Effectiveness of three different local routes of dexamethasone administration on postoperative sequelae following mandibular third molar surgery. A prospective randomised single-blind clinical study / Eficácia de três diferentes vias locais de administração de dexametasona em sequelas pós-operatórias após cirurgia de terceiros molares inferiores. Um estudo clínico prospectivo randomizado simples-cego

Objective: The aim of this study was to provide evidence for comparing the effectiveness of three different routes of local administration of Dexamethasone on the postoperative pain, edema and trismus following surgical removal of impacted mandibular third molar. Material and Methods: Forty-five patients underwent surgical removal of impacted lower third molars and were randomly allocated postoperatively into 3 groups: 8 mg of dexamethasone injected into the submucosa of the vestibule near the surgical site (group I), 8 mg of dexamethasone injected into the pterygomandibular space (group II) and 10 mg of dexamethasone powder applied to the extraction site, after bleeding control (group III). Facial swelling and maximal interincisal opening were measured at preoperatively. Pain was measured by the patient response to a visual analogue scale. Pain perception, Facial edema and trismus were evaluated for one week postoperatively. Results: There was no significant difference between the three groups concerning pain after 1, 2, 5, 7 days of follow up. However, group II showed less pain at 3 and 4 days. The difference between edema measurements was not significant in the three groups at 1, 5, 7 days, though in group I and II edema subsided from day 2. As for trismus, group I and III showed statistically significant lower maximum interincisal opening measurement than group II after two days. Conclusion: Local administration of Dexamethasone through three different routes is beneficial in decreasing postoperative sequelae following third molar surgery. Pterygomandibular space injection of Dexamethasone resulted in earlier resolution of pain, and less facial edema and trismus at the second postoperative day compared to the submucosal injection and transalveolar application. However, at one week the difference in measurements of the three variables between the groups was not significant. (AU)

Objetivo: O objetivo deste estudo foi fornecer evidências para comparar a eficácia de três diferentes vias de administração local de dexametasona na dor pós-operatória, edema e trismo após a remoção cirúrgica do terceiro molar inferior impactado. Material e Métodos: Quarenta e cinco pacientes foram submetidos à remoção cirúrgica de terceiros molares inferiores impactados e distribuídos aleatoriamente no pós-operatório em 3 grupos: 8 mg de dexametasona injetados na submucosa vestíbular próximo ao local da cirurgia (grupo I), 8 mg de dexametasona injetados no espaço pterigomandibular (grupo II) e 10 mg de pó de dexametasona aplicados no local da extração, após o controle do sangramento (grupo III). Edema facial e abertura interincisal máxima foram medidos no pré-operatório. A dor foi medida pela resposta do paciente a uma escala visual analógica. Percepção de dor, edema facial e trismo foram avaliados por uma semana de pós-operatório. Resultados: Não houve diferença significativa entre os três grupos em relação à dor após 1, 2, 5, 7 dias de acompanhamento. No entanto, o grupoII mostrou menos dor em 3 e 4 dias. A diferença entre as medidas de edema não foi significativa nos três grupos em 1, 5, 7 dias, embora nos grupos I e II o edema cedeu a partir do dia 2. Quanto ao trismo, os grupos I e III apresentaram medida de abertura interincisal máxima inferior estatisticamente significativa do que o grupo II depois de dois dias. Conclusão: A administração local de dexametasona por três vias diferentes é benéfica na redução das sequelas pós-operatórias após a cirurgia do terceiro molar. A injeção de dexametasona no espaço pterigomandibular resultou na resolução mais precoce da dor e menos edema facial e trismo no segundo dia de pós-operatório em comparação com a injeção submucosa e a aplicação transalveolar. No entanto, em uma semana, a diferença nas medidas das três variáveis entre os grupos não foi significativa.(AU)

Effect of Enterococcus faecium as a Water and/or Feed Additive on the Gut Microbiota, Hematologic and Immunological Parameters, and Resistance Against Francisellosis and Streptococcosis in Nile Tilapia (Oreochromis niloticus).

