Total rupture of Achilles tendon induces inflammatory response and glial activation on the spinal cord of mice

Rupture of Achilles tendon is a common accident affecting professional and recreational athletes. Acute and chronic pain are symptoms commonly observed in patients with rupture. However, few studies have investigated whether Achilles tendon rupture is able to promote disorders in the central nervous system (CNS). Therefore, the current study aimed to evaluate nociceptive alterations and inflammatory response in the L5 lumbar segment of Balb/c mice spinal cord after Achilles tendon rupture. We found increased algesia in the paw of the ruptured group on the 7th and 14th days post-tenotomy compared with the control group. This phenomenon was accompanied by overexpression of cyclooxygenase-2 (COX-2) and inducible nitric oxide synthase-2 (NOS-2) as well as hyperactivation of astrocytes and microglia in nociceptive areas of L5 spinal cord as evidenced by intense GFAP and IBA-1 immunostaining, respectively. Biochemical studies also demonstrated increased levels of nitrite in the L5 spinal cord of tenotomized animals compared with the control group. Thus, we have demonstrated for the first time that total rupture of the Achilles tendon induced inflammatory response and nitrergic and glial activation in the CNS in the L5 spinal cord region.

Local treatment with ascorbic acid accelerates recovery of post-sutured Achilles tendon in male Wistar rats

Tendon rupture is a very frequent accident involving average people and high-performance athletes. Clinical studies describe tendon recovery as a painful and slow process involving different biochemical and histological events. Ascorbic acid (AA) is a potent antioxidant as well as an important cofactor for collagen synthesis. In the current study, we evaluated if local treatment with AA is able to promote tendon repair in tenotomized rats. Animals were submitted to Achilles tendon rupture followed by surgical suture. Control and AA groups received in loco injection of saline solution (0.9% NaCl) and 30 mM AA, respectively. Histological and functional recovery of Achilles tendon tissue was evaluated at 7, 14, and 21 days post-surgery. Hematoxylin/eosin staining and collagen fluorescence analysis showed intense disarrangement of tendon tissue in the saline group. Tenotomized animals also showed hypercellularity in tendon tissue compared with non-tenotomized animals. The Achilles functional index (AFI) showed a significant decrease of tendon functionality in tenotomized animals at 7, 14, and 21 days post-surgery. AA accelerated tissue organization and the recovery of function of the Achilles tendons. The beneficial effect of AA treatment was also observed in the organization of the collagen network. Data presented in the current work showed that in loco treatment with AA accelerated the recovery of injured Achilles tendon post-surgery.

Análises das embalagens de plantas medicinais comercializadas em farmácias e drogarias do município de Ijuí/RS / Analyses of the packages of medicinal plants sold in pharmacies in the city of Ijuí - RS, Brazil

RESUMO: O objetivo deste estudo foi analisar as embalagens de plantas medicinais comercializadas em farmácias e drogarias do município de Ijuí/RS, a partir das legislações vigentes sobre o tema. A coleta de dados foi realizada na primeira quinzena do mês de dezembro de 2011 em 13 estabelecimentos farmacêuticos localizados na região central do município, através de formulário elaborado a partir da legislação. Foram selecionadas para análise, plantas medicinais acondicionadas em diferentes tipos de embalagens e marcas. Foram avaliadas 44 embalagens de plantas medicinais, das quais 71% estavam irregulares no que se refere a indicação terapêutica e ao modo de preparo, considerando o preconizado pela RDC 10/10. Embora nem todas as drogas vegetais analisadas estivessem notificadas nesta Resolução, considerou-se o mesmo critério para todas as amostras analisadas. Além disso, 16% dos produtos analisados não apresentavam segurança quanto ao acondicionamento. A nomenclatura popular estava presente em todas as amostras, enquanto a nomenclatura botânica em apenas 75%. Conclui-se que todas as embalagens analisadas apresentaram alguma irregularidade em relação ao que estabelece a RDC nº10/2010, tendo em vista que nenhuma apresentou todos os requisitos exigidos por ela. Os resultados observados demonstram que a ausência das informações devidas nas embalagens ou nos folhetos informativos para orientar os consumidores, pode comprometer o uso seguro das plantas e prejudicar a saúde dos usuários.

