Hasil untuk "Pharmacy and materia medica"

Ayana Korsa, Ines Krass, Connie Van et al.

Background: The emerging role of pharmacists in chronic kidney disease (CKD) care prompted the pharmacy-led screening and quality use of medicines in CKD trial (QUM-CKD), a pharmacy-led screening initiative to detect previously undiagnosed CKD and improve medication safety.Objective: To explore pharmacists' experiences and perspectives on the implementation of the QUM-CKD trial in Australian community pharmacies. Methods: A descriptive phenomenological qualitative approach was employed, involving in-depth, semi-structured telephone interviews with thirteen metropolitan and rural community pharmacists in the trial. Pharmacists were selected via purposive maximum variation sampling and were recruited mid-trial. Interviews were audio- recorded, transcribed verbatim, and thematically analysed using both deductive and inductive approaches in NVivo 14. Results: Most participating pharmacists reported having positive experiences with the trial's implementation. Facilitators of implementation included pharmacists' knowledge and beliefs, the availability of resources, support and training. The alignment with roles, values, and systems, along with perceived benefits of the service, the point-of-care testing service, a whole-team approach, and patient acceptance coupled with positive feedback, also facilitated implementation. Barriers included insufficient pharmacist staffing, time constraints, heavy workload, trial software and documentation issues, patients' lack of time, interest or unfavourable perceptions of the service, and interprofessional communication challenges between pharmacists and general practitioners (GPs). Pharmacists also suggested several potential improvements and expressed concerns about the sustainability of the service. Conclusions: Australian community pharmacists generally reported positive experiences in implementing the QUM-CKD trial. To ensure the service's success and sustainability, we recommend adequate pharmacy staffing, appropriate pharmacist remuneration, active stakeholder promotion and strong interprofessional collaboration. Pharmacists' suggestions for service improvement should also be considered.

Ruojian Wen, Yuwei Liu, Xiang Tian et al.

<b>Background/Objectives:</b> Glioblastoma (GBM) is the deadliest type of brain tumor and photodynamic therapy (PDT) is a promising treatment modality of GBM. However, insufficient photosensitizer distribution in the GBM critically limits the success of PDT. To address this obstacle, we propose tumoritropic neutrophils (NE) as active carriers for photosensitizer delivery to achieve GBM-targeted PDT. <b>Methods:</b> Isolated mouse NE were loaded with functionalized hexagonal boron nitride nanoparticles carrying the photosensitizer chlorin e6 (BNPD-Ce6). In vitro experiments were conducted to determine drug release from the loaded NE (BNPD-Ce6@NE) to mouse GBM cells and consequential photo-cytotoxicity. In vivo experiments were performed on mice bearing intracranial graft GBMs to demonstrate GBM-targeted drug delivery and the efficacy of anti-GBM PDT mediated by BNPD-Ce6@NE. <b>Results:</b> BNPD-Ce6@NE displayed good viability and migration ability, and rapidly released BNPD-Ce6 to co-cultured mouse GBM cells, which then exhibited marked reactive oxygen species (ROS) generation and cytotoxicity following 808 nm laser irradiation (LI). In the in vivo study, a single intravenous bolus injection of BNPD-Ce6@NE resulted in pronounced Ce6 distribution in intracranial graft GBMs 4 h post injection, which peaked around 8 h post injection. A PDT regimen consisting of multiple intravenous BNPD-Ce6@NE injections each followed by one extracranial tumor-directed LI 8 h post injection significantly slowed the growth of intracranial graft GBMs and markedly improved the survival of host animals. Histological analysis revealed massive tumor cell damage and NE infiltration in the PDT-treated GBMs. <b>Conclusions:</b> NE are efficient carriers for GBM-targeted photosensitizer delivery to achieve efficacious anti-GBM PDT.

Prachi Ghoderao, Eliza Kwiatkowska-Borowczyk, Sanjay Sahare et al.

