Antimicrobial resistance, enterotoxin and biofilm production genes in Staphylococcus spp. isolated from facilities and fomites in veterinary hospital in the Caatinga biome.

The Caatinga biome occurs only in Brazil and offers epidemiological conditions that should be assessed differently from other regions of Brazil and the world. Thus, the aim of this survey was to identify antimicrobial resistance, enterotoxin and biofilm production genes in Staphylococcus spp. isolated from facilities and fomites in a veterinary hospital in Caatinga biome. Samples were collected from surfaces of small animal clinical care tables (n =8), cages in the dog and cat hospitalisation sector and animals with infectious diseases (n = 21), small animal surgical centre (n =8), sterilisation sector (n =7) and stethoscopes (n = 32) by using sterile swabs. Bacterial isolation and identification, antimicrobial resistance phenotypic test and molecular detection of antimicrobial resistance, biofilm formation and enterotoxin genes were carried out. Ninety-five bacterial isolates were obtained, and 29 (30.5%) were identified as Staphylococcus spp. Overall, 13 isolates (44.8%) of six species of Staphylococcus spp. showed antimicrobial resistance profile, as well as S. haemolyticus expressed phenotypic profile of multidrug resistance. The antimicrobials with the highest resistance rates were penicillin and tetracycline. The most frequent resistance genes were blaZ and tetM, both detected in 10 (76.9%) isolates. The mecA, tetL and tetK genes had frequencies of 38.5% (5/13), 23.1% (3/13) and 15.4% (2/13), respectively. The biofilm production marker, icaD gene, was detected in one S. sciuri strain. SEE gene, which encodes enterotoxins, was detected in 15.4% (2/13) of the strains (S. pseudintermedius and S. intermedius). The occurrence of Staphylococcus spp. carrying resistance genes to diferent classes of antimicrobials, presenting MDR phenotypic pattern and carrying enterotoxins and biofim encoding genes recovered from veterinary hospital facilities and fomites in the Caatinga biome reinforce the need to implement prevention cares in veterinary practices to avoid One Health-concerning conditions.

Optimizing Nonsink Dissolution Testing for Amorphous Solid Dispersions: Exploring Sample Handling Variables.

This study aims to investigate key variables affecting the dissolution of amorphous pharmaceuticals. We examined sample treatment methods (centrifugation vs syringe filtration), time delays between sample collection and processing (immediate, 2, or 24 h), and different sample preparations (bare powder, capsules, or tablets). These factors were evaluated through both sink and nonsink dissolution experiments, using controlled supersaturation conditions (sink index ≈ 0.1) with amorphous solid dispersions (ASDs) containing low-substituted hydroxypropyl cellulose (L-HPC) and either indomethacin or posaconazole as model drugs. Our results highlighted the significant impact of syringe filtration on nonsink dissolutions, particularly the notable reduction in dissolved drug concentration, possibly due to filtration-induced precipitation. Moreover, introducing a delay of 2 or 24 h between sample collection and quantitation under nonsink conditions led to substantial concentration changes. This effect was not as pronounced when samples underwent centrifugation, and only the analysis was delayed for 2 h. The findings also emphasize the importance of accounting for delays introduced by pharmaceutical formulations, particularly in assessing the kinetic-solubility profiles of ASDs. This research offers valuable insights into the field of ASDs, enhancing our understanding of how these variables can influence dissolution results.

Amorphous solid dispersions in high-swelling, low-substituted hydroxypropyl cellulose for enhancing the delivery of poorly soluble drugs.

