Local antibiotic delivery in periodontitis: drug release and its effect on supragingival biofilms.

The effect of a drug-delivery system containing antibacterial metronidazole (MDZ) prescribed for periodontitis on supragingival biofilm was evaluated, and possible interference by this biofilm in the drug release profile was investigated. Streptococcus mutans biofilms were grown and exposed to a controlled-release formulation of MDZ or the same formulation without MDZ (vehicle control). Untreated biofilms were used as a negative control (NC). Biofilms and culture medium (containing detached cells) were collected 24, 48, 72, and 96 h after first exposure to treatments. The biomass of the MDZ group was lower than that of the NC group at all times. Although MDZ yielded low drug-release rates in the presence of the biofilm, it was sufficient for reducing viability for 24 h and affecting bacterial metabolism for 48 h. These results suggest that MDZ appears to destabilize supragingival biofilm. This biofilm may interfere with MDZ release from the formulation.

Masticatory efficiency in class II and class III dentofacial deformities.

Masticatory efficiency may be impaired in individuals with dentofacial deformities. The objective of the present study was to determine the condition of masticatory efficiency in individuals with dentofacial deformities. 30 patients with class II (DG-II) and 35 patients with class III (DG-III) dentofacial deformity participated in the study, all had an indication for orthognathic surgery. 30 volunteers (CG) with no alterations of facial morphology or dental occlusion and with no signs or symptoms of temporomandibular joint dysfunction also participated. Masticatory efficiency was analysed using a bead system (colorimetric method). Each individual chewed 4 beads, one at a time, over 20s measured with a chronometer. The groups were compared in terms of masticatory efficiency using analysis of variance (ANOVA), with the level of significance set at P<0.05. Masticatory efficiency was significantly greater in CG (P<0.05) than in DG-II and DG-III in all chewing tasks tested, with no significant difference between DG-II and DG-III (P>0.05). It was observed that the presence of class II and class III dentofacial deformity affected masticatory efficiency compared to CG, although there was no difference between DG-II and DG-III.

Stability of microencapsulated B. lactis (BI 01) and L. acidophilus (LAC 4) by complex coacervation followed by spray drying.

Microcapsules containing Bifidobacterium lactis (BI 01) and Lactobacillus acidophilus (LAC 4) were produced by complex coacervation using a casein/pectin complex as the wall material, followed by spray drying. The aim of this study was to evaluate the resistance of these microorganisms when submitted to the spray drying process, a shelf-life of 120 days at 7-37 degrees C and the in vitro tolerance after being submitted to acid pH (pH 1.0 and 3.0) solutions besides morphology of microcapsules. Microencapsulated microorganisms were shown to be more resistant to acid conditions than free ones. Microencapsulated L. acidophilus maintained its viability for a longer storage period at both temperatures. The microcapsules presented a spherical shape with no fissures. The process used and the wall material were efficient in protecting the microorganisms under study against the spray drying process and simulated gastric juice; however, microencapsulated B. lactis lost its viability before the end of the storage time.

Development of topical functionalized formulations added with propolis extract: stability, cutaneous absorption and in vivo studies.

Propolis, which is a natural product widely consumed in the folk medicine, is a serious candidate to be applied topically due to its outstanding antioxidant properties. So, the purpose of this study was to develop stable topical formulations added with propolis extract in an attempt to prevent and/or treat the diseases occurring in skin caused by UV radiation. The antioxidant activity using a chemiluminescent method was used to evaluate the functional stability and the permeation/retention in skin of these formulations. In the long-term stability study, the formulations were stored at 25+/-2 degrees C/AH and at 40+/-2 degrees C/70% RH for 360 days. It was found in this study, that the formulations prepared with Polawax showed functional and physical stability in the period of study. In addition, this formulation presented good results in the percutaneous study, allowing the antioxidant compounds present in the propolis extract to reach lower layers in pig ear skin and in the whole hairless mice skin (retention=0.12 and 0.13 microL of propolis/g of skin, respectively). In the in vivo study, it was also suggested that this formulation may be effective in protecting skin from UVB photodamage, nevertheless other assays need to be done in order to have a complete understanding of the protective effect of formulations added with propolis extract.

