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The addition of an orally administered corticosteroid can provide modest benefits in reducing the pain of herpes zoster and the incidence of postherpetic neuralgia. Ocular involvement in herpes zoster can lead to rare but serious complications and generally merits referral to an ophthalmologist. The antiviral medications are most effective when started within 72 hours after the onset of the rash.

Patients with postherpetic neuralgia may require narcotics for adequate pain control. Tricyclic antidepressants or anticonvulsants, often given in low dosages, may help to control neuropathic pain. Capsaicin, lidocaine patches and nerve blocks can also be used in selected patients. Herpes zoster results from reactivation of the varicella-zoster virus. Unlike varicella chickenpoxherpes zoster is a sporadic disease with an estimated lifetime incidence of 10 to 20 percent.

The incidence of herpes zoster increases sharply with advancing age, roughly doubling in each decade past the age of 50 years. Herpes zoster is uncommon in persons less than 15 years old. In a recent study,1 patients more than 55 years of age accounted for more than 30 percent of herpes zoster cases despite representing only 8 percent of the study population. In this same study, children less than 14 years old represented only 5 percent of herpes zoster cases.

Patients with disease states that affect cell-mediated immunity, such as human immunodeficiency virus HIV infection and certain malignancies, are also at increased risk. The normal age-related decrease in cell-mediated immunity is thought to account for the increased incidence of varicella-zoster virus reactivation. Chronic corticosteroid use, chemotherapy and radiation therapy may increase the risk of developing herpes zoster.

The incidence of herpes zoster is up to 15 times higher in HIV-infected patients than in uninfected persons, and as many as 25 percent of patients with Hodgkin s lymphoma develop herpes zoster. 23 The occurrence of herpes zoster in HIV-infected patients does not appear to increase the risk of acquired immunodeficiency syndrome AIDS and is less dependent on the CD4 count than AIDS-related opportunistic infections.

2 There is no evidence that herpes zoster heralds the onset of an underlying malignancy. Race may influence susceptibility to herpes zoster. Blacks are one fourth as likely as whites to develop this condition. Herpes zoster commonly referred to as shingles and postherpetic neuralgia result from reactivation of the varicella-zoster virus acquired during the primary varicella infection, or chickenpox. 4 Although herpes zoster is not as contagious as the primary varicella infection, persons with reactivated infection can transmit varicella-zoster virus to nonimmune contacts.

Household transmission rates have been noted to be approximately 15 percent. The most established risk factor is age; this complication occurs nearly 15 times more often in patients more than 50 years of age. Other possible risk factors for the development of post-herpetic neuralgia are ophthalmic zoster, a history of prodromal pain before the appearance of skin lesions and an immunocompromised state.

About 20 percent of patients with herpes zoster develop postherpetic neuralgia. Varicella-zoster virus is a highly contagious DNA virus. During the primary infection, the virus gains entry into the sensory dorsal root ganglia. The varicella-zoster virus genome has been identified in the trigeminal ganglia of nearly all seropositive patients. How the virus enters the sensory dorsal root ganglia and whether it resides in neurons or supporting cells are not completely understood. The virus remains latent for decades because of varicella-zoster virus specific cell-mediated immunity acquired during the primary infection, as well as endogenous and exogenous boosting of the immune system periodically throughout life.

8 Reactivation of the virus occurs following a decrease in virus-specific cell-mediated immunity. The pathophysiology of postherpetic neuralgia remains unclear. The reactivated virus travels down the sensory nerve and is the cause for the dermatomal distribution of pain and skin lesions. However, pathologic studies have demonstrated damage to the sensory nerves, the sensory dorsal root ganglia and the dorsal horns of the spinal cord in patients with this condition.

Clinical Presentation. Herpes zoster typically presents with a prodrome consisting of hyperesthesia, paresthesias, burning dysesthesias or pruritus along the affected dermatome s. The prodrome generally lasts one to two days but may precede the appearance of skin lesions by up to three weeks. During the prodromal phase, herpes zoster may be misdiagnosed as cardiac disease, pleurisy, a herniated nucleus pulposus or various gastrointestinal or gynecologic disorders. Some patients may have prodromal symptoms without developing the characteristic rash.

This situation, known as zoster sine herpete, may further complicate the eventual diagnosis. The prodromal phase is followed by development of the characteristic skin lesions of herpes zoster. The skin lesions begin as a maculopapular rash that follows a dermatomal distribution, commonly referred to as a belt-like pattern. The vesicles are generally painful, and their development is often associated with the occurrence of anxiety and flu-like symptoms.

The maculopapular rash evolves into vesicles with an erythematous base Figure 1. Typical dermatomal rash with hemorrhagic vesicles on the trunk of a patient with herpes zoster. Pain is the most common complaint for which patients with herpes zoster seek medical care. The pain may be described as burning or stinging and is generally unrelenting.