Amorphous solid dispersions (ASDs) based on water-insoluble hydrophilic polymers can sustain supersaturation in their kinetic solubility profiles (KSPs) compared to soluble carriers. However, in the limit of very high swelling capacity, the achievable extent of drug supersaturation has not been fully examined. This study explores the limiting supersaturation behavior of ASDs of poorly soluble indomethacin (IND) and posaconazole (PCZ) based on a high-swelling excipient, low-substituted hydroxypropyl cellulose (L-HPC). Using IND as a reference, we showed that the rapid initial supersaturation buildup in the KSP of IND ASD can be simulated through sequential IND infusion steps, however at large times the KSP of IND release from ASD appears more sustained than direct IND infusion. This has been attributed to potential trapping of seed crystals generated in the L-HPC gel matrix thus limiting their growth and rate of desupersaturation. Similar result is also expected in PCZ ASD. Furthermore, the current drug loading process for ASD preparation resulted in the agglomeration of L-HPC based ASD particles, producing granules of up to 300-500 µm (cf. 20 µm individual particle), with distinct kinetic solubility profiles. This feature makes L-HPC particularly suitable as ASD carriers for fine tuning of supersaturation to achieve enhanced bioavailability for poorly soluble drugs.

The Influence of Whey Protein on Muscle Strength, Glycemic Control and Functional Tasks in Older Adults with Type 2 Diabetes Mellitus in a Resistance Exercise Program: Randomized and Triple Blind Clinical Trial.

OBJECTIVES: To evaluate the effect of whey protein (WP) supplementation associated with resistance training (RT) on glycemic control, functional tasks, muscle strength, and body composition in older adults living with type 2 diabetes mellitus (T2DM). Secondly, to evaluate the safety of the protocol for renal function. METHODS: The population comprised twenty-six older men living with T2DM (68.5 ± 11.5 years old). The participants were randomly assigned to the Protein Group (PG) and the Control Group (CG). The handgrip test and evolution of exercise loads, according to the Omni Resistance Exercise Scale, evaluated muscle strength. Functional tasks were assessed by force platform in three different protocols: Sit-to-Stand, Step/Quick Turn, and Step Up/Over. Body composition was evaluated by bioimpedance and glycemic control and renal function were assessed by biochemical analyses. Both groups performed RT for 12 weeks, twice a week, prioritizing large muscle groups. Protein supplementation was 20 g of whey protein isolate and the CG was supplemented with an isocaloric drink, containing 20 g of maltodextrin. RESULTS: There was a significant difference in muscle strength, according to the evolution of the exercise loads, but it was not confirmed in the handgrip test. However, there was no significant difference between the groups, regarding performance in functional tasks, glycemic control, or body composition. Renal function showed no alteration. CONCLUSION: The intake of 20 g of WP in older male adults living with T2DM did not increase the effect of RT on muscle strength, functional tasks, and glycemic control. The intervention was proven safe regarding renal function.

Insulin-loaded nanoparticles based on acetylated cashew gum/chitosan complexes for oral administration and diabetes treatment.

Insulin is one of the most important drugs in the clinical treatment of diabetes. There is growing interest in oral insulin administration as it mimics the physiological pathway and potentially reduces side effects associated with subcutaneous injection. In this study, a nanoparticulate system was developed using acetylated cashew gum (ACG) and chitosan by the polyelectrolyte complexation method, for oral administration of insulin. The nanoparticles were characterized by size, zeta potential and encapsulation efficiency (EE%). And they had a particle size of 460 ± 11.0 nm, PDI of 0.2 ± 0.021, zeta potential of 30.6 ± 0.48 mV, and an EE% of 52.5 %. Cytotoxicity assays were performed for HT-29 cell lines. It was observed that ACG and nanoparticles did not have a significant effect on cell viability, verifying their biocompatibility. Hypoglycemic effects of the formulation were analyzed in vivo, noting that the nanoparticles reduced blood glucose by 51.0 % of baseline levels after 12 h, not inducing signs of toxicity or death. Biochemical and hematological profiles were not clinically modified. Histological study indicated no signs of toxicity. Results showed that the nanostructured system presented itself as a potential vehicle for oral insulin release.

Evolution of pediatric pharmaceutical forms for treatment of Hansen's disease (leprosy).