Therapeutic resistance remains a critical barrier in oncology, frequently leading to cancer relapse after initial treatment response. Growing evidence suggests the presence of drug-tolerant persisters (DTPs), a rare subpopulation of cancer cells that survives chemotherapy by entering a reversible specific adaptation. Unlike classical cell resistance, the DTP phenotype is independent of genetic changes and maintained through dynamic regulatory mechanisms. DTPs are phenotypically heterogeneous and can exhibit stem-like and quiescent cell phenotypes, non- or slow proliferation, and remarkable plasticity due to a di-pause-like state and executing epithelial–mesenchymal transition (EMT) or transdifferentiation processes. Despite advances in research, the molecular mechanisms underlying DTPs’ biology and their role in cancer relapse remain only partially understood. The review summarizes the current progress in processes that lead to the acquisition of cellular persistence status, which, in turn, constitute areas of vulnerability that can be exploited in cancer therapy. We highlight anti-DTP therapeutic strategies, including epigenetic modification, cell signaling and transcriptional regulation, metabolic reprogramming, and modification of cell interactions within the tumor microenvironment. Furthermore, we focus on the potential role of nanomaterials in the combat against DTPs. Nanoparticles not only act as part of the drug delivery process, enabling precise DTP targeting and enhancing intracellular drug accumulation, but their intrinsic properties can also be used to eradicate DTPs directly or by enhancing the effectiveness of other therapeutic strategies. The integrated approach offers strong potential to eliminate tumor persistence, prevent recurrence, and improve long-term patient outcomes beyond conventional therapies.

Mengran Wang, Wenpeng Zhang, Xia Wu et al.

<b>Objective:</b> This study aimed to develop a quantitative analytical method for the simultaneous determination of cannabidiol (CBD) and melatonin (MT) in mouse plasma using the protein precipitation method coupled with LC-MS/MS. Additionally, this study sought to investigate the impact of CBD on the pharmacokinetics of MT in mice using this method. <b>Methods:</b> Mouse plasma samples were precipitated with acetonitrile and analyzed using a Kromasil 100-5-C8 (2.1 × 50 mm) column. Following a single administration, thirty male ICR mice were randomly assigned to five groups: MT 2 mg/kg intravenously (<i>i.v.</i>), MT 10 mg/kg orally (<i>p.o.</i>), MT + CBD (10 + 10) mg/kg <i>p.o.</i>, MT + CBD (10 + 40) mg/kg <i>p.o.</i>, and MT 10 mg/kg <i>p.o.</i> followed by CBD 2 mg/kg <i>i.v.</i> Pharmacokinetic parameters were calculated using a non-compartmental model and analyzed to investigate the interactions of CBD with MT. <b>Results:</b> The calibration curves for CBD and MT were linear over the range of 2 to 1000 ng/mL. Co-administration of a high dose of CBD (40 mg/kg) orally reduced the C_max of MT (10 mg/kg) to 57% of the control, while the area under the curve from 0.5 to 8 h (AUC_(0.5–8h)) was 2.85-fold that of the MT-only group. When CBD (2 mg/kg) was administered intravenously alongside MT orally, the AUC_(0.5–8h) was 1.54 times that of MT given orally alone. The AUC of CBD was positively correlated with the AUC of the distribution and elimination phases of MT, while the C_max of CBD negatively correlated with the C_max of MT. <b>Conclusions:</b> The developed LC-MS/MS method is robust and suitable for pharmacokinetic studies involving CBD and MT. The in vivo effects of CBD on MT pharmacokinetics are complex. High oral doses of CBD inhibit both the intestinal absorption and metabolic clearance of MT, resulting in a more smooth PK profile.

Vahid Barati, Anna Hruzíková, Eliška Procházková et al.

Heterocyclic drugs display diverse pharmacological activities and metabolic stability. However, their poor solubility and pharmacokinetic properties often compromise bioavailability and clinical outcomes. Nevertheless, the prodrug approach provides a viable strategy to overcome unwanted attributes of drug candidates. In this proof-of-concept study, we report the synthesis and biological evaluation of glycol methylene-bridged phosphate (GMBP) prodrugs developed for heterocyclic drug delivery. Through methylene bridging, the heterocyclic nitrogen was directly attached to the phosphate, whereas the glycol moiety enabled drug release via cyclization, as confirmed by 31P NMR spectroscopy. Additional prodrugs of carboxylic acids, phenols, and thiols confirmed the broad application scope of our GMPB approach. Heterocyclic GMBP prodrugs were stable in aqueous buffers and activated by phospholipase CAL-B in vitro. Select prodrugs, including zidovudine prodrug 33, were even more potent (3 nM on HIV-1) than the parent compound. These findings demonstrate that our GMBP approach is not only feasible but also highly versatile.

