Oral ingestion of a hydrolyzed gelatin meal in subjects with normal weight and in obese patients: Postprandial effect on circulating gut peptides, glucose and insulin.

Gut hormones [ghrelin, peptide YY (PYY) and glucagon-like peptide-1 (GLP-1)] are an important group of hormones that target appetite control. They are released from endocrine L cells of the small bowel in proportion to the volume, components and calories in a meal. In the current study, 20 g of gelatin (flavored and sweetened) were given to obese patients (n=12) and lean subjects (n=10). Subsequently, plasma samples were collected at-30- minute intervals up to 180 minutes and glucose, insulin, PYY, GLP-1 and ghrelin were assayed using specific and sensitive immunofluorometric and radioimmunoassays. As expected, obese patients had normal serum glucose levels, higher serum insulin, and lower plasma concentration of ghrelin at all times compared to lean subjects. GLP-1 plasma levels were significantly elevated at 60 minutes, peaking at 120 minutes in obese patients and lean subjects. As a consequence, there was a significant rise in serum insulin levels with a significantly higher peak level at 60 min (obese) and 30 min (lean). There were no significant changes in PYY plasma concentrations and no correlation was found between body mass index and concentrations of ghrelin, PYY and GLP-1 in the group of obese patients. In conclusion, a single gelatin meal induces a rise in plasma GLP-1 followed by an increase in serum levels of insulin. These findings may be applied to maximize satiety in obese patients as a means of improving adherence to calorie-controlled diets as well as provide better control of diabetic patients.

Cyclosporine bioavailability of two physically different oral formulations.

To assess the comparative bioavailability of two cyclosporine capsule products with different pharmaceutical formulation an open randomized two-period cross over study was conducted in 24 healthy volunteers. Our results, obtained from cyclosporine HPLC determination onto the whole blood samples collected, show that the test cyclosporine non-SMEDDS formulation was not bioequivalent cyclosporine SMEDDS formulation due to a statistically significantly lower absorption rate. The outcome does not support free and full interchangeability in chronic stable graft recipients of the two products studied, unless validated clinical and laboratory conversion protocols for each kind of organ transplantation are enforce.

Cost of drugs manufactured by the university hospital--role of the Central Pharmacy.

UNLABELLED: The hospital pharmacy in large and advanced institutions has evolved from a simple storage and distribution unit into a highly specialized manipulation and dispensation center, responsible for the handling of hundreds of clinical requests, many of them unique and not obtainable from commercial companies. It was therefore quite natural that in many environments, a manufacturing service was gradually established, to cater to both conventional and extraordinary demands of the medical staff. That was the case of Hospital das Clínicas, where multiple categories of drugs are routinely produced inside the pharmacy. However, cost-containment imperatives dictate that such activities be reassessed in the light of their efficiency and essentiality. METHODS: In a prospective study, the output of the Manufacturing Service of the Central Pharmacy during a 12-month period was documented and classified into three types. Group I comprised drugs similar to commercially distributed products, Group II included exclusive formulations for routine consumption, and Group III dealt with special demands related to clinical investigations. RESULTS: Findings for the three categories indicated that these groups represented 34.4%, 45.3%, and 20.3% of total manufacture orders, respectively. Costs of production were assessed and compared with market prices for Group 1 preparations, indicating savings of 63.5%. When applied to the other groups, for which direct equivalent in market value did not exist, these results would suggest total yearly savings of over 5 100 000 US dollars. Even considering that these calculations leave out many components of cost, notably those concerning marketing and distribution, it might still be concluded that at least part of the savings achieved were real. CONCLUSIONS: The observed savings, allied with the convenience and reliability with which the Central Pharmacy performed its obligations, support the contention that internal manufacture of pharmaceutical formulations was a cost-effective alternative in the described setting.

[Patient cooperation with his therapeutic regimen]. / Cooperação do paciente com seu regime terapêutico.

The common failure of patients to follow medical instructions creates a problem for the physicians who need to know whether or not their patient are following advice. Lack of patient compliance with prescribed regimens is an important and fascinating problem in medical care. Reports indicate that patients do not follow medical instructions faithfully and that physicians are unable to determine their patient's cooperation levels. Medication compliance has been defined in terms of agreement between the prescription and the behaviour of those who will be taking medicines. The conclusion that can be drawn is that more research in the cited field is quite necessary.

[The quantitative assessment of drug use]. / Avaliação qualitativa no uso de medicamentos.

In a large number of countries where a national health care or a comparable institution is established, precise data on drug utilization are not generally available and often difficult to obtain. This unsatisfactory situation is particularly evident in cases where the preference for drugs in the treatment of certain diseases differ substantially among various countries, since there exists no information about the comparative benefits of the diverse drug regimens. The use of a defined daily dose (DDD) as a unit of measurement makes it possible to compile comparative drug statistics at any time and between regions and countries, independent of changes in prices and currency, as well as differences in drug assortment. The DDD is defined as the assumed average daily doses for adults in the main indication of the drug. It should be emphasized that the DDD is not the recommended dose, but simply a technical unit of measurement.

[Drug utilization at the University Hospital]. / Utilização de medicamentos em Hospital Universitário.

With the aim of establishing guidelines on the proper use of drugs and defined daily doses (DDD) for Brazil, a system for collecting data and analyzing the demand for and consumption of drugs is being implemented at the University Hospital of the University of São Paulo. To this end, statistics were drawn from the pharmacy and from medical records. The products standardized by the hospital using the alphanumeric code (based on the official structure of the Ministry of Health) were identified, with five levels of information. The first, expressed in letters, divides the drugs into 14 major groups, defined in accordance with specializations in medical services. The subsequent levels identify the anatomical-pharmacological subgroups, classes, active principles, and dosage forms. The system makes possible access to different levels of drug classification, and allows for introducing changes to the list of standardized drugs without affecting the already-recorded information. This study on the use of drugs, in a standard health care environment, will make it possible to draw important conclusions as to the relationship between the demand profile and the morbidity profile.

Anti-inflammatory activity of oleoresin from Brazilian Copaifera.

The oleoresin from Brazilian Copaifera species yielded copalic acid and sesquiterpenes and showed marked anti-inflammatory activity using various experimental models in rats. The oleoresin significantly inhibited carrageenin-induced pedal edema following oral doses from 0.70 to 2.69 ml/kg, but was somewhat less effective than 50 mg/kg calcium phenylbutazone. Repeated administration of the oleoresin at a dose of 1.26 ml/kg for a 6-day period reduced granuloma formation with a response comparable to that of 20 mg/kg of calcium phenylbutazone. This same dose of oleoresin also reduced the vascular permeability to intracutaneous histamine. The LD50 value of the oleoresin in rats was estimated to be 3.79 (3.21-4.47) ml/kg.

Concept and use of psychoactive drugs among university students in Sao Paulo area.

PIP: A questionnaire on drugs was distributed and administered in 25 schools at the university level in Brazil in an effort to empirically substantiate the status and pattern of drug use and misuse by university students for the purpose of providing effective and meaningful intervention. The total number of completed questionnaires was 2020. Stimulants and marihuana are used constantly or frequently by about 1% of the total number. 70% of the students drink alcoholic beverages sporadically or little; 13.1% drink regularly, and 0.9% very frequently. About 2/3 of the students who have used stimulants or marihuana did so before age 19.^ieng