INTRODUCTION: Leprosy is a neglected, infectious, granulomatous and chronic disease caused by the pathological agent Mycobacterium leprae. The course of the disease is more aggressive in patients under 15 years of age, but the current treatment offered worldwide consists of solid forms, by the combination of antibiotics such as rifampicin, clofazimine and dapsone. This represents results in lack of adherence in pediatric patients and drug therapy failure, although numerous formulations and technologies have already been developed. AREA COVERED: This study aims to analyze the technological evolution of the pharmaceutical treatment of leprosy, aimed at children. A review of patents around the world was conducted to look for technical and clinical aspects of formulations and devices. EXPERT OPINION: Innovative formulations for pediatric patients were classified according to the routes of administration as oral, inhalable, injectable and transdermal. The formulations were organized as alternatives for pediatric therapy, taking into account the physicochemical aspects of drugs and the physiological aspects of pediatric patients. Among the difficulties for the patented formulations to reach the market, of special note is the low stability of the physicochemical characteristics of the drugs. Optimization of formulations would favor the pediatric treatment of leprosy, aiming at therapeutic success.

Efficacy and safety of nanoparticles of glibenclamide and organomodified layered double hydroxides in diabetics rats.

Glibenclamide (GB) is an important drug in the treatment of type II diabetes mellitus (DM II); however, its low solubility causes variability in its oral bioavailability, negatively affecting the pharmacological treatment. Nanoparticles (NP) of GB and organophilized Layered Double Hydroxide (LDH) were developed to improve oral bioavailability and tested in streptozotocin-induced diabetic rats to evaluate therapeutic efficacy and safety. Blood glucose was measured for 12 h or after 28 days of treatment. In addition, body weight, water and feed consumption, hematological, biochemistry and morphological parameters and markers of oxidative stress were determined. After the treatment, GB with LDH normalized the blood glucose level, indicating a better release profile. Water and feed intake and body weight of animals treated with GB and GB with LDH were closer to the normoglycemic group and did not indicate signs of toxicity of the nanoparticles. The biochemical, hematological and histological results also showed no significant changes related to nanotoxicity. The combination of GB with LDH proved to be critical in the oxidative balance, as it reduced the oxidative stress of vascular tissue. In conclusion, NPs are a potential controlled release system for the treatment of DM II.

pH-responsive phthalate cashew gum nanoparticles for improving drugs delivery and anti-Trypanosoma cruzi efficacy.

Nanotechnology is a crucial technology in recent years has resulted in new and creative applications of nanomedicine. Polymeric nanoparticles have increasing demands in pharmaceutical applications and require high reproducibility, homogeneity, and control over their properties. Work explores the use of cashew phthalate gum (PCG) as a particle-forming polymer. PCG exhibited a pH-sensitive behavior due to the of acid groups on its chains, and control drug release. We report the development of nanoparticles carrying benznidazole. Formulations were characterized by DLS, encapsulation efficiency, drug loading, FTIR, pH-responsive behavior, release, and in vitro kinetics. Interaction between polymer and drug was an evaluated by molecular dynamics. Morphology was observed by SEM, and in vitro cytotoxicity by MTT assay. Trypanocidal effect for epimastigote and trypomastigote forms was also evaluated. NPs responded to the slightly basic pH, triggering the release of BNZ. In acidic medium, they presented small size, spherical shape, and good stability. It was indicated NP with enhanced biological activity, reduced cytotoxicity, high anti T. cruzi performance, and pH-sensitive release. This work investigated properties related to the development and enhancement of nanoparticles. PCG has specific physicochemical properties that make it a promising alternative to drug delivery, however, there are still challenges to be overcome.

Modification of chicha gum: Antibacterial activity, ex vivo mucoadhesion, antioxidant activity and cellular viability.

The aim of the present work was to modify the exuded gum of Sterculia striata tree by an amination reaction. The viscosity and zero potential of the chicha gum varied as a function of pH. The modification was confirmed by X-ray diffraction (XRD), infrared spectroscopy (FTIR), size exclusion chromatography (SEC), zeta potential, thermogravimetric analysis (TG), and differential scanning calorimetry (DSC). Furthermore, the chemical modification changed the molar mass and surface charge of the chicha gum. In addition, the gums were used in tests for ex vivo mucoadhesion strength, antibacterial activity against the standard strain of Staphylococcus aureus (ATCC 25923), inhibitory activity of α-glucosidase, antioxidant capacity, and viability of Caco-2 cells. Through these tests, it was found that amination caused an increase in the mucoadhesive and inhibitory activity of chicha gum against the bacterium Staphylococcus aureus. In addition, the gums (pure and modified) showed antioxidant capacity and an inhibitory effect against the α-glucosidase enzyme and did not show cytotoxic potential.