ABSTRACT: This study aimed to analyze the packages of medicinal plants sold in pharmacies and drugstores in the city of Ijuí, state of Rio Grande do Sul, Brazil, according to the Brazilian legislation about the subject. Data collection was conducted in December 2011 in 13 selected pharmaceutical establishments located downtown, and data were collected using a form prepared from the aforementioned resolution. The medicinal plants included in the analysis were from different types of packages and brands. We evaluated 44 packages of medicinal plants, of which 71% were irregular in relation to shape, therapeutic indication and method of preparation. Moreover, 16% of the total products tested had no package security. The popular nomenclature was present in all samples, while the botanical nomenclature, in 75%. We concluded that all analyzed packages were irregular according to the Brazilian RDC 10/2010 because none of them had all of the requirements. The results observed, such as lack of information on the packages or leaflets to guide consumers, may compromise the safe use of plants and endanger the health of users.

Therapeutic concentration of morphine reduces oxidative stress in glioma cell line

Morphine is a potent analgesic opioid used extensively for pain treatment. During the last decade, global consumption grew more than 4-fold. However, molecular mechanisms elicited by morphine are not totally understood. Thus, a growing literature indicates that there are additional actions to the analgesic effect. Previous studies about morphine and oxidative stress are controversial and used concentrations outside the range of clinical practice. Therefore, in this study, we hypothesized that a therapeutic concentration of morphine (1 μM) would show a protective effect in a traditional model of oxidative stress. We exposed the C6 glioma cell line to hydrogen peroxide (H2O2) and/or morphine for 24 h and evaluated cell viability, lipid peroxidation, and levels of sulfhydryl groups (an indicator of the redox state of the cell). Morphine did not prevent the decrease in cell viability provoked by H2O2 but partially prevented lipid peroxidation caused by 0.0025% H2O2 (a concentration allowing more than 90% cell viability). Interestingly, this opioid did not alter the increased levels of sulfhydryl groups produced by exposure to 0.0025% H2O2, opening the possibility that alternative molecular mechanisms (a direct scavenging activity or the inhibition of NAPDH oxidase) may explain the protective effect registered in the lipid peroxidation assay. Our results demonstrate, for the first time, that morphine in usual analgesic doses may contribute to minimizing oxidative stress in cells of glial origin. This study supports the importance of employing concentrations similar to those used in clinical practice for a better approximation between experimental models and the clinical setting.

A combined enrichment/polymerase chain reaction based method for the routine screening of Streptococcus agalactiae in pregnant women

Group B Streptococcus (GBS) is the most common cause of life-threatening infection in neonates. Guidelines from CDC recommend universal screening of pregnant women for rectovaginal GBS colonization. The objective of this study was to compare the performance of a combined enrichment/PCR based method targeting the atr gene in relation to culture using enrichment with selective broth medium (standard method) to identify the presence of GBS in pregnant women. Rectovaginal GBS samples from women at ¡Ý36 weeks of pregnancy were obtained with a swab and analyzed by the two methods. A total of 89 samples were evaluated. The prevalence of positive results for GBS detection was considerable higher when assessed by the combined enrichment/PCR method than with the standard method (35.9% versus 22.5%, respectively). The results demonstrated that the use of selective enrichment broth followed by PCR targeting the atr gene is a highly sensitive, specific and accurate test for GBS screening in pregnant women, allowing the detection of the bacteria even in lightly colonized patients. This PCR methodology may provide a useful diagnostic tool for GBS detection and contributes for a more accurate and effective intrapartum antibiotic and lower newborn mortality and morbidity.