Indeed, patients may have liam w iq option because of the pain. 10 Although any vertebral dermatome may be involved, T5 and T6 are most commonly affected. The most frequently involved cranial nerve dermatome is the ophthalmic division of the trigeminal nerve. Twenty or more lesions outside the affected dermatome reflect generalized viremia.

Of these patients, approximately one half manifest other neurologic or visceral involvement, and as many as one in seven with viremia may die. The vesicles eventually become hemorrhagic or turbid and crust over within seven to 10 days. As the crusts fall off, patients are generally left with scarring and pigmentary changes. Ocular complications occur in approximately one half of patients with involvement of the ophthalmic division of the trigeminal nerve. These complications include mucopurulent conjunctivitis, episcleritis, keratitis and anterior uveitis.

Cranial nerve palsies of the third, fourth and sixth cranial nerves may occur, affecting extraocular motility. The most common chronic complication of herpes zoster is postherpetic neuralgia. Pain that persists for longer than one to three months after resolution of the rash is generally accepted as the sign of postherpetic neuralgia. 11 Affected patients usually report constant burning, lancinating pain that may be radicular in nature. Even the slightest pressure from clothing, bedsheets or wind may elicit pain.

Patients may also complain of pain in response to non-noxious stimuli. Postherpetic neuralgia is generally a self-limited disease. Symptoms tend to abate over time. Less than one quarter of patients still experience pain at six months after the herpes zoster eruption, and fewer than one in 20 has pain at one year. Treatment of Herpes Zoster. The treatment of herpes zoster has three major objectives 1 treatment of the acute viral infection, 2 treatment of the acute pain associated with herpes zoster and 3 prevention of postherpetic neuralgia.

ANTIVIRAL AGENTS. Antiviral agents, oral corticosteroids and adjunctive individualized pain-management modalities are used to achieve these objectives. Antiviral agents have been shown to decrease the duration of herpes zoster rash and the severity of pain associated with the rash. 12 However, these benefits have only been demonstrated in patients who received antiviral agents within 72 hours after the onset of rash.

Antiviral agents may be beneficial as long as new lesions are actively being formed, but they are unlikely to be helpful after lesions have crusted. The effectiveness of antiviral agents in preventing postherpetic neuralgia is more controversial. Numerous studies evaluating this issue have been conducted, but the results have been variable. Based on the findings of multiple studies, acylovir Zovirax therapy appears to produce a moderate reduction in the development of postherpetic neuralgia.

13 Other antiviral agents, specifically valacyclovir Valtrex and famciclovir Famvirappear to be at least as effective as acyclovir. Acyclovir, the prototype antiviral drug, is a DNA polymerase inhibitor. Acyclovir may be given orally or intravenously. Major drawbacks of orally administered acyclovir include its lower bioavailability compared with other agents and its dosing frequency five times daily.

Intravenously administered acyclovir is generally used only in patients who are severely immunocompromised or who are unable to take medications orally. Valacyclovir, a prodrug of acyclovir, is administered three times daily. Compared with acyclovir, valacyclovir may be slightly better at decreasing the severity of pain associated with herpes zoster, as well as the duration of postherpetic neuralgia.

14 Valacyclovir is also more bioavailable than acyclovir, and oral administration produces blood drug levels comparable to the intravenous administration of acyclovir. Famciclovir is also a DNA polymerase inhibitor. The advantages of famciclovir are its dosing schedule three times dailyits longer intracellular half-life compared with acyclovir and its better bioavailability compared with acyclovir and valacyclovir. The choice of which antiviral agent to use is individualized.

Dosing schedule and cost may be considerations. The recommended dosages for acyclovir, famciclovir and valacyclovir are provided in Table 1. All three antiviral agents are generally well tolerated. The most common adverse effects are nausea, headache, vomiting, dizziness and abdominal pain. Treatment Options for Herpes Zoster. Medication Dosage Average cost generic. 800 mg orally five times daily for 7 to 10 days 10 mg per kg IV every 8 hours for 7 to 10 days.

174 to 248 129 to 200. 500 mg orally three times daily for 7 days. 1,000 mg orally three times daily for 7 days. 30 mg orally twice daily on days 1 through 7; then 15 mg twice daily on days 8 through 14; then 7. 5 mg twice daily on days 15 through 21. 2 2 to 4 for days 1 through 7 2 1 to 3 for days 8 through 14 1 1 to 2 for days 15 to 21. Estimated cost to the pharmacist based on average wholesale prices rounded to the nearest dollarfor seven days of therapy, in Red book.