Análise dos mecanismos de gestão estratégica e participativa do Sistema Único de Saúde numa região de saúde do Estado de Pernambuco

Este estudo analisa as interfaces entre o conselho municipal de saúde de Caruaru e a omissão intergestora regional (CIR) na IV região de saúde do estado de Pernambuco (IV Geres), buscando compreender questões centrais sobre as políticas de gestão estratégica e compartilhada. Trata-se de um estudo qualitativo com análise de 34 documentos oficiais a partir das atas com as transcrições das reuniões ocorridas nos anos de 2017 e 2018 na CIR da IV Geres e do Conselho Municipal de Saúde (CMS) de Caruaru, município sede da região de saúde. Os dados foram analisados segundo a proposta de Bardin e pelo software IRAMUTEQ. Obteve-se aprovação no Comitê de Ética. Os dados foram agrupados em duas categorias: ações referentes a CIR e ações referentes ao CMS de Caruaru. A partir disso, os núcleos de sentido foram divididos em três eixos: 1) governança; 2) regionalização; e 3) controle social. Como resultado, nota-se a presença de uma relação desconexa entre a CIR e o Conselho Municipal de Saúde, na qual a CIR atua como grande definidora das políticas, de suas implementações e negociações. As desigualdades regionais mostraram-se bastante pronunciadas dentro do colegiado, o que torna a efetivação de um sistema de saúde fortalecido e capacitado para atender as demandas da região como um dos principais desafios a serem alcançados, nos mais diferentes níveis de atenção.

Abrangência do Programa Saúde na Escola em Vitória de Santo Antão-PE / Scope of the School Health Program in the municipality of Vitória de Santo Antão in the State of Pernambuco, Brazil

RESUMO A pesquisa objetivou descrever, por meio de um estudo de avaliação, o alcance do Programa Saúde na Escola (PSE) em Vitória de Santo Antão-PE, no ano de 2016. Os dados foram coletados entre outubro de 2016 e fevereiro de 2017, mediante fonte documental das Secretarias Municipal de Saúde, de Educação e da Gerência Regional de Educação. O município apresentou 52 escolas cadastradas, e 26 realizaram alguma atividade referente ao programa. As ações englobaram atividades do componente I, como, por exemplo, 'Avaliação antropométrica', 'Verificação da situação vacinal', 'Promoção e avaliação da saúde bucal'. As temáticas do componente II também foram verificadas, como 'Promoção das práticas corporais e atividade física', 'Ações de segurança alimentar e alimentação saudável', 'Promoção da saúde ambiental e desenvolvimento sustentável', com foco nas arboviroses. O quantitativo de ações na zona urbana foi superior quando comparada a área rural. Um bom número de escolas cadastradas contrastando com a baixa ativação (implementação) do PSE ou, ainda, um alcance 'muito ruim' dos estudantes permearam as respostas da pesquisa, possibilitando a solidificação de subsídios para o surgimento de questionamentos essenciais às novas intervenções nesse campo de pesquisa e fornecendo outros conhecimentos sobre o programa para o público geral.

ABSTRACT The research aimed to describe, through an evaluation study in 2016, the scope of the School Health Program (PSE) in the municipality of Vitória de Santo Antão State of Pernambuco in the Northeast region of Brasil. Data were collected between October 2016 and February 2017 using documental source from the Municipal Health and Education secretaries and the Regional Education Management. The municipality had 52 registered schools and 26 carried out some activity related to the program. The actions encompassed component I activities such as 'Anthropometric assessment', 'Verification of vaccination status', 'Oral health promotion and assessment', for example. The themes of component II were also verified such as 'Promotion of body practices and physical activity', 'Food safety and healthy eating actions', 'Promotion of Environmental Health and sustainable development', with focus on arboviruses. The number of actions in the urban area was higher when compared to the rural area. A good number of registered schools contrasting with the low activation (implementation) of the PSE, or even a 'very bad' reach of students, permeated the survey answers, enabling the solidification of subsidies of essential questions to new interventions in this research field and providing other knowledges about the program to the general public.