In the present study, we evaluated the effects of administering Enterococcus faecium in food and/or water on the hematological and immunological parameters, intestinal microbiota, resistance to bacterial diseases (streptococcosis and francisellosis) and growth of Nile tilapia. Before the in vivo experiment, probiotic bacteria isolated from Nile tilapia were selected via inhibition tests. Sequencing, annotation, and assembly of the complete genome of the selected bacteria as well as other tests were performed using bioinformatics tools. Three treatments were implemented: G1 (probiotic feeding), G2 (probiotic in water), and G3 (probiotic in food and water); and a negative control (NC) was also employed. Treatment lasted 38 days, and each group consisted of fish and two repetitions. The fish were divided and infected with Streptococcus agalactiae S13 (serotype Ib) and Francisella orientalis. The G1 group had a higher average final weight gain than the G2, G3, and NC groups. Further, a significant increase in the number of thrombocytes was observed in the groups administered probiotics in the diet (G1 and G3). A statistical difference was observed in the mortality of fish infected with S. agalactiae in the NC compared to the treated groups. Cetobacterium was the 43 most abundant genus in the intestinal microbiota of all groups, including the NC group. E. faecium increased the immunity of fish administered the treatment and decreased the mortality caused by S. agalactiae. As an autochtone probiotic, E. faecium does not interfere with the local ecosystem and thus has a great probiotic potential for Nile tilapia in Brazil.

Errores de administración de medicamentos en enfermería / Medication administration errors in nursing

Introducción: los errores en el proceso de administración de medicamentos (EPAM) corresponden a múltiples factores, como: la condición de vulnerabilidad del usuario, dinámica que se vive dentro de las propias unidades y confusión en la terapia farmacológica, entre otros. El mayor porcentaje de los EPAM se produce en la etapa de administración, por lo que el rol de enfermería es fundamental. Existen diversas estrategias destinadas a la prevención, con distintos niveles de complejidad, en términos de implementación. Objetivo: conocer las múltiples causas que llevan al personal de enfermería a realizar una mala praxis en el proceso de administración de medicamentos. Material y métodos: se realizó una revisión de literatura mediante la búsqueda de artículos científicos en las siguientes bases de datos: Cochrane, Embase, Medline y SciELO. Conclusión: es indispensable hacer conciencia de la responsabilidad en los profesionales de enfermería para cumplir con las normas en la administración de medicamentos, con los "10 correctos" y evitar riesgos innecesarios a los pacientes que pueden en algunos casos ocasionar consecuencias graves.

Solid Lipid Nanoparticles for Drug Delivery: Pharmacological and Biopharmaceutical Aspects.

In the golden age of pharmaceutical nanocarriers, we are witnessing a maturation stage of the original concepts and ideas. There is no doubt that nanoformulations are extremely valuable tools for drug delivery applications; the current challenge is how to optimize them to ensure that they are safe, effective and scalable, so that they can be manufactured at an industrial level and advance to clinical use. In this context, lipid nanoparticles have gained ground, since they are generally regarded as non-toxic, biocompatible and easy-to-produce formulations. Pharmaceutical applications of lipid nanocarriers are a burgeoning field for the transport and delivery of a diversity of therapeutic agents, from biotechnological products to small drug molecules. This review starts with a brief overview of the characteristics of solid lipid nanoparticles and discusses the relevancy of performing systematic preformulation studies. The main applications, as well as the advantages that this type of nanovehicles offers in certain therapeutic scenarios are discussed. Next, pharmacokinetic aspects are described, such as routes of administration, absorption after oral administration, distribution in the organism (including brain penetration) and elimination processes. Safety and toxicity issues are also addressed. Our work presents an original point of view, addressing the biopharmaceutical aspects of these nanovehicles by means of descriptive statistics of the state-of-the-art of solid lipid nanoparticles research. All the presented results, trends, graphs and discussions are based in a systematic (and reproducible) bibliographic search that considered only original papers in the subject, covering a 7 years range (2013-today), a period that accounts for more than 60% of the total number of publications in the topic in the main bibliographic databases and search engines. Focus was placed on the therapeutic fields of application, absorption and distribution processes and current efforts for the translation into the clinical practice of lipid-based nanoparticles. For this, the currently active clinical trials on lipid nanoparticles were reviewed, with a brief discussion on what achievements or milestones are still to be reached, as a way of understanding the reasons for the scarce number of solid lipid nanoparticles undergoing clinical trials.