Govindaraj Sabarees, Vadivel Velmurugan, Siddan Gouthaman et al.

Choosing suitable wound dressings is crucial for effective wound healing. Spun scaffolds with bioactive molecule functionalization are gaining attention as a promising approach to expedite tissue repair and regeneration. Here, we present the synthesis of novel multifunctional quercetin with morpholine and pyridine functional motifs (QFM) embedded in silk fibroin (SF)-spun fibers (SF-QFM) for preclinical skin repair therapies. The verification of the novel QFM structural arrangement was characterized using ATR-FTIR, NMR, and ESI-MS spectroscopy analysis. Extensive characterization of the spun SF-QFM fibrous mats revealed their excellent antibacterial and antioxidant properties, biocompatibility, biodegradability, and remarkable mechanical and controlled drug release capabilities. SF-QFM mats were studied for drug release in pH 7.4 PBS over 72 h. The QFM-controlled release is mainly driven by diffusion and follows Fickian’s law. Significant QFM release (40%) occurred within the first 6 h, with a total release of 79% at the end of 72 h, which is considered beneficial in effectively reducing bacterial load and helping expedite the healing process. Interestingly, the SF-QFM-spun mat demonstrated significantly improved NIH 3T3 cell proliferation and migration compared to the pure SF mat, as evidenced by the complete migration of NIH 3T3 cells within 24 h in the scratch assay. Furthermore, the in vivo outcome of SF-QFM was demonstrated by the regeneration of fresh fibroblasts and the realignment of collagen fibers deposition at 9 days post-operation in a preclinical rat full-thickness skin defect model. Our findings collectively indicate that the SF-QFM electrospun nanofiber scaffolds hold significant capability as a cost-effective and efficient bioactive spun architecture for use in wound healing applications.

Elisabetta Novello, Giuseppina Scalzo, Giovanni D’Agata et al.

In recent decades, ionic liquids (ILs) have garnered research interest for their noteworthy properties, such as thermal stability, low or no flammability, and negligible vapour pressure. Moreover, their tunability offers limitless opportunities to design ILs with properties suitable for applications in many industrial fields. This study aims to synthetise two series of methylimidazolium ILs bearing long alkyl chain in their cations (C9, C10, C12, C14, C16, C18, C20) and with tetrafluoroborate (BF₄) and the 1,3-dimethyl-5-sulfoisophthalate (DMSIP) as counter ions. The ILs were characterised using ¹H-NMR and MALDI-TOF, and their thermal behaviour was investigated through DSC and TGA. Additionally, the antimicrobial, anticancer, and cytotoxic activities of the ILs were analysed. Moreover, the most promising ILs were incorporated at different concentrations (0.5, 1, 5 wt%) into polyvinyl chloride (PVC) by solvent casting to obtain antimicrobial blend films. The thermal properties and stability of the resulting PVC/IL films, along with their hydrophobicity/hydrophilicity, IL surface distribution, and release, were studied using DSC and TGA, contact angle (CA), SEM, and UV–vis spectrometry, respectively. Furthermore, the antimicrobial and cytotoxic properties of blends were analysed. The in vitro results demonstrated that the antimicrobial and antitumor activities of pure ILs against t <i>Listeria monocytogenes</i>, <i>Escherichia coli</i>, <i>Pseudomonas fluorescens</i> strains, and the breast cancer cell line (MCF7), respectively, were mainly dependent on their structure. These activities were higher in the series containing the BF₄ anion and increased with the increase in the methylimidazolium cation alkyl chain length. However, the elongation of the alkyl chain beyond C16 induced a decrease in antimicrobial activity, indicating a cut-off effect. A similar trend was also observed in terms of in vitro biocompatibility. The loading of both the series of ILs into the PVC matrix did not affect the thermal stability of PVC blend films. However, their T_onset decreased with increased IL concentration and alkyl chain length. Similarly, both the series of PVC/IL films became more hydrophilic with increasing IL concentration and alkyl chain. The loading of ILs at 5% concentration led to considerable IL accumulation on the blend film surfaces (as observed in SEM images) and, subsequently, their higher release. The biocompatibility assessment with healthy human dermal fibroblast (HDF) cells and the investigation of antitumoral properties unveiled promising pharmacological characteristics. These findings provide strong support for the potential utilisation of ILs in biomedical applications, especially in the context of cancer therapy and as antibacterial agents to address the challenge of antibiotic resistance. Furthermore, the unique properties of the PVC/IL films make them versatile materials for advancing healthcare technologies, from drug delivery to tissue engineering and antimicrobial coatings to diagnostic devices.