Profile of judicialization in access to antineoplastic drugs and their costs: a cross-sectional, descriptive study based on a set of all lawsuits filed between 2016 and 2018 in a state in the Northeast Region of Brazil.

BACKGROUND: The judicialization of the acquisition of medication for healthcare is not restricted to Brazil but can also be found in other Latin American countries, despite the existence of a universal health system in the case of Brazil, the Unified Health System (known as the SUS). Right-to-medicines litigation has existed ever since the emergence of a high demand for treatment of Acquired Immuno-deficiency Syndrome (AIDS) but the current focus is on cancer. Pharmaceutical Assistance (PA) is the area within the SUS that is responsible for ensuring access to medication and the aim of this article is thus to draw up a profile of litigation related to PA in one economically significant state in the Northeast Region of Brazil, in terms of the following characteristics of lawsuits: the plaintiff filing the lawsuit; medical and health information; the cost of acquiring the requested medications; and the proportion accounted for by spending on antineoplastic drugs. METHODS: A cross-sectional, descriptive study was conducted of lawsuits filed between 2016 and 2018 at the Litigation Center of the State of Pernambuco Department of Health. RESULTS: A total of 2,947 lawsuits containing at least one requested medication were analyzed. The majority of the plaintiffs were male (51.7%); 49.8% of the requests originated in the Unified Health System (SUS), and plaintiffs were primarily patients in the Metropolitan region of the State capital, Recife. The most frequent cancers involved were those classified by the ICD as C61, C71 and C50. The median general expense on medications for the actions was U$1,734.94. Considering antineoplastic drugs alone, the cost exceeded U$7,500 per lawsuit over the three years, given that the median unit price for antineoplastic drugs is approximately US$65 compared to US$4 for non-antineoplastic drugs. CONCLUSION: The present study is of relevance to the field of public health and examines how a profile of such healthcare litigation can be used as a tool for managing and improving decision-making in times of economic austerity.

Development of the stability-indicating method, structural elucidation of new photodegradation products from terconazole by LC-MS TOF, and in vitro toxicity.

Terconazole (TCZ) was the first triazole antifungal drug launched in the market and has been used in the treatment of vulvovaginal candidiasis. It is also indicated to treat dermatophytosis and fungal ocular infections. However, some of the degradation products from triazole drugs have been reported to be toxic, justifying the need of further investigations about the stability of TCZ. identification of its degradation products and evaluation of their toxicity considering the new possibilities of therapeutic indications. Therefore, in this work a systematic investigation regarding photostability of TCZ was conducted. The active pharmaceutical ingredient (API) and its methanolic solution (100 µg mL-1) were kept into a photostability chamber under a UV light (200 Wh/m2; 1.2 × 106 lux/h) during 5 days and 90 min, respectively. A high-efficiency liquid chromatography method was developed for separation and identification of TCZ and its degradation products. The solid-state API remained stable throughout the test, whereas an extensive degradation was observed when in solution. In this case, four degradation products not yet reported in the literature were identified and characterized by electrospray ionization high-resolution quadrupole time-of-flight mass spectrometry (ESI-QTOF-MS). Two degradation products presented m/z of 498 and the other two of 496 and 464, respectively. The results suggest that the degradation follows a first-order kinetic and involves the loss of chlorine atoms from the 2,4-dichlrophenyl moiety. Finally, TCZ submitted to the same stress condition as the API solution, increased significantly the opacity during the bovine corneal opacity and permeability test method (BCOP) indicating a potential to cause ocular toxicity. Further studies using the pure photolysis degradation products of TCZ characterized in this work are still necessary to confirm this find.

Chitosan-Based Films with 2-Aminothiophene Derivative: Formulation, Characterization and Potential Antifungal Activity.

