Potential of pharmaceutical formulation based on Morinda citrifolia extract for the treatment of schistosomiasis.

Schistosomiasis is a parasitic disease that can be asymptomatic, but it can progress and cause serious damage, such as hospitalization and death. This work aimed to characterize and carry out the in vivo pharmacological test of the dry extract of Morinda citrifolia and obtain a pharmaceutical dosage form based on this extract for the treatment of schistosomiasis. The aqueous extract was characterized based on the evaluation of pH, dry residue and density. The aqueous extract was dried through the freeze-drying process. The obtained dry extract was characterized through phytochemical screening, rheological analysis, acute toxicity and in vivo pharmacology. Additionally, the pre-formulation development of a pharmaceutical dosage form was pursued with the dry extract. Through the HPLC chromatogram, characteristic rutin peaks were identified. The rheological behavior of the dry extract did not show good characteristics. Acute toxicity, at a dose of 2000 mg/kg, showed excitatory activity in the central and autonomous nervous system. The in vivo pharmacological test of the dry extract showed that, at a dose of 400 mg/kg, it was possible to reduce 67.5% of the total adult worms, 66% of female worms and 60% of the number of eggs. The pharmaceutical dosage form obtained was an oral solution that was clear, transparent, without the presence of lumps and precipitates, having a density of 1.1276 g mL-1 and pH of 5.92. The results obtained will provide parameters for the production of suitable pharmaceutical formulations, as well as for the quality control of products based on M. citrifolia, with promising schistosomicidal activity.

Anestesia em paciente portadora de espondilite anquilosante avançada submetida a procedimento cirúrgico de cesariana: relato de caso / Anesthesia for cesarean delivery by a female patient with advanced ankylosing spondylitis: a case report

Justificativa e objetivos: a espondilite anquilosante é uma espondiloartropatia soronegativa que se caracteriza pelo comprometimento progressivo das articulações sacroilíacas e vertebrais, de forma ascendente e com eventual ossificação dessas articulações, em um processo denominado anquilose óssea. Por acometer a bacia óssea, é uma condição extremamente desfavorável no contexto obstétrico, apesar de ser uma das poucas condições reumatológicas que predominam em homens e sua incidência maior acontece no final da adolescência. Suas implicações no manejo anestesiológico levam em conta uma série de variáveis que podem comprometer o ato anestésico-cirúrgico e, portanto, é de suma importância que o anestesiologista esteja preparado para eventuais dificuldades. O escopo deste trabalho é apresentar a conduta anestésica em relação ao paciente com espondilite anquilosante que, no caso relatado, foi submetida a uma cesariana eletiva. Relato do caso: paciente do sexo feminino, 40 anos, 73 kg, com idade gestacional de 38 semanas, portadora de hipertensão arterial crônica e espondilopatia anquilosante em fase avançada, encaminhada à maternidade para a realização de procedimento cirúrgico de cesariana eletiva. Após várias tentativas de bloqueio subaracnóideo sem sucesso, optou-se por anestesia geral balanceada na qual a intubação orotraqueal não foi possível, sendo então introduzida máscara laríngea e realizada ventilação mecânica com sucesso. Conclusões: no caso apresentado, em que existe espondilite anquilosante avançada, a anestesia geral deveria ser primeira opção, pois se pode perder muito tempo tentando realizar bloqueios do neuroeixo ou estes podem ser até impossíveis de serem realizados. Por outro lado, deve-se levar em conta a posssibilidade de dificuldade de intubação orotraqueal e ter todos os dispositivos adequados para uma intubação difícil.(AU)

Justification and objectives: Ankylosing spondylitis is a seronegative spondyloarthropathy that progressively compromises the sacroiliac and vertebral articulations in an ascending way and with eventual ossification of the articulations, a process known as osseous ankylosis. Because it affects the pelvis, the disorder has extremely unfavorable obstetric conditions, even though this is one of the few rheumatologic conditions that prevails among men and has higher incidence in late adolescence. Its complications for anesthesia include a number of variables that can compromise the anesthetic and surgical procedure, and therefore anesthesiologists are supposed to be well prepared for eventual difficulties. This paper reports on the anesthetic procedures for an elective cesarean delivery by a patient with ankylosing spondylitis. Case report: A 40 year-old female patient, with 73 kg, gestational age of 38 weeks, carrier of chronic arterial hypertension and ankylosing spondylitis in advanced stage was admitted to maternity for elective cesarean delivery. After several unsuccessful attempts of applying subarachnoid block, the patient received balanced general anesthesia; as orotracheal intubation was not possible, a laryngeal mask was introduced and ventilation was successfully provided mechanically. Conclusions: as in the case herein reported, patients with advanced ankylosing spondylitis should be provided with general anesthesia as first option of choice, as much time may be lost in unsuccessful attempts of blocking the neuroaxis. However, practitioners must be aware of the possible difficulty of performing orotracheal intubation, and thus assure that adequate devices are in place for cases of hard intubation.

Patient and general practitioner attitudes to healthy lifestyle behaviours and medication following coronary heart disease: an exploratory study.

Patients with coronary heart disease often engage in unhealthy lifestyle behaviours. We explored patients' and general practitioners' (GPs') perceptions about the effectiveness of healthy behaviours and medications for the prevention of further cardiovascular disease. This exploratory study used semi-structured interviews with eight Sydney GPs and 13 of their patients with coronary heart disease. Patients perceived medications to be more effective than healthy behaviours in improving specific aspects of cardiovascular health, such as angina symptoms, cholesterol and blood pressure, whilst GPs perceived that medications were more effective in patients they considered at highest cardiovascular risk, patients with uncontrolled risk factors, or where adherence to healthy behaviours was poor. Among patients we found a negative perception of the effort required to adhere to healthy behaviours and possible underestimation of their future cardiovascular risk. Patients valued support from peers and family. This study opens up avenues for investigation in further research, including whether patient adherence to healthy behaviours may be enhanced by the exploration oftheir perceptions about behaviour effectiveness, barriers and cardiovascular risk and by GP facilitation of practical supports.