Jana Mojsilović, Nemanja Jovičić, Sanja Vujović Ristić et al.

This study aimed to identify risk factors for amlodipine-induced gingival enlargement, assess quality of life, and analyze gingival tissue. This cross-sectional study involved hypertensive patients on amlodipine, divided into groups with and without gingival enlargement. Assessments included sociodemographic data, clinical evaluations, and clinical parameters. Quality of life was assessed using OHIP-14 and WB-HRQoL scales. Gingival tissue samples were analyzed for oxidative status and key molecules using RT-PCR and colorimetric assays. The study included 32 patients with no significant sociodemographic differences between groups (<i>p</i> > 0.05). Patients with gingival enlargement had higher systolic blood pressure (139.63 ± 10.743 vs. 128.38 ± 7.249, <i>p</i> = 0.028) and higher OHIP-14 scores. The RT-PCR analysis showed significant differences in IL-6, TNF-α, IL-33, ST2, TGF-β1, FGF-2, CTGF, VEGF-D, and KGF expression. IL-6, TNF-α, ST2, and FGF-2 expression levels were lower in patients taking amlodipine, with and without gingival enlargement. TGF-β1 and CTGF expression levels were highest in patients with amlodipine-induced gingival enlargement. SOD activity was also highest in these patients, whereas MDA levels were higher in patients with gingival enlargement without amlodipine. Our study highlights the impact of amlodipine-induced gingival enlargement on oral health and quality of life, emphasizing fibrosis and oxidative stress, and suggests the need for integrated healthcare approaches and further research.

Ana Neves, Tânia Albuquerque, Rúben Faria et al.

Glioblastoma multiform (GBM) is considered the deadliest brain cancer. Conventional therapies are followed by poor patient survival outcomes, so novel and more efficacious therapeutic strategies are imperative to tackle this scourge. Gene therapy has emerged as an exciting and innovative tool in cancer therapy. Its combination with chemotherapy has significantly improved therapeutic outcomes. In line with this, our team has developed temozolomide–transferrin (Tf) peptide (WRAP5)/p53 gene nanometric complexes that were revealed to be biocompatible with non-cancerous cells and in a zebrafish model and were able to efficiently target and internalize into SNB19 and U373 glioma cell lines. The transfection of these cells, mediated by the formulated peptide-drug/gene complexes, resulted in p53 expression. The combined action of the anticancer drug with p53 supplementation in cancer cells enhances cytotoxicity, which was correlated to apoptosis activation through quantification of caspase-3 activity. In addition, increased caspase-9 levels revealed that the intrinsic or mitochondrial pathway of apoptosis was implicated. This assumption was further evidenced by the presence, in glioma cells, of Bax protein overexpression—a core regulator of this apoptotic pathway. Our findings demonstrated the great potential of peptide TMZ/p53 co-delivery complexes for cellular transfection, p53 expression, and apoptosis induction, holding promising therapeutic value toward glioblastoma.

Stefania-Claudia Jitaru, Andrei Neamtu, Gabi Drochioiu et al.

Peptides and their related compounds can self-assemble into diverse nanostructures of different shapes and sizes in response to various stimuli such as pH, temperature or ionic strength. Here we report the synthesis and characterization of a lysozyme derived pentapeptide and its ability to build well-defined fibrillar structures. Lysozyme FESNF peptide fragment was synthesized by solid phase peptide synthesis using the Fmoc/t-Bu strategy, purified by analytical high-performance liquid chromatography (HPLC) and its molecular weight was confirmed by matrix-assisted laser desorption/ionization mass spectrometry (MALDI–MS). Spectroscopic features of this pentapeptide were investigated by UV-visible spectroscopy and fluorimetry showing the pattern of marginal phenylalanine residues within the peptide sequence. Self-assembling properties were determined using atomic force microscopy (AFM), aggregation index and thioflavin T assay (ThT). FESNF generating fibrillar structures observed by AFM and aggregation propensity were primarily influenced by pH conditions. Moreover, the experimental data were confirmed by molecular dynamics simulation studies. The obtained fibrils will be used next to explore their potential to act as support material for medical and cosmetic application.