Formulating SLN and NLC as Innovative Drug Delivery Systems for Non-Invasive Routes of Drug Administration.

Colloidal carriers diverge depending on their composition, ability to incorporate drugs and applicability, but the common feature is the small average particle size. Among the carriers with the potential nanostructured drug delivery application there are SLN and NLC. These nanostructured systems consist of complex lipids and highly purified mixtures of glycerides having varying particle size. Also, these systems have shown physical stability, protection capacity of unstable drugs, release control ability, excellent tolerability, possibility of vectorization, and no reported production problems related to large-scale. Several production procedures can be applied to achieve high association efficiency between the bioactive and the carrier, depending on the physicochemical properties of both, as well as on the production procedure applied. The whole set of unique advantages such as enhanced drug loading capacity, prevention of drug expulsion, leads to more flexibility for modulation of drug release and makes Lipid-based nanocarriers (LNCs) versatile delivery system for various routes of administration. The route of administration has a significant impact on the therapeutic outcome of a drug. Thus, the non-invasive routes, which were of minor importance as parts of drug delivery in the past, have assumed added importance drugs, proteins, peptides and biopharmaceuticals drug delivery and these include nasal, buccal, vaginal and transdermal routes. The objective of this paper is to present the state of the art concerning the application of the lipid nanocarriers designated for non-invasive routes of administration. In this manner, this review presents an innovative technological platform to develop nanostructured delivery systems with great versatility of application in non-invasive routes of administration and targeting drug release.

Lipid-based carriers for the delivery of local anesthetics.

INTRODUCTION: There is a clinical need for pharmaceutical dosage forms devised to prolong the acting time of local anesthetic (LA) agents or to reduce their toxicity. Encapsulation of LA in drug delivery systems (DDSs) can provide long-term anesthesia for inpatients (e.g. in immediate postsurgical pain control, avoiding the side effects from systemic analgesia) and diminished systemic toxicity for outpatients (in ambulatory/dentistry procedures). The lipid-based formulations described here, such as liposomes, microemulsions, and lipid nanoparticles, have provided several nanotechnological advances and therapeutic alternatives despite some inherent limitations associated with the fabrication processes, costs, and preclinical evaluation models. AREAS COVERED: A description of the currently promising lipid-based carriers, including liposomes, microemulsions, and nanostructured lipid carriers, followed by a systematic review of the existing lipid-based formulations proposed for LA. Trends in the research of these LA-in-DDS are then exposed, from the point of view of administration route and alternatives for non-traditionally administered LA molecules. EXPERT OPINION: Considering the current state and potential future developments in the field, we discuss the reasons for why dozens of formulations published every year fail to reach clinical trials; only one lipid-based formulation for the delivery of local anesthetic (Exparel®) has been approved so far.

Nivel de adherencia al protocolo de administración de medicamentos / Level of adherence to medication administration protocol / Adesão ao protocolo de gerenciamento de nível droga

Objetivo: Determinar el nivel de adherencia al protocolo de administración de medicamentos por el personal auxiliar de enfermería en una institución de salud de cuarto nivel. Materiales y Métodos: La presente investigación es de carácter cuantitativo de tipo descriptivo de corte transversal, se trabajó con una muestra de 150 auxiliares de enfermería que cumplieron los criterios de inclusión. Para la recolección de la información se utilizó dos instrumentos: una lista de chequeo y un test de conocimientos elaborados y validados por los investigadores. Resultados: El nivel de conocimientos sobre la administración de medicamentos que tiene el personal fue adecuado en un 50%, y la aplicabilidad del protocolo se cumple en el 65% del personal. Conclusión: El nivel de adherencia al protocolo de administración de medicamentos que tiene el personal auxiliar de enfermería es del 65%, existiendo una adecuada relación entre los conocimientos y la aplicabilidad de los mismos.

