Patentes, acesso e produção local de medicamentos: reflexões a partir de experiências no SUS / Patents, access, and local production of medicines: reflections from experiences in the SUS

Resumo Este artigo procurou contribuir para a literatura e para o debate nacional e global sobre a superação de uma polarização relacionada ao aspecto jurídico e administrativo do processo de inovação, procurando se concentrar nas patentes como um fator condicionante das trajetórias tecnológicas que viabilizam o aprendizado em âmbito produtivo. Baseou-se em um arcabouço teórico e político relacionado à inovação e ao acesso a medicamentos, especialmente quanto aos direitos de Propriedade Intelectual, e na análise crítico-reflexiva de instrumentos de Propriedade Intelectual utilizados em Parcerias para o Desenvolvimento Produtivo (PDP), desenvolvidas por um instituto de tecnologia em fármacos sintéticos, público e nacional. Os resultados demonstram a relevância da compatibilização dos direitos de patentes com a construção de uma capacidade tecnológica e de inovação no país, vinculada ao acesso universal, especialmente quando envolverem produtos que se destinam ao tratamento de doenças graves, de alta complexidade tecnológica e de alto custo. Conclui-se que, para superação da dependência tecnológica e ampliação do acesso a medicamentos no Brasil, o Estado deve buscar o equilíbrio entre os interesses públicos e privados na área da saúde, a articulação entre os instrumentos jurídicos legais existentes e o alinhamento entre suas políticas de saúde, industriais, de CT&I e Propriedade intelectual.

Abstract This article aims to contribute to the literature and to the national and global debate on overcoming the polarization related to the legal and administrative aspect of the innovation process, seeking to focus on patents as a conditioning factor of the technological trajectories that enable learning in the productive scope. It was based on a theoretical and political framework related to innovation and access to medicines, especially regarding Intellectual Property rights, and on a critical-reflexive analysis of Intellectual Property instruments used in Productive Development Partnerships (PDP), developed by a public national institute for synthetic drug technology. The results demonstrate the importance of making patent rights compatible with the construction of technological and innovation capacities in the country, which are linked to universal access, especially when they involve products that are intended to treat serious, technologically complex and high-cost diseases. In conclusion, to overcome technological dependence and expand access to medicines in Brazil, the State must seek a balance between public and private interests in the healthcare area, articulate the existing legal instruments and align its health, industry, ST&I and intellectual property policies.

Estratégias de inovação em medicamentos e vacinas no âmbito do Ceis - modelos, mecanismos e expectativas / Innovation strategies in medicines and vaccines within the scope of CEIS - models, mechanisms, and expectations

RESUMO O artigo objetivou apresentar informações relevantes e originais sobre as estratégias de inovação utilizadas por Laboratórios Farmacêuticos Oficiais (LFO) para redução das vulnerabilidades do Sistema Único de Saúde (SUS) e capacitação produtiva e tecnológica do Complexo Econômico-Industrial da Saúde. Como métodos, foram utilizadas a revisão da literatura e a análise de dados primários oriundos de entrevistas realizadas em dois dos maiores LFO do País. Foram identificados e analisados os seus esforços e resultados em Pesquisa e Desenvolvimento (P&D) assim como a incorporação de tecnologias de medicamentos e vacinas, com destaque para as Parcerias para Desenvolvimento Produtivo (PDP). Conclui-se que, apesar de as atividades de P&D ainda precisarem avançar, benefícios foram trazidos pelos acordos de transferência de tecnologia, especialmente pelas PDP. No entanto, a capacidade industrial e tecnológica dos Institutos ainda é limitada e carente de investimentos, dificultando a acumulação e a difusão tecnológica. Dessa forma, melhorias são necessárias para que as estratégias de inovação para o SUS apresentem resultados mais efetivos e possam ser revertidos para o bem-estar da sociedade.

ABSTRACT The article aimed to present relevant and original information about the innovation strategies used by Official Pharmaceutical Laboratories (LFO) to reduce the vulnerabilities of the Brazilian Unified Health System (SUS) and the productive and technological capacity of the Health Economic-Industrial Complex. The methods used included a literature review and the analysis of primary data from interviews conducted in two of the largest LFOs in the country. Their efforts and results in Research and Development (R&D) and incorporation of medicines and vaccine technologies were identified and analyzed, with emphasis on Productive Development Partnerships (PDP). Although R&D activities still need to advance, benefits were brought about by technology transfer agreements, especially by PDPs. However, the industrial and technological capacity of the Institutes is still limited and lacks investments, which hinders technological accumulation and diffusion. Thus, improvements are necessary so that the innovation strategies for the SUS present more effective results and can be reversed to the welfare of society.

Caracterización de la identidad digital en estudiantes chilenos de ciencias de la salud. Un estudio de caso según género / Self-discrepancy and compulsive buying in Chilean university students

Resumen El consumo se ha instaurado en las sociedades posmodernas como un medio regulador de las relaciones sociales. En este contexto, la compra compulsiva se establece como patológica y genera un malestar psicológico significativo en las personas, al punto de deteriorar el funcionamiento social y profesional. A esto se suman graves problemas económicos como producto del endeudamiento. Bajo este escenario, los jóvenes son particularmente sensibles, ya que con el consumo acceden a objetos simbólicos que forman parte de su construcción de identidad. Una dimensión relacionada con la compra compulsiva y el acceso al consumo bajo elementos simbólicos es la discrepancia del yo, la cual establece la distancia entre quién soy y quién me gustaría ser de acuerdo a patrones sociales que motivan el consumo como extensión del sujeto y materialización de la propia identidad. En base a lo anterior, la presente investigación tiene por objetivo determinar el efecto de la discrepancia del yo sobre las actitudes hacia la compra compulsiva en estudiantes universitarios chilenos. A través de una regresión lineal múltiple se aprecia que la discrepancia del yo físico (belleza), económico y el sexo son predictores significativos de la compra compulsiva. De igual manera, se observa que las mujeres son un grupo con mayores puntuaciones en cuanto a las compras compulsivas que los hombres, las cuales pueden verse mayormente afectadas por el contexto, y las campañas de marketing pueden influir en una mayor brecha entre el yo real y el yo ideal.