Falsa laterização no EEG de escalpo na epilepsia mesial temporal mesial temporal por esclerose hipocampal: relato de casos / False lateralization on scalp EEG on mesial temporal epilepsy due to hippocampal sclerosis: cases report

A epilepsia do lobo temporal Mesial (ELMT) associada à esclerose hipocanpal(EH) necessita muitas vezes de tratamento cirúrgico. Para tanto, é necessário identificar um foco unilateral das crises. Na maioria das vezes, EH visualizada à RNM se correlaciona com a origem das descargas ao EEG de escalpo. Porém, em uma minoria, o registro de descargas colaterais ao lado da EH deixa dúvida quanto ao foco epileptogênico, cabendo aí uma investigação eletrofisiológica ivasiva, mais fidedigna. O objetivo é relatar três casos em que investigação inicial não confirmou a lateralidade das crises, ilustrando a falsa lateralização no EEG de escalpo na ELMT/EH. Como as descargas da EH provêm de regiões profundas do cérebro, estas poderiam se propagar para o lado contralateral antes de atingir a superfície. Por outro lado, é possível que o estímulo a longo prazo do lobo contralateral possa se transformar em uma área independente de crises (epileptogênese secundária), o que contra-indicaria a cirurgia.

Assistência farmacêutica como um modelo tecnológico em atenção primária à saúde / Pharmaceutical assistance as a technological model in healthcare

A Assistência Farmacêutica foi analisada neste artigo, como tecnologia em saúde. A amplitude dos procedimentos atribuídos à Assistência Farmacêutica conduz a uma diversidade de interpretações por parte dos gestores do sistema de saúde. A mais frequente é restringi-la à tecnologia de gestão. Apesar de sua importância, esta não deve ser dissociada da tecnologia do uso do medicamento, a qual exige amplo conhecimento clínico dos medicamentos, habilidade nas relações interpessoais e de comunicação com o interlocutor e está sujeita às condições do local de trabalho e do empregador. Para a implantação da Assistência Farmacêutica integral, é necessário um aprimoramento que possibilite a avaliação de seu impacto na qualidade de vida do usuário e na redução de custos para o sistema de saúde. No entanto, nas unidades de saúde básicas ou distritais, modelos tecnológicos de uso de medicamentos são difíceis de serem implantados e avaliados, devido em parte, às condições inerentes ao atendimento. Neste trabalho foi considerado o Programa de Saúde da Família como o ambiente propício para o desenvolvimento de modelos tecnológicos de uso do medicamento e avaliação de seu impacto, uma vez que este programa tem como estratégia ações de proteção e promoção à saúde dos indivíduos sadios ou doentes em seu ambiente familiar através de um atendimento contínuo e integral

Reflexão sobre o ensino farmacêutico / Reflection about pharmaceutical education

Este artigo expressa uma preocupação com o ensino farmacêutico baseado nas novas diretrizes curriculares do Conselho Nacional de Ensino. O passado recente priorizou a formação de recursos humanos para as modalidades em detrimento da área privativa do Farmacêutico, a Farmácia em toda sua abrangência. Para não incorrermos no mesmo erro, é necessário desenvolver competências, que possibilitem ao egresso aplicar o conhecimento técnico-científico no contexto social. As novas diretrizes curriculares encerram o ciclo no qual a formação profissional aparecia com o marco divisório das modalidades análises clínicas e indústria. Modelo no qual se concebia a possibilidade de assistência farmacêutica sem conhecimento integral do medicamento não pode ser repetido por uma formação superficialista, segmentada, repleta de atividades técnicas previsíveis e repetitivas e, sobretudo, se conduzido por pessoas sem o preparo necessário ao ensino da atividade. O retorno às atividades primárias do Farmacêutico deve ser precedido pela formação de recursos humanos específicos para a área, o que não acontecerá a longo prazo

Physicochemical characterization and enzymatic degradation of casein microcapsules prepared by aqueous coacervation.

The use of biopolymers in sustained release systems has been studied by many research groups because of the bioavailability and biodegradability of these compounds. Casein is a natural biopolymer whose degradation results in biologically utilisable compounds. The objective of the present study was to assess the potential of casein microcapsules (CAS/MC) as sustained release systems using acetaminophen as a model drug. CAS/MC were prepared by aqueous coacervation in lactate buffer containing gelatin, hydroxypropyl cellulose (HPC) and lecithin. After preparation, the microcapsules were treated, or not, with glutaraldehyde as a cross-linking agent. CAS/MC were loaded using two distinct procedures, either by dissolving 50% of the drug (w/w), relative to casein, in the polymer dispersion or by dissolving the drug in the coacervating solution. The drug present in CAS/MC was quantified by HPLC after an enzymatic degradation assay, and the CAS/MC were analysed by scanning electron microscopy and thermal analysis (differential scanning calorimetry and thermogravimetrical analysis). Loading of the drug was approximately 8% (w/w), with high resistance to enzymatic attack. The absence of an acetaminophen melting peak indicated that there was no drug present on the surface of the cross-linked systems. In addition, loading was accompanied by a reduction of the specific heat capacity of the systems, which suggests a decrease in stability. The outer morphology of the encapsulating polymer was affected by the process of microencapsulation. The data suggest that the microencapsulation process of aqueous coacervation and cross-linking is appropriate for the preparation of microencapsulated systems for sustained drug delivery.