Goal. Determine the level of adherence to protocol management drugs by the auxiliary nurse in a fourth level health institution. Materials and Methods. This research is a quantitative type descriptive cross-sectional, we worked with a sample of 150 nursing assistants who met the inclusion criteria. For data collection was used two instruments: a checklist and a knowledge test developed and validated by researchers. Results. The level of knowledge about managing drug that the staff has, it was adequated in 50%, and the applicability protocol is met in 65% of the staff. Conclusion. The level of adherence to medication administration protocol that the auxiliary nurses have in 65%, there will be an adequate relationship between knowledge and the applicability of these ones.

Objetivo: Determine o nível de adesão ao protocolo de gestão drogas por parte do auxiliar de enfermagem em uma unidade de saúde na sala nível. Materiais e Métodos: Esta pesquisa é do tipo quantitativa descritivo transversal, trabalhamos com uma amostra de 150 auxiliares de enfermagem que preencheram os critérios de inclusão. Para a coleta de dados foi utilizado dois instrumentos: uma lista de verificação e um teste de conhecimento desenvolvido e validado pelos pesquisadores. Resultados. O nível de conhecimento sobre o gerenciamento droga que tem o pessoal foi adequado em 50%, e a aplicabilidade protocolo é cumprida em 65% do pessoal. Conclusão. O nível de adesão ao protocolo de administração de medicamentos que tem os auxiliares de enfermagemé de 65%, será uma relação adequada entre o conhecimento ea aplicabilidade dos.

Dexmedetomidina e cetamina S(+) por via oralou intramuscular em gatas pediátricas: sedaçãoe parâmetros fisiológicos / Dexmedetomidine and ketamine S (+) orally or intramuscularly in female kittens:sedation and physiological parameters

Em virtude das particularidades dos pacientes pediátricos e da necessidade da utilização de protocolosanestésicos mais seguros e práticos, objetivou-se avaliar os efeitos sedativos da cetamina S(+) edexmedetomidina pela via intramuscular ou oral em gatas pediátricas. Foram utilizadas 12 fêmeas,sem raça definida (SRD), com 3 meses de idade e peso de 0,7±0,16kg. Os animais foram distribuídosem dois grupos: GIM (n=6), que receberam cetamina S+ (10mg/Kg) e dexmedetomidina (10μg/kg)pela via intramuscular, e GOR (n=6), que receberam os mesmos fármacos nas mesmas doses por viaoral.A frequência cardíaca (FC), frequência respiratória (f), temperatura retal (TR), pressão arterialsistólica (PAS), resposta ao pinçamento interdigital (PI), grau de sedação (GS) e relaxamento muscular(RM) foram avaliados antes da administração dos fármacos (T0) e aos 5, 15, 30, 45 e 60 minutosapós tratamento.Os valores de FC e PAS foram menores no GIM em T30 e T45 respectivamente. A ffoi menor em GIM a partir de T5, porém manteve-se dentro dos valores fisiológicos. A TR foi menora partir de T30 no GIM. Os valores obtidos com o PI foram menores para o GIM, com diminuiçãodos reflexos. No GIM obteve-se maior grau de sedação e miorrelaxamento. Conclui-se que ambosos protocolos apresentaram estabilidade cardiorrespiratória, entretanto os animais que receberam aassociação de dexmedetomidina e cetamina S(+) pela via intramuscular apresentaram maior efeitosedativo e miorrelaxamento.(AU)