Abstract Consumption has been established in postmodern societies as a means of regulating social relations. In this context, compulsive buying could be established as pathological, creating significant psychological discomfort in people, to the point of impairing social and professional functioning, coupled with serious economic problems resulting from indebtedness. Along the same lines, in the construction of a social identity and a socially shared reality, consumption patterns arise that are linked to what the public should be and what they want to be. Therefore, while compulsive buying has been conceptualized for decades, it is a substantial threat to psychological and financial well-being. Few studies have explored the link between self-discrepancy and compulsive buying within an identity construction context. In this scenario, it is young people who become particularly sensitive, since with consumption they access symbolic objects that are part of their identity construction and a dimension related to compulsive buying. Therefore, it can be hypothesized that access to the consumption of symbolic elements is self-discrepancy. That is why this research aims at determining the effect of the self-discrepancy on attitudes towards compulsive buying in Chilean university students. The study uses a quantitative, correlational, and non-experimental cross-sectional design. Study sample was comprised of 1 229 Chilean university students, who responded to the scale of attitudes towards consumption, the self-discrepancy scale, and answered questions for sociodemographic characterization including: gender (male/female), age, geographical area of residence (rural/urban), people with whom they live, and whether they have any bank credit cards. Prior to data collection, a letter was sent to Faculty Deans and Program Directors of all the universities associated with the Council of Rectors of Chile; these letters described the aims of the study, and requested information and authorization for the distribution of the instrument previously described. It is important to indicate that, after this, a random sampling process was initiated, after which each participant was contacted, so that they could sign an informed consent form, thus ensuring the anonymity ethical guidelines of the study. The data was processed through SPSS version 22 software, looking for the presence of univariate and multivariate outliers through Z-scores and Mahalanobis distance. A descriptive analysis of the variables was then carried out based on the dispersion, central trend and shape measurements. Subsequently, the data was analysed through bivariate statistics through Pearson correlations, to indicate into empirical relationships between compulsive purchase as a dependent variable and sociodemographic variables (sex and bank credit card holding) and the dimensions associated with the self-discrepancy (intellectual, physical, physical beauty, personal, social, emotional and economic) as independent variables. Once the behaviour of the variables was observed, a hierarchical multiple linear regression was performed. Regarding the results of this research, multiple linear regression shows that physical self-discrepancy (beauty), economic self-discrepancy and gender are significant predictors of compulsive buying. Similarly, it is noted that women are a group with higher scores in terms of compulsive purchases than men, which may be mostly affected by the context, where marketing campaigns can influence a greater gap between the real self and the ideal self.

Efecto del Endeudamiento Estudiantil en Salud Mental y Bienestar Subjetivo de Estudiantes de Educación Superior de Chile / Effect of Student Debt on Mental Health and Subjective Well-being on Chilean University Students

Resumen Objetivo: Identificar en qué medida la salud mental y bienestar subjetivo son predichas por el endeudamiento por motivos de estudio en estudiantes universitarios de la ciudad de Temuco, Chile. Método: Una muestra no probabilística de 151 estudiantes universitarios de quinto año o superior de su respectiva carrera universitaria respondió a medidas de salud mental (DASS-21), de bienestar subjetivo (satisfacción con la vida y felicidad subjetiva), y del nivel de endeudamiento asumido para financiar sus estudios universitarios. Los análisis incluyeron regresiones lineales múltiples jerárquicas donde se incluyeron como variables independientes la variable género en un primer paso y el endeudamiento por créditos universitarios en el segundo paso. En cada regresión se incluyó un factor de salud mental y de bienestar subjetivo como variable dependiente. Resultados: Resultados indican que el endeudamiento por motivos de estudio predice significativa- mente satisfacción con la vida (F(2, 148) = 5,95, p = 0,003, R2Adjusted = 0,06; β =-0,16, p = 0,049), pero no predice felicidad subjetiva (p = n.s.) (factores de bienestar subjetivo), sintomatología depresiva (p = n.s.), ansiosa (p = n.s.), ni estrés (p = n.s.) (factores de salud mental). Conclusión: Resultados del estudio sugieren que los estudiantes universitarios pudieran percibir el endeudamiento estudiantil como una inversión hacia el futuro lo que pudiera operar como un factor protector de su salud mental y bienestar subjetivo.

Abstract Objective: To evaluate if debt due to university loans predicts mental health and subjective well-being in university students of Temuco, Chile. Method: A non-probabilistic sample of 151 last-year university students completed measures of mental health (DASS-21), of subjective well-being (satisfaction with life, and subjective happiness), and debt levels due to student loans. Analyses included hierarchical multiple linear regressions where gender was entered in a first step and debt due to university loans on a second step as independent variables. Each regression considered a factor of mental health or a factor of subjective well-being as the dependent variable. Results: Results show that debt due to university loans predict predicts satisfaction with life (F(2, 148) = 5,95, p = 0,003, R2Adjusted = 0,06; β =-0,16, p = 0,049), but not subjective happiness (p = n.s.) (factors of subjective well-being), nor symptoms of depression (p = n.s.), anxiety (p = n.s.), or stress (p = n.s.) (factors of mental health). Conclusion: Results of this study suggest that university students may perceive student debt as an investment which may act as a protective factor of their mental health and subjective well-being.

Impacto en la morbilidad de la técnica quirúrgica abierta vs cerrada en cáncer de colon. Un reporte de 6 años de un centro único / Impact on morbidity of the open vs closed surgical technique in colon cancer.A 6-Year single-center study

Introducción: La cirugía laparoscópica es una alternativa segura para el tratamiento en el cáncer de colon y además permite todas las ventajas de un procedimiento de mínima invasión. El objetivo de la presente investigación fue medir el impacto en la morbilidad de la técnica quirúrgica abierta vs cerrada en cáncer de colon. Metodología: El estudio se realizó en el Hospital Solón Espinosa Ayala, en Quito-Ecuador, período marzo del 2012 hasta marzo del 2017, con una muestra no probabilística, se incluyeron pacientes mayores de edad, con cáncer de colon. Se incluyen variables socio-demográficas, histología, días de hospitalización, sangrado quirúrgico, tiempo quirúrgico, estancia hospitalaria, márgenes quirúrgicos, ganglios reseca-dos, inicio de dieta, % de conversión quirúrgica, complicación quirúrgica, recidiva, morbilidad quirúrgica, mortalidad quirúrgica. Se utiliza estadística descriptiva univariada y bivariada.Resultados: Se analizan 85casos, 52 casos se realizaron cirugía abierta y 33 casos se realizaron cirugía laparoscópica.La conversión quirúrgica fue 75% por adherencias y 25% por infiltración a duodeno. El tiempo quirúrgico similar 121 a 180 minutos 61%. Complicaciones laparoscópicas 2,3% y 9,4% abierta (colecciones pélvicas y fistulas intestinales 2.4% vs 1.7%). La desnutrición no presentó relación. Inicio de dieta 2 a4 días 83% laparoscópica y 67% abierta. Hospitalización de 4 a 8 días fue laparoscópica 87% y abierta 78%. Pérdida sanguínea menor a 100cc fue laparoscópicas 82%, y abiertas 60%. La resección de ganglios (+13) en laparoscopía 69.6% y abierta 68.1%. El margen proximal de pieza quirúrgica por laparoscopía 5.1 a 10cm (43.5%), por abierta (55.3%), la recaída tumoral del 56.2%y 52.3%. El estado vital por laparoscopía fue fallecido 12.5%, y abierta 28.8%, en relación a su enfermedad tumoral Conclusión: Las comorbilidades quirúrgicas y recuperación fueron menores por laparoscopía, pero la cirugía abierta mostro mejores resultados anatomopatológicos post quirúrgicos