Medical Economics Data, 2000. Cost to the patient will be higher, depending on prescription filling fee. Antiviral therapy has been shown to be beneficial only when patients are treated within 72 hours of onset of the herpes zoster rash. Acyclovir can be administered IV to severely immunocompromised patients or patients who are unable to take medications orally.

Antiviral agents are not used in combination, and selection of an agent is based on dosage schedule and cost. Orally administered corticosteroids are commonly used in the treatment of herpes zoster, even though clinical trials have shown variable results. Prednisone used in conjunction with acyclovir has been liam w iq option to reduce the pain associated with herpes zoster. 15 The likely mechanism involves decreasing the degree of neuritis caused by active infection and, possibly, decreasing residual damage to affected nerves.

Some studies designed to evaluate the effectiveness of prednisone therapy in preventing postherpetic neuralgia have shown decreased pain at three and 12 months. 1617 Other studies have demonstrated no benefit. Given the theoretic risk of immunosuppression with corticosteroids, some investigators believe that these agents should be used only in patients more than 50 years of age because they are at greater risk of developing postherpetic neuralgia.

If the use of orally administered prednisone is not contraindicated, adjunctive treatment with this agent is justified on the basis of its effects in reducing pain, despite questionable evidence for its benefits in decreasing the incidence of postherpetic neuralgia. The pain associated with herpes zoster ranges from mild to excruciating. Patients with mild to moderate pain may respond to over-the-counter analgesics.

Patients with more severe pain may require the addition of a narcotic medication. When analgesics are used, with or without a narcotic, a regular dosing schedule results in better pain control and less anxiety than as-needed dosing. Lotions containing calamine e.Caladryl may be used on open lesions to reduce pain and pruritus. Once the lesions have crusted over, capsaicin cream Zostrix may be applied. Topically administered lidocaine Xylocaine and nerve blocks have also been reported to be effective in reducing pain.

OCULAR INVOLVEMENT. Ocular herpes zoster is treated with orally administered antiviral agents and corticosteroids, the same as involvement elsewhere. Although most patients with ocular herpes zoster improve without lasting sequelae, some may develop severe complications, including loss of vision. When herpes zoster involves the eyes, ophthalmologic consultation is usually recommended. Varicella represents the primary infection in the nonimmune or incompletely immune person.

PREVENTIVE TREATMENT. It is unusual for a patient to develop herpes zoster more than once, suggesting that the first reactivation of varicella-zoster virus usually provides future immunologic protection. The morbidity and mortality of herpes zoster could be reduced if a safe and effective preventive treatment were available. Studies are currently being conducted to evaluate the efficacy of the varicella-zoster vaccine in preventing or modifying herpes zoster in the elderly.

Treatment of Postherpetic Neuralgia. 15 The recommended dosage for prednisone is given in Table 1. Although postherpetic neuralgia is generally a self-limited condition, it can last indefinitely. Occasionally, narcotics may be required. Dosage recommendations are provided in Table 2. Treatment Options for Postherpetic Neuralgia. Medication Dosage. Treatment is directed at pain control while waiting for the condition to resolve.

Capsaicin cream Zostrix. Apply to affected area three to five times daily. Apply to affected area every 4 to 12 hours as needed. Lidocaine Xylocaine patch. 10 to 25 mg orally at bedtime; increase dosage by 25 mg every 2 to 4 weeks until response is adequate, or to maximum dosage of 150 mg per day. 10 to 25 mg orally at bedtime; increase dosage by 25 mg every 2 to 4 weeks until response is adequate, or to maximum dosage of 125 mg per day. 25 mg orally at bedtime; increase dosage by 25 mg every 2 to 4 weeks until response is adequate, or to maximum dosage of 150 mg per day.

100 to 300 mg orally at bedtime; increase dosage until response is adequate or blood drug level is 10 to 20 μg per mL 40 to 80 μmol per L. 100 mg orally at bedtime; increase dosage by 100 mg every 3 days until dosage is 200 mg three times daily, response is adequate or blood drug level is 6 to12 μg per mL 25. 100 to 300 mg orally at bedtime; increase dosage by 100 to 300 mg every 3 days until dosage is 300 to 900 mg three times daily or response is adequate.

Drug levels for clinical use are not available. Additional modalities include transcutaneous electric nerve stimulation TENSbiofeedback and nerve blocks. Capsaicin, an extract from hot chili peppers, is currently the only drug labeled by the U. Pain therapy may include multiple interventions, such as topical medications, over-the-counter analgesics, tricyclic antidepressants, anticonvulsants and a number of nonmedical modalities.

Substance P, a neuropeptide released from pain fibers in response to trauma, is also released when capsaicin is applied to the skin, producing a burning sensation. Analgesia occurs when substance P is depleted from the nerve fibers. To achieve this response, capsaicin cream must be applied to the affected area three to five times daily. Food and Drug Administration for the treatment of postherpetic neuralgia. Patients must be counseled about the need to apply capsaicin regularly for continued benefit.