Due to the particularities of pediatric patients and the necessity of use of safe and practical anestheticprotocols, the aim was to evaluate the sedative effects of S(+) ketamine and dexmedetomidine administeredorally or intramusculary in pediatric female cats. Twelve pediatric female cats, 0.7±0.16Kg,were used. The animals were divided in two groups: in the IMG (n=6), S(+) ketamine (10mg/Kg) anddexmedetomidine (10μg/Kg) were administered intramuscularly; in the ORG (n=6), the same drugsat the same doses were given orally. The heart rate (HR), respiratory rate (RR), rectal temperature (RT), non-invasive systolic arterial pressure (SAP), pedal withdrawal reflex (PWR), sedation degree (SD) and muscle relaxation(MR) were measured before drugs administration(T0)and at 5,15, 30,45and60minutes after the treatment.The HR and SAP were lower in GIM at T30 and T45, respectively. In GIM, RR was lower from T5, but remained inphysiological values. The RT was lower from T30 in GIM. The means of ICR were lower in GIM, with diminishedreflexes. In GIM, a higher degree of sedation and muscle relaxant were obtained. We conclude that both protocolsmaintained cardiorespiratory stability, but the animals that received the combination of dexmedetomidine andketamine S (+) intramuscularly showed greater muscle relaxant and sedative effects than the oral route.(AU)

Dexmedetomidina e cetamina S(+) por via oralou intramuscular em gatas pediátricas: sedaçãoe parâmetros fisiológicos / Dexmedetomidine and ketamine S (+) orally or intramuscularly in female kittens:sedation and physiological parameters

Em virtude das particularidades dos pacientes pediátricos e da necessidade da utilização de protocolosanestésicos mais seguros e práticos, objetivou-se avaliar os efeitos sedativos da cetamina S(+) edexmedetomidina pela via intramuscular ou oral em gatas pediátricas. Foram utilizadas 12 fêmeas,sem raça definida (SRD), com 3 meses de idade e peso de 0,7±0,16kg. Os animais foram distribuídosem dois grupos: GIM (n=6), que receberam cetamina S+ (10mg/Kg) e dexmedetomidina (10μg/kg)pela via intramuscular, e GOR (n=6), que receberam os mesmos fármacos nas mesmas doses por viaoral.A frequência cardíaca (FC), frequência respiratória (f), temperatura retal (TR), pressão arterialsistólica (PAS), resposta ao pinçamento interdigital (PI), grau de sedação (GS) e relaxamento muscular(RM) foram avaliados antes da administração dos fármacos (T0) e aos 5, 15, 30, 45 e 60 minutosapós tratamento.Os valores de FC e PAS foram menores no GIM em T30 e T45 respectivamente. A ffoi menor em GIM a partir de T5, porém manteve-se dentro dos valores fisiológicos. A TR foi menora partir de T30 no GIM. Os valores obtidos com o PI foram menores para o GIM, com diminuiçãodos reflexos. No GIM obteve-se maior grau de sedação e miorrelaxamento. Conclui-se que ambosos protocolos apresentaram estabilidade cardiorrespiratória, entretanto os animais que receberam aassociação de dexmedetomidina e cetamina S(+) pela via intramuscular apresentaram maior efeitosedativo e miorrelaxamento.

Due to the particularities of pediatric patients and the necessity of use of safe and practical anestheticprotocols, the aim was to evaluate the sedative effects of S(+) ketamine and dexmedetomidine administeredorally or intramusculary in pediatric female cats. Twelve pediatric female cats, 0.7±0.16Kg,were used. The animals were divided in two groups: in the IMG (n=6), S(+) ketamine (10mg/Kg) anddexmedetomidine (10μg/Kg) were administered intramuscularly; in the ORG (n=6), the same drugsat the same doses were given orally. The heart rate (HR), respiratory rate (RR), rectal temperature (RT), non-invasive systolic arterial pressure (SAP), pedal withdrawal reflex (PWR), sedation degree (SD) and muscle relaxation(MR) were measured before drugs administration(T0)and at 5,15, 30,45and60minutes after the treatment.The HR and SAP were lower in GIM at T30 and T45, respectively. In GIM, RR was lower from T5, but remained inphysiological values. The RT was lower from T30 in GIM. The means of ICR were lower in GIM, with diminishedreflexes. In GIM, a higher degree of sedation and muscle relaxant were obtained. We conclude that both protocolsmaintained cardiorespiratory stability, but the animals that received the combination of dexmedetomidine andketamine S (+) intramuscularly showed greater muscle relaxant and sedative effects than the oral route.