Introduction:Laparoscopic surgery is a safe alternative for colon cancer treatment and allows all the advantages of a minimally invasive procedure. The objective of the present investigation was to measure the impact on morbidity of the open vs. closed surgical technique in colon cancer.Methodology: The study was carried out at the Solón Espinosa Ayala Hospital, in Quito-Ecuador, from March 2012 to March 2017, with a non-probabilistic sample, including elderly patients with colon cancer. Socio-demographic variables, histology, days of hospitalization, surgical bleeding, surgical time, hospital stay, surgical margins, resected lymph nodes, the start of the diet, % surgical conversion, surgical com-plication, recurrence, surgical morbidity, and surgical mortality are included. Univariate and bivariate de-scriptive statistics are used.Results: 85 cases are analyzed; 52 underwent open surgery, and 33 underwent laparoscopic surgery. The surgical conversion was 75% due to adhesions and 25% due to duodenal infiltration. The similar surgical time is 121 to 180 minutes 61%. Laparoscopic complications 2.3% and 9.4% open (pelvic col-lections and intestinal fistulas 2.4% vs 1.7%). Malnutrition was not related. Start of diet 2 to 4 days 83% laparoscopic and 67% open. Hospitalization from 4 to 8 days was laparoscopic 87% and open 78%. Blood loss less than 100cc was laparoscopic in 82% and opened in 60%. Lymph node resection (+13) in lapa-roscopy 69.6% and open 68.1%. The proximal margin of the surgical piece by laparoscopy is 5.1 to 10cm (43.5%), by open (55.3%), the tumor recurrenceof 56.2% and 52.3%. The mortality in laparoscopy surgery was 12.5%, and in open surgery was 28.8%.Conclusion: Laparoscopy's surgical comorbidities and recovery were lower, but open surgery showed better post-surgical pathological results

Desenvolvimento de novos medicamentos para doenças negligenciadas: uma análise bibliométrica / New drug development for neglected diseases: a bibliometric analysis / Desarrollo de nuevos fármacos para enfermedades desatendidas: un análisis bibliométrico

Doenças negligenciadas impõem um fardo humano, social e econômico devastador a mais de um bilhão de pessoas em todo o mundo. Embora existam ferramentas para controlar e até mesmo eliminar muitas dessas doenças, novos produtos terapêuticos precisam urgentemente ser desenvolvidos. Este artigo se baseia em um estudo que buscou quantificar e caracterizar a produção científica global sobre desenvolvimento de novos medicamentos para doenças negligenciadas, por meio de uma análise bibliométrica. De modo a investigar a pesquisa relacionada ao desenvolvimento de novos medicamentos para as doenças negligenciadas em âmbito global na última década, foi utilizada a base de dados Scopus. Observou-se aumento da produção de conhecimento sobre o tema, com relevante participação de autores, instituições e financiamento brasileiros, sobretudo de instituições públicas. Contudo, os esforços realizados têm sido insuficientes, sendo necessária a implementação de estratégias futuras de pesquisa e de financiamento que propiciem maior produção científica e uma tradução da pesquisa básica para a prática clínica.

Neglected diseases impose a devastating human, social, and economic burden on more than one billion people worldwide. While tools exist to control and even eliminate many of these diseases, new therapeutic products urgently need to be developed. This article is based on a study that sought to quantify and characterize the global scientific production on new drug development for neglected diseases through a bibliometric analysis. The Scopus database was used to investigate the research related to the development of new drugs for neglected diseases globally in the last decade. An increase in the production of knowledge about the theme and the relevant participation of Brazilian authors, institutions and funding, especially from public institutions were observed. However, their efforts have been insufficient, and the implementation of future research and funding strategies that provide greater scientific production and a translation of basic research into clinical practice is necessary.

Las enfermedades desatendidas imponen una carga humana, social y económica devastadora a más de mil millones de personas en todo el mundo. A pesar de haber herramientas para controlar y incluso eliminar muchas de estas enfermedades, es necesario desarrollar con urgencia nuevos productos terapéuticos. Este artículo se basa en un estudio lo cual ha buscado cuantificar y caracterizar la producción científica global sobre el desarrollo de nuevos fármacos para enfermedades desatendidas, a través de un análisis bibliométrico. Para inspeccionar investigaciones relacionadas con el desarrollo de nuevos medicamentos para enfermedades desatendidas en ámbito mundial durante la última década se utilizó la base de datos Scopus. Hubo un aumento de la producción de conocimiento sobre el tema, con una participación relevante de autores, instituciones y financiamiento brasileños, especialmente de instituciones públicas. Sin embargo, los esfuerzos realizados siguen siendo insuficientes, requiriendo la implementación de futuras estrategias de investigación y financiamiento que propicien una mayor producción científica y una traducción de la investigación básica a la práctica clínica.

O papel dos produtores públicos de medicamentos e ações estratégicas na pandemia da Covid-19 / The role of public producers of medicines and strategic actions in the Covid-19 pandemic

RESUMO Na pandemia da Covid-19, os laboratórios farmacêuticos públicos adquiriram maior visibilidade em consequência de suas iniciativas para enfrentamento da doença e manutenção dos diversos programas da assistência farmacêutica. O artigo objetivou analisar as atividades cotidianas desses laboratórios durante a pandemia, a fim de compreender seu caráter estratégico para o Sistema Único de Saúde (SUS), destacando os Institutos Butantan, Bio-Manguinhos e Farmanguinhos, haja vista o protagonismo em relação a vacinas e medicamentos. Mediante estudo de caso múltiplo, com abordagem qualitativa-descritiva, apresentou dados que indicam a mudança de perfil que vêm demonstrando nas últimas décadas. Identificaram-se as ações de maior relevância no enfrentamento da pandemia, tendo, como data de corte, julho de 2021. Como resultados, trouxe informações atuais sobre suas atividades e produtos, estágio das Parcerias para Desenvolvimento Produtivo, quadro funcional, fragilidades (internas e externas) e desafios atuais. Conclui-se pela importância dessas instituições do Estado para a garantia do acesso universal do SUS e desenvolvimento e produção de medicamentos e produtos de saúde essenciais, envolvendo desde os mais básicos até os de maior complexidade e valor agregado. Destarte, identifica-se a necessidade de uma agenda de mudanças, visando sustentabilidade em longo prazo e ampliação da contribuição para fortalecimento do Complexo Econômico-Industrial da Saúde.