Prevalence of hypertension in the urban population of Catanduva, in the State of São Paulo, Brazil.

OBJECTIVE: To study the prevalence of systemic hypertension and its control in the population of Catanduva, in the state of São Paulo, Brazil. METHODS: We carried out a randomized cross-sectional population-based study of the urban population of Catanduva with individuals above 18 years of age (688 individuals accounting for 0.9% of the referred population). We interviewed study participants to analyze the major qualitative and quantitative variables that could influence the hypertensive scenario and the risk for systemic hypertension. Blood pressure was measured through the indirect method according to the III Consenso Brasileiro de Hipertensão (III Brazilian Consensus on Hypertension), which established blood pressure levels >/= 140/90 mm Hg as hypertensive. RESULTS: The prevalence of systemic hypertension was higher in individuals with: (1) history of hypertension (p<0.0001); (2) diabetes mellitus (p=0.05); (3) body mass index (B. M. I) >/= 25 kg/m(2) (p<0.001); (4) low educational level (p<0.0001); (5) familial income ranging from 1 to 5 minimum wages (p<0.05); (6) unmarried status (divorced/separated and widow(er)s) (p<0.0001). Of the interviewed individuals, 27.6% (p=0.05) had blood pressure levels under control. CONCLUSION: Our study showed that the prevalence of systemic hypertension was 31.5%, and that 27.6% of the individuals interviewed had blood pressure levels under control at the time of the interview.

Comparison of the fluorescent polarization (TDx) and the enzymatic competitive (EMIT 2000) immune assays for the measurement of cyclosporin A blood concentration.

Evaluation of Cyclosporin A (CyA) blood concentration is imperative in solid organ transplantation in order to achieve maximal immunosuppression with the least side effects. We compared the results of whole blood concentrations of CyA in 50 blood samples simultaneously evaluated by the fluorescent polarization immune assay (TDx) and the enzymatic competitive immune assay (EMIT 2000). There was a strong correlation between both kits for any range of CyA blood concentration (R=0.99, p<0.001). The within-run and between-days coefficient of variation were less than 4% for both assays. The cost for each CyA measurement was 50% lower for the EMIT assay when compared to the TDx assay. We concluded that the EMIT is as accurate as the TDx in measuring CyA blood concentration and has the advantage of a lower cost, as well as the possibility of widespread access to the EMIT methodology in contrast to the TDx equipment, allowing the laboratory to perform several routines within a working day.

Influence of formulation on the physicochemical properties of casein microparticles.

Casein microparticles (CAS/MP) have a potential clinical use for targeting drugs. However, the use of organic solvents in their preparation is undesirable. This study was designed to investigate the influence of preparation procedures in aqueous media on the formulation and physicochemical properties of CAS/MP. The first stage involved the influence of the coacervating agents (lactic acid, succinic anhydride, succinic acid and tartaric acid). The second stage studied was the influence of the ionic strength and the third, the influence of adding a thickener, hydroxypropyl cellulose or hydroxypropyl methycellulose (HPC or HPMC), and a plasticizing agent (gelatin). Some physicochemical properties of CAS/MP were evaluated. While the infrared and the thermal analysis showed that all coacervating agents were appropriate for coacervation, the scanning electron microscopy studies showed that the external morphology of the particles was more homogeneous when lactic acid was used. Utilizing lactic acid as the coacervating agent, there was a trend effect of adding NaCl implying that the increasing of the ionic strength resulted in better stability. Finally, the addition of 0.1% HPC plus either 0.25 or 0.5% gelatin resulted in homogeneous formulations. In conclusion, the use of lactic acid plus 0.1% HPC and 0.25% gelatin results in biodegradable and homogeneous CAS/MP, presenting a potentially useful drug delivery system.

New approaches to the treatment of phenylketonuria.

