos seminíferos e as células espermatogênicas foram objeto de estudo. RESULTADOS: A comparação entre os grupos demonstrou que houve atrofia dos testículos que foram submetidos à torção, inclusive o grupo que recebeu o alopurinol. CONCLUSÃO: O alopurinol não protegeu as gônadas dos efeitos da isquemia reperfusão.

Copyright of Nefrologia is the property of Revista Nefrologia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

A isquemia transitória hepática tem sido cada vez mais amplamente utilizada. Contudo, essa atitude, embora muitas vezes benéfica, é contrabalançada pelos efeitos adversos advindos da isquemia hepática e da congestão esplênica, assim como, das conseqüências da reperfusão. O objetivo dos autores é determinar os efeitos da isquemia seletiva em animais pré-tratados ou não com alopurinol, inibidor da xantina oxidase sobre a mortalidade dos animais. Foram utilizados 30 ratos assim divididos: Grupo I (n=10): pré-tratados com alopurinol e submetidos à laparotomia e exposição do pedículo hepático por 45 minutos. Grupo II (n=10): tratados com alopurinol e submetidos à isquemia hepática seletiva por 45 minutos. Grupo III (n=10): submetidos apenas à isquemia por 45 minutos. A mortalidade pós-operatória foi avaliada a cada 24 horas, por um período de 10 dias. Entre os animais do grupo I, não foram observados óbitos, entretanto, naqueles dos grupos II e III, as mortalidades globais foram respectivamente 20 e 46,7%. Diferença estatisticamente significativa, apenas, entre a mortalidade observada no grupo III em relação ao controle (p

Os autores relatam um caso de leishmaniose cutâneo-mucosa em uma paciente de 89 anos, diabética e hipertensa, tratada inicialmente com alopurinol por 10 meses não havendo cicatrização das lesões. Posteriormente, recebeu antimoniato de N-metil glucamina (glucantime) por 4 dias, na dose total de 2.380mg do Sb v, mas desenvolveu cardiotoxicidade e hipocalemia, sendo suspenso o tratamento, entretanto, evoluiu com regressão clínica total das lesões, apesar de ter recebido pequena dose desta medicação.

Se discute el caso de una paciente de 51 años con rash maculopapular generalizado y fiebre, con antecedente de ingestión de alopurinol desde un mes previo, indicado por hiperuricemia asintomática, en quien luego de múltiples estudios de laboratorio y gabinete, así como cultivos negativos, pese a la presencia de procalcitonina elevada, no se logró documentar un agente infeccioso; por el contrario, se demostró por biopsia, hemograma y la evolución clínica con el tratamiento médico, que se trataba de un síndrome de DRESS por alopurinol.

Com objetivo de avaliar a eficácia do tratamento, verificar a ocorrência de possíveis recidivas da doença e pesquisar a presença de parasitas após a realização do tratamento, foram utilizados sete cães naturalmente infectados por Leishmania sp., submetidos a tratamento com antimoniato de meglumina e alopurinol. Para tanto, foram realizadas punções biópsias aspirativas de linfonodos e de medula óssea em sete momentos. Após o término dos seis meses de observação, todos os cães foram submetidos à eutanásia e realizados "imprints" e cultivo in vitro do baço e fígado para a pesquisa de formas amastigotas. Todos os animais apresentaram remissão dos sintomas e durante todo o período de observação nenhum cão apresentou recidiva da doença apesar de ter sido observada a presença de formas amastigotas do parasita em dois animais, ao término do experimento. Desta forma, foi possível concluir que o tratamento promove a cura clínica, entretanto não elimina completamente os parasitas.

Foi avaliada a atividade antiparasitária do alopurinol, referente ao Trypanosoma cruzi, através de procedimento que depende da utilização de triatomíneos infectados. De acordo com a metodologia usada, o fármaco não eliminou o protozoário do tubo digestivo dos insetos. Não ocorreu, portanto, obtenção de novo subsídio para melhor entendimento da posição do alopurinol no contexto do tratamento etiológico da infecção pelo T. cruzi, porquanto ela continua em foco, se bem que eivada de divergências e contradições.

The hypersensitivity drug síndrome is characterized by the triad of fever, rash and multiorgan involvement. This term encompasses different entities, that describe as common pattern a severe drug reaction; when combined with allopurinol intake has been called allopurinol hypersensitivity syndrome (AHS), with a reported mortality of up to 40% in cases with multiorgan involvement. The etiopathogenic of allopurinol hypersensitivity syndrome is not well-known, cutaneous presentation of these patients is variable the same as systemic manifestations. The diagnosis is established by the exposure to the drug, clinical, laboratory, and making differential diagnosis with other diseases. The therapeutic management so far includes suspension of the offending drug, supportive treatment and prevention of sepsis. We report the case of a 48-year-old male with chronic kidney disease, the patient was prescribed allopurinol, and four weeks after starting treatment had a severe drug reaction, which conditioned acute liver failure. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the current management of gout in general practitioners and specialists in Buenos Aires city. Material and methods: Multiple choice, anonymous, survey, performed on 33 rheumatologists (REU), 52 Internal Medicine specialists (EMI) and 86 general practitioners (Otros). Results: Gout is a very common or usual disease for 51.5% of REU vs 11.5% EMI and 8.1% Otros. At diagnosis, uric acid crystals are identified by 51.5% REU vs 28.8% EMI and 26.7% Otros and tophi observed by 60.6% REU vs 30.8% EMI and 30.2% Otros. REU and EMI should indicate colchicine for acute gout in 75.8% and 80.8% respectively vs 7.7% of Otros. REU measure patient's height/weight and waist circumference less frequently than EMI (66.7% vs 92.3% and 45.5% vs 75% respectively). Conclusions: REU usually examine patients with gout but in a chronic stage. The identification of crystals in synovial fluid is low. The use of colchicine is still high. REU should improve the evaluation of the metabolic syndrome. [ABSTRACT FROM AUTHOR]

The quality control of raw materials is intended to ensure the quality of the finished product. The objective of this study was to carry out physicochemical and pharmacotechnical assessments of allopurinol raw materials. This drug is widely prescribed for the prevention and treatment of gout and is produced both by drug manufacturers and compounding pharmacies. Samples (A, B, C and D) from 4 different suppliers were subjected to pharmacopoeial testing (organoleptic characteristics; solubility; identification tests: precipitation and scanning UV; purity tests: clarity of solution, loss on drying, sulphated ash; assay), thermal analysis (DSC, TG), particle size analysis and flow property tests (angle of repose, bulk density and tapped density, Hausner ratio, compressibility and compactibility). The samples were approved in all the pharmacopoeial tests. In the DSC curves, the melting point was about 380 °C for all samples and after fusion there was degradation, confirmed by TG, with a weight loss of approximately 100%. From the particle size distributions, samples A and B were classified as fine powders and C and D as very fine powders. The angles of repose characterized the samples A, B, C and D as having weak flow, while the Hausner ratio and compressibility index indicated that they had very, very poor flow. The tests proved useful for assessing the quality of the samples and showed that appropriate adjuvants need to be added to the allopurinol formulations to improve the flow. [ABSTRACT FROM AUTHOR]