They also need to be counseled that their pain will likely increase during the first few days to a week after capsaicin therapy is initiated. Patients should wash their hands thoroughly after applying capsaicin cream in order to prevent inadvertent contact with other areas. Patches containing lidocaine have also been used to treat postherpetic neuralgia. One study found that compared with no treatment, lidocaine patches reduced pain intensity, with minimal systemic absorption.

Over-the-counter analgesics such as acetaminophen e.Tylenol and nonsteroidal anti-inflammatory drugs have not been shown to be highly effective in the treatment of post-herpetic neuralgia. However, these agents are often useful for potentiating the pain-relieving effects of narcotics in patients with severe pain. Because of the addictive properties of narcotics, their chronic use is discouraged except in the rare patient who does not adequately respond to other modalities.

TRICYCLIC ANTIDEPRESSANTS. Tricyclic antidepressants can be effective adjuncts in reducing the neuropathic pain of postherpetic neuralgia. These agents most likely lessen pain by inhibiting the reuptake of serotonin and norepinephrine neurotransmitters. Tricyclic antidepressants commonly used in the treatment of postherpetic neuralgia include amitriptyline Elavilnortriptyline Pamelorimipramine Tofranil and desipramine Norpramin.

These drugs are best tolerated when they are started in a low dosage and given at bedtime. The dosage is increased every two to four weeks to achieve an effective dose. Although lidocaine was efficacious in relieving pain, the effect was temporary, lasting only four to 12 hours with each application. The tricyclic antidepressants share common side effects, such as sedation, dry mouth, postural hypotension, blurred vision and urinary retention.

Nortriptyline and amitriptyline appear to have equal efficacy; however, nortriptyline tends to produce fewer anticholinergic effects and is therefore better tolerated. Treatment with tricyclic antidepressants can occasionally lead to cardiac conduction abnormalities or liver toxicity. The potential for these problems should be considered in elderly patients and patients with cardiac or liver disease. Because tricyclic antidepressants do not act quickly, a clinical trial of at least three months is required to judge a patient s response.

The onset of pain relief using tricyclic antidepressants may be enhanced by beginning treatment early in the course of herpes zoster infection in conjunction with antiviral medications. Phenytoin Dilantincarbamazepine Tegretol and gabapentin Neurontin are often used to control neuropathic pain. A recent double-blind, placebo-controlled study showed gabapentin to be effective in treating the pain of postherpetic neuralgia, as well as the often associated sleep disturbance.

The anticonvulsants appear to be equally effective, and drug selection often involves trial and error. Lack of response to one of these medications does not necessarily portend a poor response to another. The dosages required for analgesia are often lower than those used in the treatment of epilepsy. Anticonvulsants are associated with a variety of side effects, including sedation, memory disturbances, electrolyte abnormalities, liver toxicity and thrombocytopenia. Side effects may be reduced or eliminated by initiating treatment in a low dosage, which can then be slowly titrated upward.

There are no specific contraindications to using anticonvulsants in combination with antidepressants or analgesics. However, the risk of side effects increases when multiple medications are used. Effective treatment of postherpetic neuralgia often requires multiple treatment approaches. In addition to medications, modalities to consider include transcutaneous electric nerve stimulation TENSbiofeedback and nerve blocks. Final Comment. Herpes zoster and postherpetic neuralgia are relatively common conditions, primarily in elderly and immunocompromised patients.

Although the diagnosis of the conditions is generally straightforward, treatment can be frustrating for the patient and physician. Approaches to management include treatment of the herpes zoster infection and associated pain, prevention of postherpetic neuralgia, and control of the neuropathic pain until the condition resolves. Primary treatment modalities include antiviral agents, corticosteroids, tricyclic antidepressants and anticonvulsants.

SETH JOHN STANKUS, MAJ, MC, USA, is chief of neurology and staff family physician at Eisenhower Army Medical Center, Fort Gordon, Ga. Stankus received a doctor of osteopathy degree from the University of Osteopathic Medicine and Health Sciences, Des Moines, Iowa, and completed separate residencies in family practice and neurology at Madigan Army Medical Center, Tacoma, Wash. Stankus is board certified by the American Board of Family Practice and the American Board of Psychiatry and Neurology.

MICHAEL DLUGOPOLSKI, MAJ, MC, USA, is currently a general medical officer at Fort Hood, Tex. He received his medical degree from the Uniformed Services University of the Health Sciences F.and completed two years of the combined family practice and psychiatry residency program at Eisenhower Army Medical Center. DEBORAH PACKER, MAJ, MC, USA, is staff family physician and predoctoral program coordinator at Eisenhower Army Medical Center. Packer graduated from the University of Maryland School of Medicine, Baltimore, and completed a family practice residency at Eisenhower Army Medical Center.