Balázs Horváth, Norbert Szentandrássy, János Almássy et al.

Late sodium current has long been linked to dysrhythmia and contractile malfunction in the heart. Despite the increasing body of accumulating information on the subject, our understanding of its role in normal or pathologic states is not complete. Even though the role of late sodium current in shaping action potential under physiologic circumstances is debated, it’s unquestioned role in arrhythmogenesis keeps it in the focus of research. Transgenic mouse models and isoform-specific pharmacological tools have proved useful in understanding the mechanism of late sodium current in health and disease. This review will outline the mechanism and function of cardiac late sodium current with special focus on the recent advances of the area.

Nusaiba Al-Nemrawi, Fatima Hameedat, Tamam El-Elimat

Silver nanoparticles (AgNPs) have broad biocidal activities, and are widely employed as an active ingredient in antiseptic, anti-viral, and anti-inflammatory preparations. Green-synthesizing AgNPs would be a rapid, cheap, and environmentally friendly method of synthesis. The methanolic extract of the leaves of <i>Bellevalia flexuosa</i> Boiss. (Asparagaceae) was used for the green synthesis of the AgNPs. The effects of the pH and the concentration of silver nitrate (AgNO₃) on the synthesis of the AgNPs were investigated. The AgNPs produced above pH 10, and 1 mM of AgNO₃ resulted in lower hydrodynamic diameters. Ultraviolet-visible spectroscopy, Fourier-transform infrared spectroscopy, and X-ray diffraction proved the formation of the AgNPs, with a face-centered, cubed geometry. Scanning electron microscopy images showed colloidal and well-dispersed nanoparticles. In addition, the antibacterial activities of the prepared AgNPs were assessed by optical densities (ODs) against Gram-positive bacteria (<i>Enterococcus faecalis</i> and <i>Staphylococcus epidermidis</i>) and Gram-negative bacteria (<i>Pseudomonas aeruginosa</i>, <i>Escherichia coli</i>, <i>Klebsiella pneumoniae</i>, and <i>Salmonella enterica</i>). The broths of Gram-negative and Gram-positive bacteria that contained AgNPs, showed lower OD values compared to the controls. In conclusion, AgNPs were prepared using <i>B. flexuosa</i> methanolic extract, and showed antibacterial activity against the tested bacterial strains.

Yeo-Jin Choi, Keunhyeong Bak, Yoon Yeo et al.

Accumulating evidence indicates a link between diabetes and cancer. Selective estrogen receptor modulators (SERMs) may increase diabetes risk via antiestrogen effects. This study investigated incident diabetes risk of SERM treatment and its effects on metastatic cancer and death prevention in breast cancer survivors. This retrospective cohort study included female patients with early-stage breast cancer, treated with or without SERMs, between 2008 and 2020 in a tertiary care hospital in Korea. Four propensity score-matched comparison pairs were designed: SERM use versus non-use, long-term use (≥1500 days) versus non-use, tamoxifen use versus non-use, and toremifene use versus non-use; then, logistic regression analysis was performed for risk analysis. SERMs in general were not associated with an elevated risk of diabetes; however, when used for ≥1500 days, SERMs—especially toremifene—substantially increased diabetes risk in breast cancer patients (OR 1.63, <i>p</i> = 0.048). Meanwhile, long-term SERM treatment was effective at preventing metastatic cancer (OR 0.20, <i>p</i> < 0.001) and death (OR 0.13, <i>p</i> < 0.001). SERM treatment, albeit generally safe and effective, may increase diabetes risk with its long-term use in women with breast cancer. Further studies are required to verify the association between toremifene treatment and incident diabetes.

Jeng-Wei Lu, Yuxi Sun, Liang-In Lin et al.