ABSTRACT In the Covid-19 pandemic, public pharmaceutical laboratories gained greater visibility because of their initiatives to fight the disease and maintain the various pharmaceutical assistance programs. The article aimed to analyze their daily activities during the pandemic, to understand their strategic character for the Unified Health System (SUS), highlighting the Butantan, Bio-Manguinhos, and Farmanguinhos Institutes, given their leading role in relation to vaccines and medicines, respectively. Through a multiple case study, with a qualitative-descriptive approach, it presented data that indicate the change in profile that has been demonstrated in recent decades. The most relevant actions in combating the pandemic were identified, with the cut-off date of July 2021. As a result, it brought current information about its activities and products, stage of the Partnerships for Productive Development, staff, weaknesses (internal and external), and current challenges. It is concluded that these State Institutions are important to guarantee universal access to the SUS and the development and production of essential medicines and health products, ranging from the most basic to those with greater complexity and added value. Thus, the need for an agenda of changes is identified, aiming at long-term sustainability and expanding the contribution to strengthen the Economic-Industrial Health Complex.

HPLC-DAD analysis, antifungal and antioxidant activity of Solanum dolichosepalum bitter extracts and fractions

Abstract Solanum dolichosepalum is a plant with anti-infective effects. It is a healing agent and has ethnopharmacological uses. In this study, the antifungal activity of extracts and fractions of this species on C. albicans and F. oxysporum was evaluated. The antioxidant activity was measured using the ABTS and DPPH methods, and by determining the total content of phenolic compounds. An HPLC-DAD qualitative analysis was carried out to identify phenolic compounds and alkaloids. Pearson's correlation coefficients were calculated. Inhibitory effects were found in all the extracts and fractions on the analyzed microorganisms. F. oxysporum was the microorganism most sensitive to the action of S. dolichosepalum extracts. All extracts and fractions showed antioxidant activity, with the acetone extract and the acetone fraction being those that generated the best results. The content of total phenolic compounds showed that acetone has a greater affinity with the phenolic compounds present in S. dolichosepalum. In this plant, p-Hydroxybenzoic, vanillic, ferulic, trans-cinnamic, caffeic, p-coumaric, and rosmarinic acids were found, as well as theobromine, quercetin, and luteolin. The content of total phenolic compounds was determined to be directly proportional to the inhibition of the ABTS and DPPH radicals, and the inhibition of the analyzed microorganisms. It was determined that the extracts and fractions obtained from S. dolichosepalum show antioxidant and antifungal activity.

Perceptions of self-medication of the population, during the covid-19 pandemic in Peru / Percepciones de automedicación de la población durante la pandemia covid-19 en Perú

Background: Describe characteristics of self-medication of the population, in the context of the COVID 19 pandemic. Material and Methods: We carried out a cross-sectional survey with students in a major public Peruvian university. We measured perception of self-medication of the population, as well as characteristics, consequences, and associated factors. Results: A total of 274 students of Pharmacy and biochemistry filled in the questionnaire, 80.3% of which reported to know someone that self-medicated during the COVID-19 pandemic. 98.9 % of surveyed participants considered that the current pandemic increased self-medication practices in the population and that it occurred more frequently when people have symptoms associated with COVID-19 (65.4%). The medicines most frequently used were ivermectin (79.2%), azithromycin (71.2%) and hydroxychloroquine (38.7%). Conclusion: According to the surveyed participants, self-medication has increased in the general population during the COVID-19 pandemic. Strategies to prevent these practices are needed, as they could delay adequate medical care.

Introducción: Describir las características de la automedicación de la población, en el contexto de la pandemia de COVID 19. Material y Metodos: Realizamos una encuesta transversal con estudiantes de una importante universidad pública peruana. Se midió la percepción de la automedicación de la población, así como características, consecuencias y factores asociados. Resultados: Completaron el cuestionario un total de 274 estudiantes de Farmacia y Bioquímica, de los cuales el 80,3% refirió conocer a alguien que se automedicó durante la pandemia de COVID-19. El 98,9% de los encuestados consideró que la pandemia actual aumentó las prácticas de automedicación en la población y que se presentó con mayor frecuencia cuando las personas presentan síntomas asociados al COVID-19 (65,4%). Los medicamentos más utilizados fueron ivermectina (79,2%), azitromicina (71,2%) e hidroxicloroquina (38,7%). Conclusión: Según los participantes encuestados, la automedicación ha aumentado en la población general durante la pandemia de COVID-19. Se necesitan estrategias para prevenir estas prácticas, ya que podrían retrasar la atención médica adecuada.

Queratoquiste odontogénico: características diagnósticas y tratamiento quirúrgico conservador / Odontogenic keratocyst: diagnostic characteristics and coservative surgical treatment

El queratoquiste es una lesión odontogénica benigna de comportamiento agresivo, que deriva probablemente de la lámina dental. Se localiza frecuentemente en la parte posterior del hueso mandibular en la zona del tercer molar, ángulo mandibular y puede progresar hacia la rama y el cuerpo, presentando una asociación directa con órganos dentales retenidos. Existe una amplia variedad de técnicas para el tratamiento de esta lesión, como pueden ser descompresión, marsupialización, enucleación y la resección en bloque, así como también la combinación de estas con métodos coadyuvantes. El interés en esta lesión radica por su elevado índice de recidiva que se estima en un 20-30% en la población en general, sin embargo, en la actualidad se ha optado por el uso de tratamientos conservadores como la marsupialización y la descompresión que han demostrado una mayor efectividad y menor recidiva. Es por esto que tras el tratamiento de las lesiones es importante dar un seguimiento a largo plazo. El objetivo de la publicación es presentar el reporte de un caso clínico de un paciente masculino de 21 años con un diagnóstico de queratoquiste odontogénico tratado con una técnica de descompresión durante cinco meses para su posterior enucleación quirúrgica.Se ha comprobado que el tratamiento de descompresión seguido de enucleación y acompañado de métodos coadyuvantes resulta un manejo terapéutico adecuado para los queratoquistes por demostrar su menor tasa de recidiva y su comportamiento noble con estructuras vitales vecinas. Sin embargo, en todos los casos se debe realizar un seguimiento periódico para prevenir la recurrencia de la lesión.