Packer is board certified by the American Board of Family Practice. Edward Hébert School of Medicine, Bethesda, Md. Address correspondence to Seth John Stankus, MAJ, MC, USA, Chief of Neurology Service, Eisenhower Army Medical Center, Fort Gordon, GA 30905. The views expressed herein are exclusively those of the authors and do not necessarily represent the opinions of the United States Army or Department of Defense.

Donahue JG, Choo PW, Manson JE, Platt R. The incidence of herpes zoster. Alliegro MB, Dorrucci M, Pezzotti P, Rezza G, Sinicco A, Barbanera M, et al. Herpes zoster and progression to AIDS in a cohort of individuals who seroconverted to human immunodeficiency virus. Italian HIV Seroconversion Study. Smith JB, Fenske NA. Herpes zoster and internal malignancy. Schmader K, George LK, Burchett BM, Pieper CF, Hamilton JD.

Racial differences in the occurrence of herpes zoster. Brody MB, Moyer D. Varicella-zoster virus infection. Postgrad Med. Choo PW, Galil K, Donahue JG, Walker AM, Spiegelman D, Platt R. Risk factors for postherpetic neuralgia. Overview the biology of varicella-zoster virus infection. Immunization to reduce the frequency and severity of herpes zoster and its complications. Pathophysiology of postherpetic neuralgia towards a rational treatment.

A retrospective study of the clinical presentation and outcome of herpes zoster in a tertiary dermatology outpatient referral clinic. Int J Dermatol. Clinical features and pathophysiologic mechanisms of postherpetic neuralgia. Management of herpes zoster in elderly patients. Infect Dis Clin Pract. Crooks RJ, Jones DA, Fiddian AP.

Zoster-associated chronic pain an overview of clinical trials with acyclovir. Scand J Infect Dis Suppl. Beutner KR, Friedman DJ, Forszpaniak C, Andersen PL, Wood MJ. Valaciclovir compared with acyclovir for improved therapy for herpes zoster in immunocompetent adults. Antimicrob Agents Chemother. Whitley RJ, Weiss H, Gnann J, Tyring S, Mertz GJ, Pappas PG, et al. Acylclovir with and without prednisone for the treatment of herpes zoster. A randomized, placebo-controlled trial.

The National Institute of Allergy and Infectious Diseases Collaborative Antiviral Study Group. Eaglstein WH, Katz R, Brown JA. 19 Trials have shown this drug to be more efficacious than placebo but not necessarily more so than other conventional treatments. The effects of early corticosteroid therapy on the skin eruption and pain of herpes zoster. Keczkes K, Basheer AM. Do corticosteroids prevent post-herpetic neuralgia. Prednisolone does not prevent post-herpetic neuralgia.

Lee PJ, Annunziato P. Current management of herpes zoster. Br J Dermatol. MacFarlane BV, Wright A, O Callaghan J, Benson HA. Chronic neuropathic pain and its control by drugs. Pharmacol Ther. Rowbotham MC, Davies PS, Verkempinck C, Galer BS. Lidocaine patch double-blind controlled study of a new treatment method for post-herpetic neuralgia. Ardid D, Guilbaud G. Antinociceptive effects of acute and chronic injections of tricyclic antidepressant drugs in a new model of mononeuropathy in rats.

Rowbotham M, Harden N, Stacey B, Bernstein P, Magnus-Miller L. Gabapentin for the treatment of postherpetic neuralgia. Members of various medical faculties develop articles for Practical Therapeutics. This article is one in a series coordinated by the Department of Family and Community Medicine at Eisenhower Army Medical Center, Fort Gordon, Ga. Guest editor of the series is Ted D. Epperly, COL, MC, USA. Copyright 2000 by the American Academy of Family Physicians. Infectious Disease, Viral Herpes Zoster Neuralgia -.

Continue reading from April 15, 2000. 8 April 15, 2000 Management of Herpes Zoster Shingles and Postherpetic Neuralgia. Esmann V, Geil JP, Kroon S, Fogh H, Pererslund NA, Petersen CS, et al. Mapeo de temperatura. Sabías que los mapeos térmicos deben realizarse periódicamente. Qué es un mapeo de temperatura.

Un mapeo de temperatura es un estudio para documentar las temperaturas en las zonas de almacenamiento y distribución de productos. Su objetivo es demostrar un perfil térmico dentro del área de almacenamientotanto en condiciones normales, como en condiciones de carga. En qué consiste. Consiste en garantizar las condiciones de almacenamiento, en conformidad con lo señalado en los estudios de estabilidad de los medicamentos y aprobado por los registros sanitarios, mediante la instalación de data loggers o de sensores para registrar la temperatura del área.