The poor prognosis for patients with hepatocellular carcinoma (HCC) is related directly to metastasis. The <i>T</i><i>wist1</i> gene encodes for a transcription factor essential to embryogenesis. It has also been shown to promote epithelial-to-mesenchymal transition (EMT), invasion, and metastasis; however, there is currently no in vivo evidence that <i>Twist1</i> plays a role in the metastasis of liver tumors. Zebrafish are increasingly being used as an alternative cancer model. In the current study, an adult-stage zebrafish HCC model was used to examine the synergistic effects of <i>twist1a</i> and <i>xmrk</i>, a well characterized oncogene, during HCC metastasis. We also examined the effects of two inflammatory agents, lipopolysaccharides (LPS) and dextran sulfate sodium (DSS), on the hepatocyte-specific expression of transgenic <i>twist1a</i> and <i>xmrk</i>. The conditional overexpression of <i>twist1a</i> and <i>xmrk</i> was shown to promote liver tumor metastasis in zebrafish, resulting in increased apoptosis and cell proliferation as well as tumor maintenance and propagation independent of the inherent EMT-inducing activity of <i>xmrk</i>. Exposing <i>twist1a+</i>/<i>xmrk+</i> transgenic zebrafish to LPS or DSS was shown to promote metastasis, indicating that the overexpression of <i>twist1a</i> and <i>xmrk</i> led to crosstalk between the signaling pathways involved in EMT. This study provides important evidence pertaining to the largely overlooked effects of signaling crosstalk between <i>twist1a</i> and <i>xmrk</i> in regulating HCC metastasis. Our results also suggest that the co-expression of <i>twist1a</i>/<i>xmrk</i> in conjunction with exposure to LPS or DSS enhances HCC metastasis, and provides a valuable in vivo platform by which to investigate tumor initiation and metastasis in the study of liver cancer.

Amna Manzar, Kainat Anwar, Komal Shabbir et al.

Objective: Patient convenience and compliance-oriented research has resulted in bringing out safer and newer drug delivery systems. Recently, fast dissolving drug delivery systems have started gaining popularity and acceptance. Fast dissolving films (FDF) were initially introduced in the market as breath fresheners and personal care products such as dental care strips and soap strips, but now regarded as the most advanced form of oral route of drug Administration. Problems such as poor solubility and wettability of drugs has resolved to higher extent. This project was aimed to formulate Fast Dissolving Oral Thin films of Glimepiride GOTFs, glimepiride is a new oral sulfonylurea hypoglycemic agent for the treatment of non-insulin dependent (type II) diabetes mellitus. It is classified under class II according to biopharmaceutical classification system with low solubility and high permeability. Method: GOFTs were prepared by using solvent casting method and Hydroxy Methyl Propyl Cellulose (HPMC) as a polymer. Results: GOTFs 0.1mm in thickness were prepared which were appropriate in appearance as well as fulfilled all criterions of Oral Thin Films Formulations. The disintegration time for GOFTs was 3 seconds and oral films. The pH of films was 6.2, Tensile strength was 7 N/mm2 and percent elongation was 19%. Conclusion: From the results of this study it can be concluded that prepared optimized fast dissolving Oral Films of glimepiride are the better option to treat diabetes.

M. C. Weinstein, George Torrance, Alistair Mcguire et al.

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Arianna Cecilia Cozzi, Benedetta Briasco, Enrico Salvarani et al.

Plastic material is used for a wide variety of commercial packaging due to being inexpensive, lightweight, and due to its resistance. In pharmaceutics, container-content compatibility studies are required for product authorization. Many guidelines and publications are available; however, the information is often only related to the raw materials used to produce packaging. During the manufacturing process, substances can be added to improve the product characteristics and performance, resulting in a processed material that is considerably different from the unprocessed material. In this study, the mechanical properties of low-density polyethylene (LDPE) and linear low-density polyethylene (LLDPE) specimens fabricated according to standard ISO 527 and specimens fabricated with the same materials, but obtained from final packaging, were evaluated. Furthermore, we examined the interaction between a semisolid formulation and LLDPE and LDPE as a final packaging, by subjecting two samples to accelerated degradation testing. Then, mechanical properties and volatile organic extractable were evaluated. Simulated solar radiation did not induce changes in the packaging mechanical properties and no extracts were detectable. The thermal shock strongly influenced the mechanical behavior, and interactions between packaging contents were identified. The present work underlines the difference between analyzing the standard ISO specimens versus samples obtained from final packaging in order to evaluate the packaging under real use conditions. An evaluation on the final packaging, instead on standard specimens, can provide information about the plastic material after the manufacturing process and the interaction between packaging and content.