Análise das prescrições de medicamentos usados no tratamento da obesidade dispensadas em drogaria no município de Ijuí- RS / Analysis of prescriptions for medicines to treat obesity dispensed in a pharmacy in the city of Ijuí (RS, Brazil)

Uma prescrição é um documento que deve permitir a interlocução entre prescritor, dispensador e usuário em prol do uso correto e racional de medicamentos, para tanto, precisa cumprir alguns requisitos. O objetivo deste estudo foi verificar o cumprimento de alguns dos aspectos legais nas prescrições/notificações de medicamentos usados no tratamento da obesidade aviadas numa drogaria no município de Ijuí/RS e discutir sua repercussão na dispensação e utilização destes medicamentos. Foram analisadas 80 prescrições, onde as principais informações ausentes foram endereço do usuário (95%), prescrição do medicamento pela DCB (80%), forma farmacêutica (67%), posologia (13,75%) e data da emissão (15%). Entre elas destacou-se a ausência da posologia, que pode levar a administração de uma dose ineficaz do medicamento, desencadeando reações adversas ou diminuindo o resultado esperado. Os resultados apontam um conjunto de riscos relacionados a terapia medicamentosa da obesidade, indicando a necessidade de reavaliação da conduta de todos os sujeitos envolvidos no processo: usuários, prescritores, dipensadores e órgãos fiscalizadores. Destaca-se a importância da educação continuada de prescritores e dispensadores frente aos aspectos éticos que norteiam a prescrição e dispensação de medicamentos, principalmente quando se trata de medicamentos sujeitos a controle especial que devem servir de suporte para uma terapia que vai além do uso de medicamentos.

A prescription is a document that should enable a dialogue between prescriber, dispenser and user, conducive to the correct and rational use of medicines. To that end, the prescription must fulfill certain requirements. The objective of this study was to check compliance with some aspects of the law in prescriptions for medicines used to treat obesity, dispensed in the city of Ijuí, and to discuss the repercussions on the dispensing and use of these medicines. We analyzed80 prescriptions, in which the most frequently omitted items were the user?s address (95%), prescription of medication by Brazilian Common Name (BCN) (80%), pharmaceutical form (67%), dosage (13.75%) and date of issue (15%). Of particular concern is the absence of the dosage, which could lead to the administration of an inappropriate dose of the medicine, triggering adverse reactions or diminishing the expected effect. The results point to a set of risks related to the medical treatment of obesity, indicating a need to reassess the conduct of all the participants in the process: users, prescribers, dispensers and regulatory bodies. The study highlights the importance of continuing education of prescribers and dispensers in the light of ethical issues that should guide the prescribing and dispensing of medicines, especially those subject to special control, which should be used to support a therapy that goes beyond medication.

Perfil da prescrição e dispensação de antibióticos para crianças em uma Unidade Básica de Saúde (UBS) no município de Ijuí-RS / Prescription profile and dispensing of antibiotics for children in a Primary Health Center in the city ofIjuí (RS, Brazil)

Os hábitos prescritivos e o processo de dispensação de medicamentos são determinantes para o uso racional de antibióticos. Com o objetivo de descrever o perfil de prescrição e dispensação de antibióticos usados por crianças, foram analisadas 100 prescrições pediátricas que continham antibióticos aviadas em uma Unidade Básica de Saúde do município de Ijuí/RS de abril a dezembro de 2009. Observou-se prevalência de meninas (53%) com idades entre quatro e seis anos (39%) e que receberam prescrição de azitromicina (45%) e amoxicilina (40%). Verificou-se em média 3,5±8,71 medicamentos por prescrição devido à associação de analgésicos, anti-inflamatórios, antitérmicos e antialérgicos aos antibióticos prescritos. Nenhuma prescrição apresentou todos os itens avaliados: o endereço do usuário e advertências sobre o uso dos medicamentos prescritos não foram encontrados nas prescrições analisadas e apenas 5% estavam legíveis. Já posologia, denominação genérica, nome completo do usuário e dados do prescritor foram verificados em todas as prescrições. Sugere-se a qualificação das equipes de saúde a fim de atuarem nos processos de prescrição e dispensação de medicamentos e implantarem ações educativas sobre uso, guarda e descarte de antibióticos junto aos usuários. O acompanhamento farmacoterapêutico pode ser uma estratégia efetiva para prevenir resistência microbiana e reações adversas a antibióticos.