Por qué es importante. El almacenamiento inadecuado de un producto puede resultar en un producto contaminado y rechazado. Porque un mapeo de temperatura garantiza, que las áreas de almacenamiento cumplan con las condiciones térmicas establecidas en los productos para su conservación y calidad. Garantiza la trazabilidad de tus productos con un mapeo térmico. Mapeos de temperatura. Cada cuánto tiempo debe realizarse un mapeo de temperatura.

Se recomienda ejecutar los mapeos térmicos al menos dos veces al año en las condiciones más críticas para los países estacionales. En periodos de mayor calor y en periodos más fríos. Las zonas de almacenamiento con temperatura controlada, requieren de un mapeo de temperatura para garantizar un almacenamiento seguro. Estos parámetros son exigidos por la Norma Técnica 147 del ISP en cuanto a Droguerías y Centros de Distribución, con criterios establecidos en la Resolución Exenta Nº 6590 para Chilela OMS, ISPE, USP 39, EMA, FDA, DIGEMID, INVIMA y ANVISA y en las Buenas Prácticas de Almacenamiento y Distribución.

Las empresas deben asegurarse que el almacenamiento y distribución de productos se den bajo los requerimientos aprobados en los registros sanitarios. Qué equipos o áreas requieren de un mapeo térmico. El procedimiento de un mapeo térmico debe realizarse en. Cámara Fría. Es un espacio con condiciones de refrigeración establecidas 2 a 8 grados que forma parte de los procesos de conservación de los productos.

Las cámaras frías deben ser calificadas exitosamente y mantener su estado validado. Son equipos que garantizan las condiciones de estabilidad de cada producto. Mantienen una temperatura precisa para el almacenamiento y su conservación. Áreas de Almacenamiento de temperatura controlada. Son áreas con condiciones térmicas específicas para mantener y resguardar las características de los productos controlados.

Áreas que no requieren de un control de temperatura activa. Espacios que presentan condiciones normales de almacenamiento, es decir, un local con temperaturas entre 15ºC y 25 C. La duración del Mapeo de Temperatura en Equipos Refrigerados es de 24- 72 horas y de 7-10 días para las bodegas o áreas de almacenamiento. En qué consiste el Mapeo de Temperatura. El mapeo térmico se realiza en 4 fases que se especifican en los aspectos técnicos de mapeos térmicos de la Resolución Exenta Nº 6590 de fecha 14.

Mediante un protocolo, especificamos los detalles del mapeo térmico con descripción de los aspectos técnicos, basado en la gestión de calidad de tu empresa. Ejecución del mapeo. Ejecutamos el servicio basado en las Buenas Prácticas de Manufactura y en la norma WHO 961-2015tomando en cuenta las variaciones de temperatura y sus fluctuaciones. Presentamos un informe técnico, una propuesta de ubicación de sensores, un informe cualitativo y cuantitativo de los resultados finales datos crudos, documentación técnica y análisis de datos.

Plan de acción correctiva. Dependiendo de los resultados, proponemos un plan de acción que incluye planos o diagramas de almacenamiento, determinación de puntos fríos y calientes y recomendaciones. Pasos para solicitar un Mapeo de Temperatura. Agenda tu servicio. Solicita una cotización y agenda tu servicio de mapeo térmico.

Visita de ejecución de servicio. Hacemos una visita de levantamiento en bodega para determinar tus necesidades y ejecutamos el servicio basado en las normativas de las entidades regulatorias. Entrega de informes. Además de entregar el informe físico, cargamos los resultados en la plataforma online donde puedes descargarlo cuando lo desees.

Ofrecemos capacitación gratuita a tu personal para que entiendan los resultados del informe y comprendan la importancia de un mapeo de temperatura. Garantiza la calidad de tus medicamentos con un mapeo térmico. Con el apoyo de nuestro personal humano, ético y técnico especializado en Mapeos de temperatura, te aseguramos el cumplimiento de las Buenas Prácticas de Almacenamiento y Distribución. Además, te ayudamos a evitar los riesgos asociados a productos contaminados, manejo indebido, falsificación de productos y pérdida de trazabilidad que pueden traer consecuencias negativas para tu empresa y clientes.

Calidad de servicio. Trabajamos con una metodología basados en la normativa a nivel regional, nacional e internacional. Chile, Colombia, Perú, México, USA, Europa. Nuestro proceso de ejecución de servicio de mapeo de temperatura es de inmediato. Hacemos mapeos térmicos para cámaras frías y equipos en 24 horas y para bodegas en 7 días continuos. Respaldo técnico. Contamos con un equipo experto, preparado, ético y sobre todo comprometido por tus intereses, para brindarte un respaldo técnico regulatorio.