Introduction: Keratocyst is a benign odontogenic lesion with aggressive behavior, probably derived from the dental lamina. It is frequently located in the posterior part of the mandibular bone in the area of the third molar, mandibular angle and can progress towards the ramus and the body, presenting a direct association with retained dental organs. There is a wide variety of techniques for the treatment of this lesion, such as decompression, marsupialization, enucleation, and en bloc resection, as well as the combination of these with adjuvant methods. The interest in this lesion stems from its high recurrence rate, which is estimated to be 20-30% in the general population, however, at present the use of conservative treatments such as marsupialization and decompression has been chosen. demonstrated greater effectiveness and less recurrence. This is why after treating the lesions it is important to give a long-term follow-up.The objective of the publication is to present the report of a clinical case of a 21-year-old male patient with a diagnosis of odontogenic keratocyst treated with a decompression technique for five months for subsequent surgical enucleation.Conclusion: It has been proven that decompression treatment followed by enucleation and accompanied by adjuvant methods is an adequate therapeutic management for keratocysts as it demonstrates its lower rate of recurrence and its noble behavior with neighboring vital structures. However, in all cases, regular monitoring should be carried out to prevent recurrence of the lesion

Vulnerabilidades das indústrias nacionais de medicamentos e produtos biotecnológicos no contexto da pandemia de COVID-19 / Vulnerabilities of Brazil's domestic pharmaceutical and biotech industry in the context of the COVID-19 pandemic / Vulnerabilidades de las industrias nacionales de medicamentos y productos biotecnológicos en el contexto de la pandemia de COVID-19

Resumo: Em tempos de pandemia, a vulnerabilidade econômica, tecnológica e dos sistemas de saúde fica ainda mais exposta. No Brasil, os maiores desafios são o controle do déficit da balança comercial e a dificuldade de acesso a medicamentos e produtos da saúde ou até mesmo de seu desenvolvimento. A forte dependência externa de insumos e produtos para a saúde é um dos fatores negativos do país no enfrentamento da emergência sanitária mundial ocasionada pelo novo coronavírus SARS-CoV-2. Nesse contexto, o artigo procurou discutir as vulnerabilidades do subsistema de base química e biotecnológica nacional diante da atual pandemia, tendo como foco a indústria de medicamentos e de produtos biotecnológicos e a articulação entre os campos da saúde e da economia política. Realizou-se pesquisa qualitativa, utilizando, como procedimentos metodológicos, revisão bibliográfica e análise de dados secundários. Os resultados encontrados, relacionados a baixo investimento em saúde pública, baixa capacidade de inovação, perfil da indústria farmacêutica, dependência externa, política cambial, patentes, entre outros, demonstram a grande fragilidade inovativa e tecnológica da indústria de medicamentos e produtos biotecnológicos e a essencialidade de articulação entre diversos campos, em especial, da saúde e da economia, para incorporação de uma visão sistêmica, que crie condições para redução das vulnerabilidades, no que tange ao enfrentamento da pandemia, e equacione um projeto de desenvolvimento para o país.

Abstract: During a pandemic, economic, technological, and health systems' vulnerability become even more evident. A key challenge in Brazil is to control the trade deficit and difficulty in access to medicines and health products, even their development. Brazil's heavy external dependency on health inputs and products is one of the negative factors in confronting the global health emergency caused by SARS-CoV-2. The article aimed to discuss the vulnerabilities of the domestic chemical and biotechnological subsystem in the face of the current pandemic, with a focus on the pharmaceutical and biotech industry and the linkage between the fields of health and political economics. A qualitative study was performed with a literature review and analysis of secondary data as the methodological procedures. The results revealed low investment in public health, low innovation capacity, the pharmaceutical industry's profile, external dependency, currency exchange policy, patents, and other factors, demonstrating the major vulnerability in innovation and technology in the domestic pharmaceutical and biotech industry and the essential nature of linkage between various fields, especially health and the economy, for the incorporation of a systemic vision that creates the conditions to reduce vulnerabilities in the response to the pandemic and promote a development project for the country.

Resumen: En tiempos de pandemia, la vulnerabilidad económica, tecnológica y de los sistemas de salud queda aún más expuesta. En Brasil, uno de los mayores desafíos es el control del déficit de la balanza comercial, así como la dificultad de acceso a medicamentos y produtos de salud o incluso de su desarrollo. La fuerte dependencia externa de insumos y productos para la salud es uno de los factores negativos del país en el combate a la emergencia sanitaria mundial, ocasionada por el nuevo coronavirus SARS-CoV-2. En este contexto, el artículo procuró discutir las vulnerabilidades del subsistema de base química y biotecnológica nacional ante la actual pandemia, poniendo el foco en la industria de medicamentos y de productos biotecnológicos, así como la coordinación entre los campos de la salud y economía política. Se realizó una investigación cualitativa, utilizando como procedimientos metodológicos la revisión bibliográfica y el análisis de datos secundarios. Los resultados hallados, relacionados con la baja inversión en salud pública, baja capacidad de innovación, perfil de la industria farmacéutica, dependencia externa, política de cambio, patentes, entre otros, demuestra la gran fragilidad innovadora y tecnológica de la industria de medicamentos, así como de productos biotecnológicos, y la necesidad de una coordinación entre diversas áreas, en especial, de la salud y economía, para que se incorpore una visión sistémica, que cree condiciones para la reducción de las vulnerabilidades, en lo que atañe al combate de la pandemia y que cree un proyecto equilibrado de desarrollo para el país.

Healthcare telemonitoring and business dynamics: challenges and opportunities for SUS / Telemonitoramento e a dinâmica empresarial em saúde: desafios e oportunidades para o SUS

ABSTRACT OBJECTIVE To point out challenges and opportunities for the Brazilian Unified Health System (SUS) with the use of telemonitoring to face the increasing costs of non-communicable chronic diseases, based on its general panorama in Brazil, business dynamics and reapplication of data from American studies. METHODS Quali-quantitative approach with exploratory research. The field work focused on the analysis of the national market from private companies, since no experiences or studies related to this theme were identified in the SUS. To analyze the panorama and market dynamics, we investigated the offer of this technology based on the products and services available and their demand by reference hospitals the ten largest private health plan companies. To support the central discussion, we analyzed the reduction of costs with hospital admissions by the SUS due to chronic non-communicable diseases sensitive to telemonitoring (HCDST), using data from Datasus and some American studies from the MEDLINE/PubMed database. RESULTS Although in the embryonic phase, business agents search for new business opportunities, whereas public initiatives for the use of telemonitoring in collective health seem inexistent. The reapplication of U.S. data would reduce spending on HCDST and provide benefits, such as the reduction in emergency room care, acute hospitalizations, readmissions and home care time, among others, which point to even greater economic gains. CONCLUSIONS The development of a major project to reduce HCDST using this technology has the potential to advance in a comprehensive network of primary care, contribute to a greater dynamism of the national productive and innovative base and induce innovations along the chain of this emerging industry.