Chiara Robba, Ega Qeva, Beatrice Borsellino et al.

Background and Aims: In patients undergoing surgery for cervical myelopathy, induction of general anesthesia can induce systemic arterial hypotension that may worsen spinal cord hypoperfusion and precipitate spinal injury. In this randomized, controlled, clinical trial study, we compared the hemodynamic changes related to anesthesia induction with intravenous (IV) propofol- and sevoflurane-based inhalational induction in patients undergoing fiberoptic intubation for cervical spine surgery. Material and Methods: A total of 72 patients were studied. Hemodynamic effects were assessed measuring mean arterial pressure (MAP), and the echocardiographic evaluation of the left ventricular function. A Student's t-test with Bonferroni correction or Chi-squared test was used, when appropriate, to assess differences in hemodynamic (extent of MAP drop and incidence of episodes of severe arterial hypotension) and other variables (occurrence and duration of episodes of apnea). Results: Patients assigned to total IV anesthetic approach had a lower MAP, and more significant changes in cardiac function compared to those who received the inhalational approach (68.1 ± 9.3 mmHg vs. 75.5 ± 10.3 mmHg; 25% vs. 5.5%). Conclusion: Anesthesia induction with both propofol or sevoflurane is safe and effective. However, total IV anesthesia induction is associated with more pronounced MAP drop which can worsen spinal cord hypoperfusion.

Rômulo Moreira dos Santos, Ivana Maria Fechine Sette, Lindomar de Farias Belém

The high incidence of chronic diseases in the elderly leads to increased intermittent drug therapies. The presence of concomitant diseases and prescriptions made out by various health professionals facilitate the practice of polypharmacy, the emergence of iatrogenic diseases, and therapeutic regimens that are inconvenient for patients. The present study was carried out among elderly patients hospitalized at the Hospital Care Foundation of Paraiba, Campina Grande, with the objectives of studying the consumption of drugs by these patients, noting the possible adverse drug reactions (ADR), drug interactions and the presence of high-risk drugs prescribed to this age group. The study had a descriptive and cross-sectional quantitative design and involved a sample of 65 patients accompanied by the Pharmacovigilance Centre of the hospital, from August 2009 to July 2010. Over 90% of the patients were on polypharmacy, and the possible ADR found were related to the gastrointestinal tract where the most frequent interactions were with cardiovascular drugs. Within the context of pharmacoepidemiology, pharmacists can contribute by improving the quality of life of patients and preventing unnecessary expense with erroneous and poorly evaluated treatments.<br>A elevada incidência de doenças crônicas na terceira idade induz ao aumento de terapias medicamentosas intermitentes. A presença de patologias concomitantes e prescrições elaboradas por diversos profissionais de saúde facilitam a prática da polifarmácia, surgimento de doenças iatrogênicas e esquemas terapêuticos pouco cômodos para o paciente. O estudo foi realizado junto aos pacientes idosos internados no Hospital da Fundação Assistencial da Paraíba (FAP), Campina Grande, com objetivo de estudar o consumo de medicamentos por estes pacientes, observando as possíveis reações adversas a medicamentos (RAM), interações medicamentosas apresentadas e a presença de medicamentos de alto risco prescritos para este grupo etário. A pesquisa foi descritiva e transversal, com abordagem quantitativa, constituída por uma amostra de 65 pacientes, acompanhados através do Centro de Farmacovigilância do hospital, no período de agosto de 2009 a julho de 2010. Mais de 90% dos pacientes estavam sob polifarmácia, as possíveis RAM encontradas estavam mais relacionadas ao trato gastrintestinal e as interações foram mais frequentes com os medicamentos de ação cardiovascular. Dentro do contexto da farmacoepidemiologia, o profissional farmacêutico pode contribuir para a melhoria da qualidade de vida dos pacientes e evitar gastos desnecessários devido à terapêuticas errôneas e mal avaliadas.