Descarga tu informe en donde estés. Contamos con una plataforma online para el acceso inmediato de tu informe técnico. Informe técnico según tus requerimientos. Ofrecemos flexibilidad en la entrega de nuestros informes, disponibles en diferentes idiomas Inglés, Francés, Portugués, Español, entre otros. Capacitación y asesoría. Concientizamos a tu personalbrindamos asesoría para el entendimiento de los informes técnicos y el manejo de equipos.

Descarga tu informe técnico dónde y cuándo lo necesites. Cumple con las Buenas Prácticas de Manufactura. Cumple con las normas nacionales e internacionales. Asegura el cumplimiento de los requerimientos exigidos por los entes regulatorios como la OMS, ISP y las Buenas Prácticas de Almacenamiento y Distribución para la calidad de los productos durante su almacenamiento y comercialización en el mercado. Consigue un almacenamiento seguro.

Garantiza un almacenamiento seguro de productos mediante la uniformidad de la temperatura. Evita fallas de productos, reclamos, retiro de productos del mercados e incumplimiento de los criterios para el almacenamiento y distribución. Garantiza el cumplimiento del sistema de calidad. De lo contrario, se enfrentan a productos contaminados, productos rotos o dañados por un manejo indebido, pérdida de la trazabilidad del producto y falsificación del mismo. Cumple con el sistema de gestión de calidad de tu empresa, con espacios seguros para el almacenamiento.

Asegúrate de trabajar sólo con equipos calificados y aptos para la correcta distribución y comercialización de tus productos. Capacitamos a tu personal gratis. La capacitación de tu personal es una parte importante para que el mapeo de temperatura se realice de forma segura. Nuestro servicio incluye una capacitación gratuita online o presencial según tu preferencia de la mano de expertos en el área para que tu equipo de trabajo comprenda y ejecute los resultados obtenidos en nuestras auditorías.

Cumple con las exigencias y requerimientos para tus áreas de almacenamiento y distribución. CONOCE A NUESTRO EQUIPO. Raúl Quevedo. 25 años de experiencia. Amplio conocimiento y liam w iq option de implementación de proyectos de cumplimiento para industrias reguladas por ISP, SAG, SEREMI de Salud, Superintendencia de Electricidad y combustibles SEC ANVISA, DIGEMID, INVIMA. Además de participar en implementación de GMP, GLP, GEP y GDP con base a estándares FDA, EMEA y OMS.entre otros.

Actividades de Ingeniería en áreas para Áreas Limpias, Hidráulica, Construcción, Energías Renovables, Asesor y consultante en comités de calidad para Instituto Internacional de Normalización INN e INDECOPI. Paula Calderón. 10 años de experiencia. Amplia experiencia laboral en el área de la calidad de sistemas informáticos, documentación y validación de sistemas computarizados del sector industrial, requeridos para certificaciones ISO, GMP y auditorías de entidades como INVIMA y otros entes regulatorios; conocimiento de la norma ISO 9001 2008 y auditoría.

Experiencia por más de 7 años en el manejo de usuarios finales On line, On sitesoporte técnico y servicio al cliente, manejo de sistemas operativos, redes y herramientas administradoras de usuarios; alta capacidad de análisis e investigación para documentación en general. Carolina Valdivia. Experiencia, conocimiento y habilidades para organizar, dirigir y controlar proyectos de calificación de equipos y validación de sistemas para la industria farmacéutica humana y animalasí como también para área de alimentos, cosmética y clínica bajo los estándares Nacionales e Internacionales de las entidades regulatorias ISO, GMP, OMS, ISP, ANVIMA, INVISA, FDA, EMEA.

Cómo puedo solicitar un mapeo térmico. Somos expertos en el área y nuestro compromiso es ayudarte a garantizar el cumplimiento de las normas. Optimiza la calidad de tus procesos de almacenamiento y distribución de productos médicos, cosméticos y alimentos para el cumplimiento de procesos y tu sistema de gestión de calidad. Nos adaptamos a tus requerimientos. Rellena el siguiente formulario con tus datos, y un asesor te contactará para evaluar tu caso y ofrecerte la mejor solución.

Monseñor Sotero Sanz 100, Piso 9 - Of. 902 -Providencia, Santiago de Chile 56 2 2811 8824 email protected. Juan de Aliaga 360, Magdalena del Mar, Lima, Perú 51 730 6762 email protected. Cercal Group. Todos los derechos reservados 2020. Experta en desarrollo de protocolos DQ, IQ, OQ, PQ. Necesita ayuda para encontrar lo que necesita. Llámenos al 96 265 44 94, solucionaremos sus dudas.