RESUMO OBJETIVO Apontar desafios e oportunidades para o Sistema Único de Saúde (SUS) com o uso do telemonitoramento para enfrentar o aumento crescente dos custos com as doenças crônicas não transmissíveis, a partir do seu panorama geral no Brasil, dinâmica empresarial e reaplicação de dados de estudos americanos. MÉTODOS Este trabalho se enquadra na abordagem quali-quantitativa com pesquisa do tipo exploratória, e o trabalho de campo se concentrou na análise do mercado nacional a partir das empresas privadas, pois não se identificaram experiências ou estudos relacionados a esse tema no SUS. Para análise do panorama e da dinâmica do mercado, investigou-se a oferta a partir dos produtos e serviços disponíveis e a demanda por meio dos hospitais de referência, bem como as dez maiores empresas de planos de saúde privados. Para subsidiar a discussão central deste estudo, analisou-se a redução de custos com as internações hospitalares pelo SUS decorrentes das doenças crônicas não transmissíveis mais impactadas pelo telemonitoramento (IDCST), utilizando-se dados do Datasus e de alguns estudos americanos da base de dados MEDLINE/PubMed. RESULTADOS Embora em fase embrionária, os agentes empresariais se posicionam na busca por novas oportunidades de negócios, enquanto na saúde coletiva não há aparentemente iniciativas públicas para o uso do telemonitoramento. A reaplicação dos dados estadunidenses implicaria uma redução significativa nos gastos com IDCST pelo SUS, sem considerar outros benefícios, tais como a redução nos atendimentos nas salas de emergência, internações agudas, reinternações e tempo de cuidados domiciliares, entre outros, que apontam para ganhos econômicos ainda superiores com o uso do telemonitoramento. CONCLUSÕES O desenvolvimento de um grande projeto para a redução das IDCST a partir dessa tecnologia tem potencial para avançar em uma rede integral de atenção básica, contribuir para uma maior dinamização da base produtiva e inovativa nacional e induzir inovações em toda a cadeia dessa indústria emergente.

Trends in cancer incidence and mortality over three decades in Quito - Ecuador / Tendencias en incidencia y mortalidad por cáncer durante tres decadas en Quito - Ecuador

Abstract Introduction: The National Registry of Tumors has collected, processed, analyzed and regularly disseminated information on new cases of cancer diagnosed in the city of Quito, Ecuador over the last three decades. Aim: This article analyzed the trend of cancer incidence and mortality rates for the period 1985-2013. Methods: Incidence and mortality rates standardized by age were estimated by the direct method, using the world standard population. Analysis of the time trends, from selected locations, the joinpoint regression was used. Results: A decrease in the incidence and mortality rates of cervical and stomach cancers were documented. There was an increase in breast and colorectal cancer rates. The increase of the incidence rate of thyroid cancer in women was notorious. Lung cancer also increased in women while in men their values remained stable. Conclusion: There are important variations in the evolution of cancer in Quito; the information presented is an instrument for monitoring and evaluating the interventions that are developed in the Country.

Resumen Introducción: El Registro Nacional de Tumores ha recolectado, procesado, analizado y divulgado regularmente la información de los casos nuevos de cáncer diagnosticados en la ciudad de Quito, Ecuador durante las últimas tres décadas. Objetivo: Analizar la tendencia de las tasas de incidencia y mortalidad por cáncer durante el periodo 1985-2013. Métodos: Se estimaron las tasas de incidencia y mortalidad estandarizadas por edad a través del método directo, utilizando la población estándar mundial. Para el análisis de la tendencia de las tasas, de localizaciones seleccionadas, se utilizó la regresión joinpoint. Resultados: Se documentó un descenso de las tasas de incidencia y mortalidad de los tipos de cáncer de cuello uterino y estómago. Existe incremento de las tasas de cánceres de mama y colon-recto. Es notorio el crecimiento de la tasa de incidencia de cáncer de tiroides en mujeres. El cáncer de pulmón se incrementó en las mujeres en tanto que en los varones sus valores se mantuvieron estables. Conclusión: Se evidencian importantes variaciones en la evolución del cáncer en Quito, la información presentada constituye un instrumento para el seguimiento y evaluación de las intervenciones que se desarrollen.

Vulnerabilidade do SUS em relação à variação cambial: análise da dinâmica de importações de medicamentos e equipamentos de saúde entre 1996 e 2014 / SUS vulnerability regarding exchange rate variation: Analysis of the dynamics of drugs and health equipment import between 1996 and 2014

RESUMO Este artigo tem como objetivo verificar a vulnerabilidade do Sistema Único de Saúde ante a influência das variações cambiais sobre a dinâmica de importação de medicamentos e equipamentos médicos de 1996 a 2014. A hipótese que orientou o trabalho é que as condições externas e a política econômica, expressas nas taxas de câmbio, afetam a dinâmica de produção e inovação do Complexo Econômico-Industrial da Saúde. Conclui que a elasticidade da relação entre variação cambial e importação dos segmentos estudados foi relativizada no período, consideradas as mudanças ocorridas. Este resultado sugere a importância de desenhar modelos econômicos que incorporem essas variáveis.

ABSTRACT This article is aimed at determining the vulnerability of the Unified Health System when subject to the influence of exchange rates variations on the dynamics of drugs and medical equipment import from 1996 to 2014. The hypothesis that guided this work is that external conditions and economics policies expressed in exchange rates do affect the dynamics of both production and innovation of the Economic-Industrial Complex of Health. It comes to the conclusion that, considering changes that took place, the elasticity of the relationship between import and exchange rate of the segments analyzed herein was not so heavily affected over the period. This result suggests the importance of designing economic models that incorporate those variables.