In this study, films of chitosan and 2-amino-4,5,6,7-tetrahydrobenzo[b]thiophene-3-carbonitrile (6CN), a 2-aminothiophene derivative with great pharmacological potential, were prepared as a system for a topical formulation. 6CN-chitosan films were characterized by physicochemical analyses, such as Fourier-transform infrared spectroscopy (FTIR), differential scanning calorimetry (DSC), thermogravimetric analysis (TGA), X-ray diffraction (XRD), and scanning electronic microscopy (SEM). Additionally, the antifungal potential of the films was evaluated in vitro against three species of Candida (C. albicans, C. tropicalis, and C. parapsilosis). The results of the FTIR and thermal analysis showed the incorporation of 6CN in the polymer matrix. In the diffractogram, the 6CN-chitosan films exhibited diffraction halos that were characteristic of amorphous structures, while the micrographs showed that 6CN particles were dispersed in the chitosan matrix, exhibiting pores and cracks on the film surface. In addition, the results of antifungal investigation demonstrated that 6CN-chitosan films were effective against Candida species showing potential for application as a new antifungal drug.

Intense orthodontic force induces the three dental pulp nitric oxide synthase isoforms and leads to orofacial discomfort in rats.

OBJECTIVE: The objective of this study was to evaluate the role of nitric oxide synthase (NOS) isoforms influence during tooth movement with different forces. SETTINGS AND SAMPLE POPULATION: 100 male Wistar rats (n = 10/group) were divided into a Sham group (animals not submitted to device installation nor Induced Toot Movement [ITM]), Negative Control Group (NCG) (animals submitted to device installation but not to ITM) and three experimental groups (F1, F2 and F3) (submitted to ITM with forces of 25, 50 and 100 gF respectively). MATERIALS AND METHODS: A daily count of biting and scratching on the vibrissae and the Grimace scale were applied. After 4 (D4) and 11 (D11) days, the molar diastema was measured, and the animals were euthanized for histological (vascular parameters) and immunohistochemistry (iNOS, eNOS and nNOS) in the dental pulp. RESULTS: On D4, there was significant movement in the F3 group (P = .001) and on D11 in F1, F2 and F3 (P < .001). The number of bites (P < .001) and scratching (P = .006) was higher in F2-F3, and F3 had higher Grimace scores (P < .001) and weight loss (P < .001). At D4, there was an increase in pulp ectasia in F2-F3 (P = .021) and a reduction in the number of vessels in F3 (P = .005). In D4 and D11, there was a significant increase in immunostaining for iNOS and eNOS in F1 (P = .025 and P < .001 respectively) and F2 (P = .007 and P < .001 respectively). At D4, F2 and F3 showed higher immunostaining for nNOS (P = .027). CONCLUSION: Thus, IDM induced inflammatory changes in the dental pulp reflecting in force-dependent pain/suffering signs.

Why do few drug delivery systems to combat neglected tropical diseases reach the market? An analysis from the technology's stages.

INTRODUCTION: Many drugs used to combat schistosomiasis, Chagas disease, and leishmaniasis (SCL) have clinical limitations such as: high toxicity to the liver, kidneys and spleen; reproductive, gastrointestinal, and heart disorders; teratogenicity. In this sense, drug delivery systems (DDSs) have been described in the literature as a viable option for overcoming the limitations of these drugs. An analysis of the level of development (TRL) of patents can help in determine the steps that must be taken for promising technologies to reach the market. AREAS COVERED: This study aimed to analyze the stage of development of DDSs for the treatment of SCL described in patents. In addition, we try to understand the main reasons why many DDSs do not reach the market. In this study, we examined DDSs for drugs indicated by WHO and treatment of SCL, by performing a search for patents. EXPERT OPINION: In this present work we provide arguments that support the hypothesis that there is a lack of integration between academia and industry to finance and continue research, especially the development of clinical studies. We cite the translational research consortia as the potential alternative for developing DDSs to combat NTDs.

New Perspectives in Drug Delivery Systems for the Treatment of Tuberculosis.