Prescribing habits and the process of dispensing medicines are determining factors for the rational use of antibiotics. With the objective of describing the profile of antibiotic prescription and dispensing for children, 100 pediatric prescriptions containing antibiotics, issued at a district Primary Health Center in the city of Ijuí, from April to December 2009, were analysed. There was a prevalence of girls (53%), aged between four and six years (39%), who were prescribed azithromycin (45%) and amoxicillin (40%). The mean number of medicines per prescription was 3.5±8.71, owing to the combination of analgesic, anti-inflammatory, antipyretic and anti-allergy drugs with the antibiotics prescribed. Not one prescription included all the items assessed: the patient?s address and warnings about the use of prescribed medications were not found in the prescriptions analyzed and only 5% were legible. On the other hand, dosage, generic name, full name of the user and the prescriber data were found in all prescriptions. It is suggested that health teams be qualified to work in the processes of prescription and dispensing of medicines and to conduct educational activities on the use, storage and disposal of antibiotics among the users. Pharmacotherapeutic follow-up can be an effective strategy to prevent bacterial resistance and adverse reactions to antibiotics.

Adesão ao tratamento medicamentoso pelos portadores de Diabetes Mellitus atendidos em uma Unidade Básica de Saúde no município de Ijuí/RS: um estudo exploratório / Adherence to medical treatment in patients with diabetes mellitus attended at a Public Health Unit in the city of Ijuí (RS, Brazil): an exploratory study

Atualmente, é indiscutível a contribuição dos diferentes tratamentos farmacológicos prescritos em associação às medidas não farmacológicas, visando o manejo ou a cura de doenças e melhorando a qualidade de vida de portadores de problemas crônicos, além de diminuir gastos com saúde. O presente estudo teve por objetivo verificar a adesão da terapia medicamentosa em diabéticos atendidos na Unidade Básica de Saúde (UBS), localizada no bairro Modelo do município de Ijuí-RS. A coleta de dados foi realizada entre agosto e outubro de 2009 e a pesquisa foi aprovada pelo Comitê de Ética e Pesquisa (CEP) da UNIJUÍ. Tendo em vista características dos voluntários da pesquisa e fatores que podem influenciar no uso correto dos medicamentos, verificou-se elevada adesão ao tratamento medicamentoso, o que provavelmente está relacionado ao trabalho desenvolvido pela equipe da UBS. Foi possível perceber também que os encontros mensais e o acompanhamento dos profissionais de saúde foram úteis na redução de erros e/ou descuidos com os medicamentos, reduzindo os efeitos indesejáveis e a evolução da doença.

Nowadays, there is no doubt that various medicine-based treatments, prescribed in association with non-pharmacological measures, with the aim of managing or curing diseases, improve the quality of life of patients with chronic conditions and can even reduce medical costs. The present study was carried out to determine the adherence of patients with diabetes to drug therapy prescribed at a Public Health Unit located in the Modelo district of the city of Ijuí (RS, Brazil). Data collection was conducted from August to October 2009, the study having been approved by the Ethics and Research Committee of UNIJUÍ. Considering the characteristics of the research volunteers and factors that could influence the correct use of medicine or interfere with adherence, there was a high rate of compliance to medical treatment, which is probably related to the teamwork practiced at the Health Unit. It was also noticeable that the monthly meetings and monitoring of health professionals helped to reduce errors and/or oversights in the medication, reducing side effects and slowing the progression of the disease.