Tienda de fontaneria online. Inicio Fontanería. Codos PVC Enlaces PVC Manguitos PVC Tapón PVC Te PVC Válvulas PVC PVC presión encolar PVC presión encolar roscar PVC presión roscar roscar. Accesorios y tubo PVC Manguitos extensibles Sifones y sumideros. Cobre Contadores de Agua Monta Fácil Multicapa Polietileno PVC presión. bañera y ducha lavabo bidé fregadera Calderetas, Canaletas y gran evacuación. Asientos y Tapas Accesorios Baño. Accesorios Calderas Emisores Electricos Radiadores Termos y Calentadores.

Accesorios Lowcost Accesorios Elite Complementos. Bajo encimera Lavabos con mueble Lavabos murales Sobre encimera Sobre mueble. Baño - Ducha - Lavabo - Bidet Grandes Duchas Termostática. Electrónica Temporizado lavabo Temporizada fregadero y otros Temporizada inodoro urinario Temporizada Ducha Baño. Acrílicos Cerámico Cuarzo Inox. Bajo encimera Sobre encimera Empotrados Industriales. Inicio Fontanería Alimentación Agua Cobre Contadores de Agua Monta Fácil Multicapa Polietileno PVC presión Codos PVC Enlaces PVC Manguitos PVC Tapón PVC Te PVC Válvulas PVC PVC presión encolar PVC liam w iq option encolar roscar PVC presión roscar roscar Racorería Valvulería Antiolores Evacuación Agua Accesorios y tubo PVC Manguitos extensibles Sifones y sumideros bañera y ducha lavabo bidé fregadera Calderetas, Canaletas y gran evacuación Gran evacuación Injertos y Manipulados pvc Recambio cisterna Riego y jardineria Varios Adhesivo y derivados Calefacción Accesorios Calderas Emisores Electricos Radiadores Termos y Calentadores Bombas y motores Bombas y Motores Bombas Piscina Bombas Sumergibles Bombas Verticales Horizontales de superficie Bombas Manuales Grupos de presión Osmosis y descalcificadores Piscinas Recambios Baños Asientos y Tapas Accesorios Baño Accesorios Lowcost Accesorios Elite Complementos Bañeras Lavabos Bajo encimera Lavabos con mueble Lavabos murales Sobre encimera Sobre mueble Mayores y Minusvalías Niños Piezas especiales Plato de ducha Sanitario Grifería Grifos de Baño Baño - Ducha - Lavabo - Bidet Grandes Duchas Termostática Grifos de Cocina Grifo Empotrado Grifos Temporizados Electrónica Temporizado lavabo Temporizada fregadero y otros Temporizada inodoro urinario Temporizada Ducha Baño Medicinal Rociadores y mangos Otros grifos Fregaderos Acrílicos Cerámico Cuarzo Inox Bajo encimera Sobre encimera Empotrados Industriales Lavaderos Recomendados.

Somos especialistas en la venta de material de fontaneríasuministros, recambios, calefacción, baño, grifería o fregaderos, sin olvidar nuestra sección especial con descuentos en fontanería y liquidaciones de stock. Productos destacados en Fontanería. Sifón extensible ahorro espacio. Asiento y tapa inodoro Marina Gala GENERICO. Sumidero terraza, sifón seco con Antirretorno por membrana.

Rosetón embellecedor tubo calefacción. Juego excéntrica y florón cromo supergigante. Válvula antiroedores, antiretorno y antiolores. Secciones destacadas. RIEGO Y JARDINERÍA. ASIENTOS Y TAPAS. Top visitas en Fontanería. Caja contador agua incluye contador agua - valvula entrada y salida -llave puerta. Tubo pvc evacuación serie B tramos 2 m. Codo pvc con ángulo de 30º. Lo que opinan nuestros clientes.

La amplia gama de productos y la rápida entrega ha sido una gran solución para muchos trabajos. Gracias por la rapidez y la ayuda buscando soluciones, se agradece tratándose una tienda online. Bernardo Domingo Fontanería Bernardos e hijos. Bombas Piscina Bombas Sumergibles Bombas Verticales Horizontales de superficie Bombas Manuales Grupos de presión.

Fijación de Precios. This course contains affiliates links, meaning when you click the links and make a purchase, we receive a commission. Detalles del Curso. Tags Relacionadas.

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The DDR4-4133 variant PVB416G413C8K achieves its advertised speeds at 18-22-22-42 timings, and 1. The DDR4-4266 variant PVB416G426C8K ticks at 18-26-26-46 timings, and 1. The top-spec DDR4-4400 variant PVB416G440C8K was tested with liam w iq option same 18-26-26-46 timings as the DDR4-4266 variant, but with 1.

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Different Android phones may differ in appearance.