Anti-inflammatory effects and acute oral toxicity of Copaifera spp. essential oil-loaded nanoemulsion / Efectos antiinflamatorios y toxicidad oral aguda de nanoemulsión cargada de aceite esencial de Copaifera spp

Copaifera spp. essential oil (EOC) was extracted by hydrodistillation of Copaifera oleoresin (COR). The EOC was characterized by GC/MS and a novel EOC-loaded nanoemulsion was developed to enhance the EOC solubility and to evaluate its utility as antinflammatory. EOC contain 14 volatile compounds (including ß-caryophyllene: 51.52%) having a required HLB of 11. The Surfactant: EOC: Water ratio of 13:15:75 (%, w:w:w) produced the optimal formulation (particle size: 94.47 nm). The EOC-loaded nanoemulsion presented a pseudoplastic/thixotropic behavior with excellent shelf stability for 6 months. The anti-inflammatory effect of the nanoemulsion was more potent than that of the EOC, and statistically equal to diclofenac (50 mg/kg). The EOC-loaded nanoemulsion showed no oral acute toxicity (in mice) at 2000 mg/kg; hence, it is considered a nontoxic product. The development of the EOC-loaded nanoemulsion added value to both the COR and the EOC by providinga suitable formulation that could be used as an anti-inflammatory product.

El aceite esencial (EOC) fue extraído por hidrodestilación de oleoresina de Copaifera spp. El EOC fue caracterizado químicamente por GC/MS. Se formuló una nanoemulsión con EOC para mejorar la solubilidad del EOC y evaluar su utilidad como antiinflamatorio. El EOC contiene 14 compuestos volátiles (incluido el ß-cariofileno: 51,52%) con un HLB requerido de 11. La relación Tensioactivo: EOC: Agua de 13:15:75 (%, p:p:p) produjo la formulación óptima (tamaño de partícula: 94,47 nm).. La nanoemulsión cargada con EOC presentó un comportamiento pseudoplástico/tixotrópico con una excelente estabilidad en almacenamiento durante 6 meses. El efecto antiinflamatorio de la nanoemulsión fue más potente que el del EOC y estadísticamente igual al diclofenaco (50 mg/kg). La nanoemulsión cargada con COE no mostró toxicidad aguda oral (en ratones) a 2000 mg/kg; por lo tanto, se considera un producto no tóxico. El desarrollo de la nanoemulsión cargada con EOC agregó valor tanto al COR como al EOC al proporcionar una formulación adecuada que podría usarse como un producto antiinflamatorio.

Epidemiological, clinical and immune factors that influence the persistence of antiphospholipid antibodies in leprosy

Abstract Introduction: Antiphospholipid antibodies (aPL) are described in individuals with leprosy without the clinical features of antiphospholipid antibody syndrome (APS), a condition involving thromboembolic phenomena. We have described the persistence of these antibodies for over 5 years in patients with leprosy after specific treatment. Objectives: To determine whether epidemiological, clinical and immunological factors played a role in the longterm persistence of aPL antibodies in leprosy patients after multidrug therapy (MDT) had finished. Methods: The study sample consisted of 38 patients with a diagnosis of leprosy being followed up at the Dermatology and Venereology Outpatient Department at the Alfredo da Matta Foundation (FUAM) in Manaus, AM. ELISA was used to detect anticardiolipin (aCL) and anti-β2 glycoprotein I (anti-β2GPI) antibodies. Patients were reassessed on average of 5 years after specific treatment for the disease (MDT) had been completed. Results: Persistence of aPL antibodies among the 38 leprosy patients was 84% (32/38), and all had the IgM isotype. Mean age was 48.1 ± 15.9 years, and 23 (72.0%) were male. The lepromatous form (LL) of leprosy was the most common (n = 16, 50%). Reactional episodes were observed in three patients (9.4%). Eighteen (47.37%) were still taking medication (prednisone and/or thalidomide). Mean IgM levels were 64 U/mL for aCL and 62 U/mL for anti-β2GPI. In the multivariate binary logistic regression the following variables showed a significant association: age (p = 0.045, OR = 0.91 and CI 95% 0.82-0.98), LL clinical presention (p = 0.034; OR = 0.02 and CI 95% = 0.0-0.76) and bacterial index (p = 0.044; OR = 2.74 and CI 95% = 1.03-7.33). We did not find association between prednisone or thalidomide doses and positivity for aPL (p = 0.504 and p = 0.670, respectively). No differences in the variables vascular thrombosis, pregnancy morbidity, diabetes, smoking and alcoholism were found between aPL-positive and aPL-negative patients. Conclusion: Persistence of positivity for aPL antibodies was influenced by age, clinical presentation and bacterial index. However, further studies are needed to elucidate the reason for this persistence, the role played by aPL antibodies in the disease and the B cell lineages responsible for generation of these antibodies.

Headache-related disability among medical students in Amazon: a cross-sectional study / Incapacidade relacionada à cefaleia em estudantes de medicina no Amazonas: um estudo transversal

ABSTRACT Objective To evaluate the prevalence of headache in medical students, and quantify the degree of disability through HIT-6 and MIDAS scale. Method The criteria established by International Headache Society were used and the HIT-6 and MIDAS, to asses disability. Results 140 medical students from UFAM were evaluated. 16.43% cases of migraine headache, 6.43% of probable migraine, and 23.57% of tension headaches were detected. 6.42% reported an absence of headache; and another 11.42% had secondary headache. According to the HIT-6 questionnaire, in 7.14% and 18.57% of the students, headaches were classified as having substantial to severe impact, respectively. Conclusion Migraine and probable migraine had higher scores than the other types of headache and, therefore, led to higher levels of disability. The present study did not find a significant correlation between student semester, age or extracurricular activities on the impact generated by headache.