A prática da automedicação por funcionários de uma Instituição de Ensino Superior portadores de enxaqueca / Practice of self-medication of migraine by employees at a higher education institution

O objetivo desta pesquisa foi identificar, na prática de automedicação, possíveis interações medicamentosas e descrever o perfil dos funcionários portadores de enxaqueca de uma Instituição de Ensino Superior localizada no município de Ijuí-RS. Este estudo foi aprovado pelo Comitê de Ética em Pesquisa da UNIJUI. Após a busca dos enxaquecosos, foi aplicado um questionário padronizado com perguntas acerca da patologia. Foram entrevistados, com consentimento, 32 indivíduos, sendo que a maioria (31-97%) tinha idade entre 30 e 39 anos (37,5%), pele branca (94%), eram casados (59%) e, no caso das mulheres, 71% (22) apresentavam ciclo menstrual regular e 55% (17) usavam anticoncepcional oral. Dentre os fatores desencadeantes da enxaqueca, os mais citados foram alguns tipos de alimentos, seguidos do estresse e fatores hormonais associados ao ciclo menstrual. Trinta (93,75%) voluntários praticavam automedicação, sendo que todos faziam uso de analgésicos e associações de fármacos. Portanto, verifica-se uma relação entre a patologia e a automedicação. Foram observadas 15 interações medicamentosas diferentes. Vinte (62,5%) indivíduos foram expostos a, pelo menos, uma interação decorrente da automedicação, ao consumo de medicamentos crônicos prescritos, a álcool e a cigarros. Nesse sentido, cabe ao profissional farmacêutico auxiliar o portador de enxaqueca no reconhecimento dos fatores desencadeantes desse problema para promover o uso racional de medicamentos e incentivar a automedicação responsável.

The aim of this study was to describe the profile of migraine-sufferers employed at a higher education institution located in the town of Ijuí (RS, Brazil) and identify possible drug interactions resulting from the self-medication practiced by those patients. After an active search for migraine patients, a standard questionnaire was used to enquire about their condition and themselves. The study was approved by the Research and Ethics Committee at UNIJUI. Thirty-two consenting adults were interviewed, most of whom (31, 97%) were aged between 30 and 39 years (37.5%), of white skin (94%) and married (59%), while among the women, 71% (22) had a regular menstrual cycle and 55% (17) used an oral contraceptive. Among migraine-triggering factors, most subjects cited specific foods, followed by stress and hormonal factors associated with the menstrual cycle. Thirty (93.75%) volunteers practiced self-medication, all of them making use of analgesics and combinations of drugs, showing that there was a relation between this condition and self-medication. The results revealed 15 different drug interactions. Twenty (62.5%) subjects were exposed to at least one interaction arising from self-medication, chronic prescribed drug use, alcohol and cigarettes. Accordingly, it is up to the pharmaceutical professional to help the migraine patient to recognize triggering factors, to promote the rational use of medicines and encourage responsible self-medication.

Utilização de medicamentos e risco de interações medicamentosas em idosos atendidos pelo Programa de Atenção ao Idoso da Unijuí / Use of medications and risk of drug interactions in the elderly population at the Elderly Care Program in Unijuí

Idosos utilizam elevado número de medicamentos, apresentando alto potencial para desenvolver interações medicamentosas. Objetivou-se verificar o perfil de utilização de medicamentos e conhecer possíveis interações medicamentosas em idosos acompanhados pelo Programa de Atenção ao Idoso (PAI) da Unijuí. Os dados foram coletados em julho de 2009. Classificaramse os medicamentos no sistema Anatomical Therapeutic Chemical e possibilidades de interações segundo Drug Interaction Facts. De março/2008 até julho/2009 o PAI atendeu 31 idosos, estando 16 em acompanhamento, os quais apresentaram média de 78,4 ± 6,8 anos e utilizaram 83 medicamentos, com média de 5,2 ± 3,7/ idoso. Os fármacos mais prevalentes foram os que atuam no aparelho cardiovascular, no sistema nervoso e para o trato alimentar e metabolismo. Verificaram-se 36 possíveis interações entre 9 pacientes, com média de 4/idoso. O fármaco mais envolvido foi digoxina. Quanto a classificação, 4 apresentaram nível de significância 1, dez nível 2, cinco nível 3, sete nível 4 e dez nível 5. O número de possíveis interações verificadas foi expressivo, entretanto nem todos os idosos apresentarão reações relacionadas às interações, mas apresentaram o risco. Portanto, é importante que prescritores conheçam a influência de um fármaco sobre outro. Seria necessário treinamento intensivo para intervenção farmacêutica, sendo o relacionamento com o médico indispensável.