BACKGROUND: Tuberculosis is a chronic respiratory disease caused by Mycobacterium tuberculosis. The common treatment regimens of tuberculosis are lengthy with adverse side effects, low patient compliance, and antimicrobial resistance. Drug delivery systems (DDSs) can overcome these limitations. OBJECTIVE: This review aims to summarize the latest DDSs for the treatment of tuberculosis. In the first section, the main pharmacokinetic and pharmacodynamic challenges posed by the innate properties of the drugs are put forth. The second section elaborates on the use of DDS to overcome the disadvantages of the current treatment of tuberculosis. CONCLUSION: We reviewed research articles published in the last 10 years. DDSs can improve the physicochemical properties of anti-tuberculosis drugs, improving solubility, stability, and bioavailability, with better control of drug release and can target alveolar macrophages. However, more pre-clinical studies and robust bio-relevant analyses are needed for DDSs to become a feasible option to treat patients and attract investors.

Factors associated with the waiting time for access to specialized oral healthcare services in Brazil.

OBJECTIVES: To explore the factors associated with the waiting time for access to specialized care at Dental Specialties Centers (CEO, in Portuguese), by specialty (Stomatology, Surgery, Endodontics, Patients with Special Needs and Periodontology). METHODS: The study was a descriptive and analytic exploratory secondary analysis of data from the 2nd phase of the National Program for Improving the Access to and Quality of CEO (PMAQ-CEO, in Portuguese). All 1097 CEO in Brazil were evaluated in loco in 2018. Binary logistic regression was used to analyse the likelihood of users having a shorter time for assistance at CEO, by specialty. RESULTS: The highest and lowest median waiting times were found for endodontics (30 days) and stomatology (5 days), respectively. Smaller centres (type I CEO) had a shorter waiting list for patients with special needs (95%CI: 1.20-3.37), Endodontics (95%CI: 1.03-3.02) and Surgery (95%CI: 1.04-3.05). As for the specialties with the longest waiting list (Endodontics and Surgery), the direct route of user access to CEO was more effective than that regulated by the Healthcare System. CONCLUSIONS: Factors related to the service, management, and to the form of relationship with primary health care influenced the waiting time for specialized care in CEO. The contact between professionals in the oral health network (primary care and secondary) was associated with a shorter waiting time, regardless of the specialty.

Synthesis of Eudragit® L100-coated chitosan-based nanoparticles for oral enoxaparin delivery.

Enoxaparin is an effective biological molecule for prevention and treatment of coagulation disorders. However, it is poorly absorbed in the gastrointestinal tract. In this study, we developed an Eudragit® L100 coated chitosan core shell nanoparticles for enoxaparin oral delivery (Eud/CS/Enox NPs) through a completely eco-friendly method without employing any high-energy homogenizer technique and any organic solvents. Spherical nanocarriers were successfully prepared with particle size lower than 300 nm, polydispersity index about 0.12 and zeta potential higher than +25 mV, entrapment efficiency greater than 95% and the in vitro release behavior confirms the good colloidal stability and the successful Eudragit® L100 coating process demonstrated by negligible cumulative enoxaparin release (<10%) when the particles are submitted to simulated gastric fluid conditions. Finally, we demonstrated that the core-shell structure of the particle influenced the drug release mechanism of the formulations, indicating the presence of the Eudragit® L100 on the surface of the particles. These results suggested that enteric-coating approach and drug delivery nanotechnology can be successfully explored as potential tools for oral delivery of enoxaparin.

Recent advances of Sterculia gums uses in drug delivery systems.

Trees of the genus Sterculia produce polysaccharide-rich exudates, such as karaya gum (Sterculia urens), chicha gum (Sterculia striata), and Sterculia foetida gum. These anionic biomaterials are biodegradable, with high viscosity, low toxicity, and gelling properties in aqueous media. According to these properties, they show promising applications as a polymer matrix for use in drug delivery systems. For this application, both the chemically modified and the unmodified polysaccharide are used. This review focuses on analyzing the state of the art of recent studies on the use of Sterculia gums in a variety of pharmaceutical forms, such as tablets, hydrogels, micro/nanoparticles, and mucoadhesive films. Sterculia gums-based delivery systems have potential to be explored for new drug delivery systems.