Características emprendedoras personales y alfabetización económica: Una comparación entre estudiantes universitarios del sur de Chile / Personal entreprenuerial characteristics and economic literacy: A comparision between university students of southern Chile

El objetivo de la investigación que se informa fue comparar las características emprendedoras personales y la alfabetización económica en estudiantes de dos facultades de una universidad pública ubicada en el sur de Chile. El diseño fue cuantitativo, no experimental, con un alcance descriptivo comparativo. Se aplicaron el Test de Características Emprendedoras Personales (PECs) y el Test de Alfabetización Económica para Adultos (TAE-A) a 200 estudiantes de las facultades de Ingeniería, Ciencias y Administración (FICA) y de Educación, Ciencias Sociales y Humanidades (FESCH). En primer lugar se realizó un análisis factorial exploratorio del Test PECs, para luego caracterizar los niveles de alfabetización económica y comparar los resultados de ambas escalas y sus dimensiones entre los estudiantes de ambas facultades. Los resultados sugieren una nueva estructura de nueve dimensiones para el PECs. Ambas facultades muestran un bajo nivel de alfabetización económica, y al compararlas se encontró que los estudiantes de FICA presentan puntuaciones más elevadas en las siguientes dimensiones del Test PECs: anticipación del riesgo, persistencia y confianza, autoexigencia y calidad, búsqueda de control y excelencia, propositividad y previsión del futuro. De manera similar, estos estudiantes también obtuvieron puntuaciones más elevadas en la dimensión de Economía Internacional del TAE-A. Los resultados permiten concluir la necesidad de hacer una revisión del Test PECs antes de administrarlo en entornos profesionales, como así también revisar los planes de estudios de carreras universitarias cuyo objetivo explícito es la formación de profesionales emprendedores, de tal manera que incorporen de manera efectiva contenidos y competencias vinculadas al emprendimiento y a la alfabetización económica.

Entrepreneurship is defined as the capacity to detect and act upon economic opportunities in the environment, to gain an individual or collective benefit. Interest in this subject has led to relate this construct with individual and social variables. However, few studies have focused on the characteristics of entrepreneurs and their level of knowledge about the economic world, known as economic literacy. This is relevant given that entrepreneurship cannot be solely understood from the concept of opportunity or the traits of the entrepreneur, and instead these elements must be understood in their interaction. From this point of view, economic literacy is fundamental. Understanding the economic world allows the entrepreneur to better manage resources and projects and to take informed decisions about daily economic problems. Following principles from Economic Psychology, this research aims to compare the personal entrepreneurial characteristics and the economic literacy of Chilean university students of two faculties. The design of this study is quantitative, non-experimental, with a descriptive scope. The Test of Entrepreneurial Personal Characteristics (PECs) and the Test of Economic Literacy for Adults (TAE-A) and was answered by 200 students from the faculties of Engineering, Science and Management (FICA) and Education, Social Sciences and Humanities (FESCH). A convenience sample was chosen, which comprised 57.5% men and 42.5% women, with a mean age of 22 years. The test PECs measures 10 dimensions, related to the three basic elements of entrepreneurship: innovation, risk-taking and proactivity. The TAE-A measures knowledge on General Economy, Microeconomics, Macroeconomics and International Economy. An exploratory factor analysis was conducted over the PECs Test, and a following Student's t Test to compare the scores between students from both faculties. The exploratory factor analysis of the test PECs suggests a new nine-dimensional structure for the Chilean student population, thus changing the original structure and categories of the test. Both faculties showed a low level of economic knowledge. When comparing both faculties in the PECs test, significant differences were found in six out the nine dimensions, that is, the FICA students presented significantly higher scores for the following personal entrepreneurial characteristics: Risk anticipation, Persistence and confidence, Self-demand and quality, Search for control and excellence, Propositivity and Foresight. Similarly, FICA students had higher levels of economic knowledge of International Economy, although no significant differences were found when comparing the overall performance on economic literacy. Neither faculty reached the degree of economic literacy expected for this education level. This should be a cause of concern because previous research asserts that a deficit in economic literacy in adults puts them at risk of compulsive economic behavior, consumerism, overspending and debt. In conclusion, although the emergent structure of the PECs test may be useful, a confirmatory factor analysis and further studies of its psychometric properties are suggested for its use in research and assessment of interventions on entrepreneurship in university populations. These results highlight the importance of strengthening economic literacy and the promotion of entrepreneurial personal characteristics, as part of the personal and professional development of university students with emphasis on those careers that are explicitly linked to entrepreneurship. Limitations of the study are the convenience sampling method used and the lack of exploration of other sources of economic knowledge outside academia and also, the design and scope of this study does not allow to conclude if the differences found are due to the learning inside the university context or if students with different profiles are drawn to different careers and faculties. Drawing from both findings and limitations, suggestions for future research in the subject of economic literacy and entrepreneurship and related issues are outlined.

Neurological complications and death in children with dengue virus infection: report of two cases

Background Dengue virus infection can have different complications; the best known is hemorrhagic dengue fever. However, other effects such as neurological disorders may endanger the lives of patients. Dengue neurological manifestations can be confused with encephalitis symptoms and can lead to cerebral edema and death. Therefore, we consider important in the endemic areas to take into account the diagnosis of dengue encephalitis in patients with neurological disorders, and to request the determination of serology in cerebrospinal fluid for the NS1 antigen test. Case presentation We present the cases of two patients from the state of Morelos, Mexico, with 17 and 14 years of age. Both cases presented a rapid evolution characterized by fever, seizures and neurological deterioration secondary to severe cerebral edema that evolved to cerebral death in both cases. The diagnosis of brain death was confirmed by electroencephalogram in both patients. The two patients were submitted to serology for NS1 that tested positive in both cases. They died between the second and fifth day after admission. Conclusions Retrospective studies have found that up to 4% of the patients have dengue virus infections, which leads us to believe that in endemic areas, this infection should be suspected in cases of encephalic and febrile symptoms. RT-PCR should be performed to identify cases of encephalitis caused by the dengue virus, and early interventions should be performed to attempt to reduce the morbidity and mortality of these cases.(AU)

Neurological complications and death in children with dengue virus infection: report of two cases

Abstract Background Dengue virus infection can have different complications; the best known is hemorrhagic dengue fever. However, other effects such as neurological disorders may endanger the lives of patients. Dengue neurological manifestations can be confused with encephalitis symptoms and can lead to cerebral edema and death. Therefore, we consider important in the endemic areas to take into account the diagnosis of dengue encephalitis in patients with neurological disorders, and to request the determination of serology in cerebrospinal fluid for the NS1 antigen test. Case presentation We present the cases of two patients from the state of Morelos, Mexico, with 17 and 14 years of age. Both cases presented a rapid evolution characterized by fever, seizures and neurological deterioration secondary to severe cerebral edema that evolved to cerebral death in both cases. The diagnosis of brain death was confirmed by electroencephalogram in both patients. The two patients were submitted to serology for NS1 that tested positive in both cases. They died between the second and fifth day after admission. Conclusions Retrospective studies have found that up to 4% of the patients have dengue virus infections, which leads us to believe that in endemic areas, this infection should be suspected in cases of encephalic and febrile symptoms. RT-PCR should be performed to identify cases of encephalitis caused by the dengue virus, and early interventions should be performed to attempt to reduce the morbidity and mortality of these cases.