Elderly people take a large number of medicines, entailing a high risk of developing drug interactions. The aim was to study the profile of medicines prescribed and the possible drug interactions in the public Elderly Care Program (PAI) run at Unijuí, a university in south Brazil. The data were collected in July 2009. The Anatomical Therapeutic Chemical (ATC) Classification System was used to classify medicines, while the potential interactions were classified with the aid of Drug Interaction Facts. Between March 2008 and July 2008, the PAI attended 31 elderly patients, of whom 16 were monitored, with a mean age of 78.4 ± 6.8 years. This group received 83 medicines, making an average of 5.2 ± 3.7 medicines/patient. The most prevalent drugs were those acting on the cardiovascular system, nervous system, digestive tract and metabolism. There were 36 possible interactions in 9 patients, an average of 4 interactions per patient. The drug most frequently involved was digoxin. The interactions were classified as follows: 4 at level 1, 10 at level 2, 5 at level 3, 7 at level 4 and 10 at level 5. This number of possible interactions is considerable; although not all elderly patients show the effects of the drug interactions, they do run the risk. Therefore, it is highly important that prescribers are familiar with the drug interactions. For the pharmacist to help the patient, intensive training for pharmaceutical intervention and a good relationship with the doctor are indispensable.

Farmácia caseira e descarte de medicamentos no bairro Luiz Fogliatto do município de Ijuí - RS / Home storage and disposal of medicines in the LuizFogliatto Neighborhood of Ijuí city (RS, Brazil)

O objetivo do estudo foi determinar a prevalência da farmácia caseira, conhecer os medicamentos que a compõem, os locais destinados ao armazenamento e descarte. Realizou-se estudo transversal junto a famílias do bairro Luiz Fogliatto, Ijuí, RS, cadastradas na Unidade Básica de Saúde deste bairro. As entrevistas foram realizadas nos domicílios de junho a agosto de 2008. Dentre 640 famílias, foram visitadas 321, das quais 91,59% possuíam medicamentos em casa. Encontraram-se 1.234 medicamentos, com predomínio dos atuantes no sistema nervoso (27,28%). A cozinha foi o principal local de armazenamento. Foram encontrados medicamentos vencidos em 17 residências, predominando o descarte no lixo (56,87%). Não foi encontrada legislação que regulamente o descarte de medicamentos em nível domiciliar. O conhecimento quanto ao tema abordado ainda é restrito e impede sua adequada organização em nível domiciliar. O farmacêutico deve orientar quanto ao armazenamento e descarte, capacitando os Agentes Comunitários de Saúde, visando evitar a exposição da população a riscos, assim como a contaminação do meio ambiente.

The aim of this study was to determine the prevalence of household stocks of medicine, to know which medicines are stocked in the home and the places where they are stored and discarded. A cross-sectional survey was conducted with families from the Luiz Fogliatto neighborhood of Ijuí city (RS), registered at the neighborhood Health Service clinic. The interviews were carried out at home in June to August, 2008. There are 640 families in the neighborhood and 321 were visited, of which 91.59% had some medicines at home. In all, 1234 medicines were found, mostly those that act on the nervous system (27.28%). The kitchen was the main place used to store medicines. Expired medicines were found in 17 residences, and the main disposal route was in the common garbage (56.87%). No legislation was found that regulates the disposal of household medicines. Knowledge on storage and disposal of medicines is restricted and does not suffice for its proper organization at home. The pharmacist should educate the patient about storage and disposal and capacitate Community Health Agents, in order to avoid exposure of the public to risks, as well as contamination of the environment.