RESUMO Objetivo Avaliar a prevalência de cefaleia em estudantes médicos e quantificar o grau de incapacidade através das escalas HIT-6 e MIDAS. Método Os critérios da Sociedade Internacional de Cefaleia foram usados e as escalas Hit-6 e MIDAS foram usadas para medir a incapacidade. Resultados 140 estudantes de medicina da UFAM foram avaliados. 16.43% eram migrânea, 6.43% de provável migrânea e 23.57% de cefaleia tipo tensional. 6,42% relataram ausência de cefaleia e 11.42% possuíam cefaleia secundária. De acordo com o questionário HIT-6 em 7,14% e 18,57% dos estudantes, a cefaleia foram classificadas como impacto substancial e grave respectivamente. Conclusão Migrânea e provável migrânea tiveram escores mais elevados do que os outros tipos de cefaleia e maiores níveis de incapacidade. O estudo não encontrou uma associação significante entre o período de graduação, idade ou das atividades extracurriculares com o impacto gerado pela cefaleia.

Sepse: diagnóstico e tratamento / Sepsis: diagnosis and treatment

JUSTIFICATIVA E OBJETIVOS: A sepse é um importante problema de saúde no Brasil, incluindo serviços públicos e privados, com altos custos de tratamento e mortalidade. Desde 2003, a Campanha Sobrevivendo a Sepse vem sugerindo a implementação de medidas para o tratamento desta condição mórbida, de modo a reduzir sua mortalidade em 25%. O objetivo deste estudo foi contextualizar a atividade do emergencista no tratamento da sepse, bem como revisar os principais aspectos da epidemiologia da sepse no Brasil e seus tratamentos com base na Campanha Sobrevivendo a Sepse. CONTEÚDO: Utilizando as palavras-chave sepse, Surviving Sepsis Campaign, epidemiologia, fisiopatologia foi procedida a busca de referências no PubMed, Scopus, SciElo. Na Campanha Sobrevivendo à Sepse, foi utilizado um sistema de notas para orientar a avaliação de qualidade e evidência de alta (A) a muito baixa (D) e, deste modo, determinar a força de recomendações. Neste artigo foram registradas estas recomendações como: recomendação forte [1] indica os efeitos desejáveis da intervenção claramente superiores aos seus efeitos indesejáveis, ou claramente não; recomendação fraca [2] indica que a distinção entre os efeitos desejáveis e indesejáveis é menos clara. CONCLUSÃO: O clinico e, sobretudo o clínico emergencista, exerce papel central no tratamento da sepse na medida em que novas evidencias demonstram que a precocidade do tratamento é peça-chave no sucesso do tratamento.

BACKGROUND AND OBJECTIVES: Sepsis remains an important international health problem including Brazil, with high treatment costs and unacceptable morbidity and mortality. Since 2003, the Sepsis Surviving Campaign was created and suggested guidelines for sepsis and the campaign objective is reducing sepsis mortality rate around 25%. In this aim this work reviews the most important aspects of sepsis diagnosis and treatment, especially in the emergencist physician context and abording Brazilian epidemiology aspects. CONTENTS: This overview was performed using sepsis, septic shock, Surviving Sepsis Campaign, sepsis epidemiology and fisiopathology as keywords in PubMed, Scopus and Scielo databases. In Surviving Sepsis Campaign, was used a grade system to guide assessment to quality and evidence from high (A) to very low (D) and, at this way, determine the strength of recommendations. In this article this recommendations was registered as a follow: strong recommendation [1] indicates the intervention?s desirable effects clearly outweigh its undesirable effects, or clearly do not; weak recommendations [2] indicate that the tradeoff between desirable and undesirable effects is less clear. CONCLUSION: Physicians, even emergence physicians, plays a central role in the modern management of sepsis and septic shock, across the golden hours of treatment, which ones new evidences demonstrate the importance of nearly approach of patient's results in sepsis mortality decrease

Heparin-antivenom association: differential neutralization effectiveness in Bothrops atrox and Bothrops erythromelas envenoming

Heparin, in some regions of Brazil has been used in the treatment of bothropic accidents, but the data found in the literature are inconclusive about its effectiveness. The venoms of Bothrops atrox and of B. erythromelas were characterized according to their biological activities. The capacity of heparin in neutralizing these activities was tested with doses of 3 and 6 IU in isolated form and associated to Antibothropic Serum (ABS). It was verified that heparin, in doses of 3 and 6 IU, was not effective in neutralizing the desfibrinating and edema-forming activities of B. atrox venom and the hemorrhagic and coagulant actions of both venoms. Heparin diminished the effectiveness of the ABS in the neutralization of the hemorrhagic and edema-forming activities of the B. atrox venom. However, heparin in the 6 IU dose was capable of neutralize the edema-forming of the B. erythromelas and increase the effectiveness of the ABS. Heparin also neutralized the phospholipasic A2 activity of B. atrox (14.3 percent) and B. erythromelas (28.0 percent) venoms. For B. erythromelas venom, the associated treatment, heparin and ABS, was more effective in the neutralization of its lethal activity