Phenylketonuria (PKU) is the most common of all aminoacidopathies and is caused by autosomal recessive deficiency of the hepatic phenylalanine hydroxylase system. The diagnosis of PKU should be multifactorial and based on a protein overload test that reveals increased plasma phenylalanine levels during the ingestion of a normal diet, a phenylalanine tolerance test, and in vitro and in vivo activity of the liver enzyme. An individualized diagnosis that characterizes the severity of the disease in each patient provides objective and effective criteria for the dietary treatment of each particular case.

Predictors of sudden cardiac death for patients with Chagas' disease: a hospital-derived cohort study.

This study was carried out to identify patients with Chagas' disease at risk of sudden cardiac death, inasmuch as such patients have not been recognized thus far. Seventy-four consecutive patients with a positive complement fixation test for Chagas' disease prospectively followed up at the Cardiomyopathy Clinic from January 1990 to June 1993 were entered into the study. Patients underwent medical history, physical examination, serological tests, resting electrocardiography, chest X-ray and two-dimensional echocardiography. Eighteen of 74 (24%) patients died during the study period, 8 (10%) suddenly and 10 (14%) from pump failure. Sudden death comprised 44% of total deaths. In the univariate model, cardiomegaly in the chest X-ray, left ventricular systolic and diastolic dimension, left ventricular ejection fraction, left atrial dimension and apical aneurysm as detected echocardiographically, and systolic blood pressure were associated with sudden cardiac death. In the multivariate model, however, apical aneurysm and left ventricular diastolic dimension were retained as predictors of sudden cardiac death. We conclude that chagasic patients with apical aneurysm and left ventricular dilation are at risk of sudden cardiac death.

Effect of chronic ethanol consumption on the activities of residual small bowel brush-border enzymes after proximal jejunum resection in the rat.

Ethanol consumption has a toxic effect on the epithelium of the small bowel, but enterocyte maturity is very difficult to measure under these circumstances. However, when ethanol intake is combined with enterectomy, enterocyte immaturity is greater, permitting an easier separation of these two effects. In a group of rats (13 male Wistar rats weighing approximately 220 g) fed a liquid diet containing 35% ethanol for 4 weeks after resection of the proximal jejunum, the residual small intestine brush border maltase, sucrase, and lactase activities were similar to those of a pair-fed control group (13 animals). However, alkaline phosphatase activity was decreased in the mucosa and in the enterocyte brush border, probably because of the lower activity of this enzyme in the jejunum-ileum remnant of the alcoholic group.

Casein, hydrolyzed casein, and amino acids that simulate casein produce the same extent of mucosal adaptation to massive bowel resection in adult rats.

We determined the effect of the extent of protein polymerization on the intestinal hyperplastic adaptation of adult male Wistar rats after 80% resection of the jejunal-ileal segment. Rats received one of four chemically defined solid diets prepared by using casein, two casein hydrolysates of different peptide size distributions, or free amino acids simulating casein and identical in all other components for 12 d, starting 3 d after surgery. Semipaired feeding was used to ensure that the same quantity of food was ingested by each group and as a consequence, nitrogen and energy intakes were reduced to 63% of that obtained with ad libitum feeding of the casein diet to intact rats. No significant differences were demonstrable in food ingestion, weight gain, nitrogen balance, or morphometric data for the remaining jejunal and ileal segments (number of cells/villus, number of cells/crypt, and crypt cell mitosis rate). These data demonstrate that the extent of polymerization of the protein nitrogen source did not affect the hyperplastic adaptative process of the rat. Additional studies in humans are necessary to determine whether intact protein diets can be used first as a nitrogen source in nutritional support of patients with a nonspecific hyperplastic response to surgical resection before the use of expensive hydrolysates and the more expensive amino acid mixtures.

[Biochemical basis of enteral nutrition]. / Bases bioquímicas do suporte nutricional enteral.

Basic biochemical studies have demonstrated the products of protein intraluminal digestion are amino acids and peptides, and the those amino acids as well as small peptides are absorbed by independent mechanisms. The formers are absorbed by specific absorption systems mediated by carriers. The small peptides (di-and tripeptides) are absorbed intact from and may be intracelularlly hydrolised. Peptides with four or more residues are hydrolysed by peptidases located on the brush border of the intestinal villi and then absorbed as amino acids and/or small peptides. Such an absorption through a peptide mechanism is faster than the absorption of free amino acids. These are basic aspects that should direct the use of protein partial enzymatic hydrolisate in human nutrition.