Telemedicine: challenges to dissemination in Brazil / Telemedicina: retos para su difusión en Brasil / Telemedicina: desafios à sua difusão no Brasil

Abstract: Telemedicine has been seen as an important tool for facing the challenges of universal health systems. The goal of this article is to discuss the main challenges to its full dissemination in Brazil. Being a somewhat new area, there are not many scientific papers that systematize it. This article is an exploratory paper, as it aims to provide an overall perspective on the subject. From an economic point of view, telemedicine is a strategic area due to its an intrinsic potential of being a source for generating innovation, for requiring and incorporating technological breakthroughs from other areas, and for its interdisciplinary nature and dynamic inter-relations that drive different industries. From the social perspective, it has the potential to make access to health services democratic, by connecting remote regions with health services located in hospitals and centers of reference for prevention, diagnosis and treatment.

Resumen: La telemedicina está siendo vista como una herramienta importante para enfrentarse a los desafíos de los sistemas de salud universales. El objetivo de este artículo fue discutir los principales desafíos para su plena diseminación en Brasil. En función del carácter relativamente emergente de este área, existe una escasez relativa de trabajos científicos que la sistematicen. Por ello, este artículo se encasilla en la categoría de trabajo exploratorio, ya que tiene por objetivo proporcionar una visión general sobre el tema. Se señala que, desde el punto de vista económico, la telemedicina constituye un área estratégica por su potencial intrínseco al ser fuente generadora de innovaciones, por demandar e incorporar avances tecnológicos oriundos de otras áreas y, en función de su naturaleza interdisciplinaria y de sus interrelaciones dinámicas, por la posibilidad de impulsar diferentes industrias. Desde el punto de vista social, tiene potencial de democratizar el acceso a los servicios de salud, integrando regiones remotas con servicios de salud localizados en hospitales y centros de referencia, en lo que atañe a la prevención, diagnóstico y tratamiento.

Resumo: A telemedicina está sendo vista como uma ferramenta importante para enfrentar os desafios dos sistemas de saúde universais. O objetivo deste artigo foi discutir os principais desafios para a sua plena disseminação no Brasil. Em função do caráter relativamente emergente desta área, existe uma escassez relativa de trabalhos científicos que a sistematizem. Por isso, este artigo se enquadra na categoria de trabalho exploratório, já que tem por objetivo proporcionar uma visão geral sobre o tema. Destaca-se, que do ponto de vista econômico, a telemedicina se constitui em uma área estratégica por seu potencial intrínseco de ser fonte geradora de inovações, por demandar e incorporar avanços tecnológicos oriundos de outras áreas e, em função da sua natureza interdisciplinar e de suas inter-relações dinâmicas, pela possibilidade de impulsionar diferentes indústrias. Do ponto de vista social, tem o potencial de democratizar o acesso aos serviços de saúde, integrando regiões remotas com serviços de saúde localizados em hospitais e centros de referência no que se refere à prevenção, diagnóstico e tratamento.

Aceite esencial de Thymus vulgaris L (tomillo), su combinación con EDTA contra Cándida albicans y formulación de una crema / Thymus vulgaris L (thyme) essential oil and its combination with EDTA against Candida albicans; formulation of a cream

El patógeno Cándida albicans puede causar infecciones invasivas graves y frecuentes lesiones superficiales. Los fármacos usados en el tratamiento presentan inconvenientes y es necesario buscar alternativas. Objetivos. Determinar la actividad del aceite esencial (AE) de Thymus vulgaris y de su combinación con EDTA sobre Cándida albicans, y formular una crema con el AE suplementado con derivados terpénicos naturales. Diseño. Estudio experimental in vitro y toxicidad in vivo. Lugar. Facultad de Medicina y Facultad de Farmacia y Bioquímica, Universidad Nacional Mayor de San Marcos, Lima, Perú. Material biológico. Cepa de Cándida albicans para las pruebas in vitro y conejos para la toxicidad dérmica. Métodos. La actividad antifúngica se determinó por el método de difusión en pozo de agar; la concentración inhibitoria mínima (CIM), por el método de microdilución en caldo. La crema se formuló con el AE al 1 por ciento y otra suplementada con carvacrol, timol, citral y EDTA. La toxicidad dérmica se determinó en conejos. Principales medidas de resultados. Halos de inhibición, CIM, signos de toxicidad. Resultados. El AE a 100 mg/mL inhibió el crecimiento de Cándida albicans con halos de inhibición de 30,33 ± 0,58 mm, mientras que la adición de EDTA produjo halos de 35,33 ± 0,58 mm. La CIM para el AE y AE + EDTA fue de 8 mg/mL y 0,5 mg/mL, respectivamente. La crema con AE 1 por ciento produjo halos de inhibición de 13,33 ± 0,58 mm, mientras que la adición de EDTA, timol, carvacrol y citral aumentó el halo hasta 24,33 ± 0,58 mm. No se evidenció signos de toxicidad dérmica en conejos. Conclusiones. El AE de Thymus vulgaris presentó actividad inhibitoria sobre Cándida albicans y el EDTA incrementó dicha actividad; asimismo, el aceite esencial, EDTA, carvacrol, timol y citral formulados en una crema mostraron efecto sinérgico y sin signos de toxicidad dérmica...

Candida albicans may cause severe invasive infections and frequently superficial lesions. Drugs used in treatment present drawbacks and search of alternatives becomes necessary. Objectives: To determine the activity of Thymus vulgaris essential oil (EO) alone and combined with EDTA on Candida albicans, and formulate a cream with EO supplemented with natural terpenes. Design: In vitro experimental and in vivo toxicity study. Setting: Faculty of Medicine and Faculty of Pharmacy, Universidad Nacional Mayor de San Marcos, Lima, Peru. Biological material:Candida albicans strain for in vitro study and rabbits for dermal toxicity tests. Methods:Antifungal activity was determined by agar well diffusion method, and minimum inhibitory concentration (MIC) by broth microdilution method. A cream was formulated with EO 1 per cent and another supplemented with carvacrol, thymol, citral and EDTA. Dermal toxicity in rabbits was determined. Main outcome measures: Inhibition halos, MIC, signs of toxicity. Results: EO at 100 mg/mL inhibited Candida albicans growth with 30.33 ± 0.58 mm inhibition halos; adding EDTA produced 35.33 ± 0.58 mm halos. MIC for EO and EO + EDTA was respectively 8 mg/mL and 0.5 mg/mL. EO 1 per cent cream originated 13.33 ± 0.58 mm inhibition halos, and addition of EDTA, thymol, carvacrol and citral increased halos to 24.33 ± 0.58 mm. No signs of dermal toxicity in rabbits were observed. Conclusions:Thymus vulgaris EO showed inhibitory activity against Candida albicans and EDTA increased this activity; essential oil, EDTA, carvacrol, thymol and citral formulated in cream also showed synergistic effect without evidence of dermal toxicity...