Bases bioquímicas do suporte nutricional enteral / Biochemical basis of enteral nutrition

Estudios bioquímicos básicos demostraram que o produto da digestao intraluminal das proteínas sao aminoácidos e peptídeos, e que os aminoácidos e pequenos peptídeos sao absorvidos por mecanismos independientes. Os aminoácidos sao absorvidos por sistemas de absorcao específicos, mediados por transportadores (carrier). Os pequenos peptídeos (di-e tripeptídeos) sao absorbidos intactos e sofrem ou nao hidrólise intra-celular. Os peptídeos com quatro ou mais aminoácidos sofrem hidrólise pelas peptidases da borda em escova e sao absorvidos, via aminoácidos ou pequenos peptídeos, sendo que absorcao dos aminoácidos a partir de peptídeos supera a absorcao dos aminoácidos livres. Sao estes os aspectos básicos que devem nortear uso de hidrolisados enzimáticos proteicos parciais em nutricao humana.

Ileum brush border alkaline phosphatase activity in an experimental model of chronic alcoholism after small bowel proximal resection in the rat.

Literature reports that chronically ingested ethanol induces changes in the morphology of the small bowel mucous membranes. It has a topical toxic effect on the epithelium of the proximal jejunum and a blood-borne effect on the epithelium of the ileum because its absorption is almost complete in the stomach, duodenum and proximal jejunum. In addition there are also reports showing stimulation of enterocyte proliferation after segmental intestine resection. In this report we compare a group of rats submitted to resection of the proximal jejunum and fed a liquid diet containing 35% of the total calories intake as ethanol for four weeks to its control pair-fed group. In both groups we studied the mucosal alkaline phosphatase (APase) activity by histochemical as well as biochemical methods. We found a decreased APase activity in the homogenate of the intestinal mucous membrane in the alcoholic group and a reduced enzymatic activity in the brush border of the ileum enterocytes, as demonstrated by histochemical qualitative and densitometric assays. The result suggests that this change in APase activity of the brush border may represent enterocyte immaturity induced by long-standing ethanol intake in the remnant ileum after proximal resection.

Noninvasive predictors of mortality for patients with Chagas' heart disease: a multivariate stepwise logistic regression study.

This prospective investigation was conducted in an attempt to identify noninvasive predictors of mortality for patients with Chagas' heart disease through a multivariate stepwise logistic regression study. Fifty-six patients with a positive complement fixation test for Chagas' disease were followed up at the Cardiomyopathy Clinic of our institution from April 1990 to April 1992. Patient age was 59 +/- 17 years; 28 (50%) were male. Upon admission, 19 patients (33%) were in the New York Heart Association (NYHA) class III and 8 (14%) in the NYHA class IV. Systolic blood pressure was 125 +/- 23 mm Hg, diastolic blood pressure 76 +/- 11 mm Hg and resting heart rate 77 +/- 11 beats/min. Forty patients (71%) were given digitalis and 39 (69%) angiotensin-converting enzyme inhibitors. Plasma Na+ was 140 +/- 4 mEq/l, K+ was 4.34 +/- 0.73 mEq/l and creatinine level 1.34 +/- 0.31 mg/100 ml. Cardiomegaly was observed in the chest X-ray of 41 of 51 (79%) available patients. Atrial fibrillation was observed in the resting ECG of 24 of 54 (44%) available patients, premature ventricular contractions in 23 (41%), right bundle branch block in 26 (46%) and left anterior hemiblock in 26 (46%) patients. Echocardiography revealed a left ventricular ejection fraction of 0.45 +/- 0.16, left ventricular systolic dimension of 51.23 +/- 13.53 mm and left ventricular diastolic dimension of 62.94 +/- 19 mm. Sixteen (28%) patients died during the 2-year study, 11 of them suddenly.(ABSTRACT TRUNCATED AT 250 WORDS)

Absence of Trypanosoma cruzi myocardial infection reactivation in Chagas' heart transplant.

The risk of Trypanosoma cruzi myocardial infection reactivation after immunosuppressive therapy has led to precluding heart transplantation as a therapeutic procedure for patients with end-stage Chagas' heart disease. We report a case of an orthotopic heart transplantation in a 43-year-old critically ill chagasic patient with an uneventful postoperative period. He was treated with azathioprine and cyclosporine to control graft rejection and showed no reactivation of the chagasic infection. One year following surgery, the patient is doing well. Nonsteroidal therapy appears not to reactivate T. cruzi infection in transplant chagasic patients.