The Hazardous Level of Heavy Metals in Different Medicinal Plants and Their Decoctions in Water: A Public Health Problem in Brazil.

The determination of Cd, Co, Cr, Cu, Fe, Na, Zn, and Pb by inductively coupled plasma-optical emission spectrometry (ICP OES) was performed on dry matter and decoctions of the medicinal plants Cordia salicifolia, Chiococca alba (L.) Hitchc., and Echites peltata used as an appetite suppressant and diuretic in Brazil. The accuracy of the measurements was analyzed by the spike recovery test. Results showed that the concentration of these seven metals (Cd, Co, Cr, Cu, Fe, Na, and Zn) in dry plant samples is below the oral concentration of elemental impurities established by the United States Pharmacopoeia Convention (USP). However, there are no concentration limits for Fe, Na, and Zn established by the USP in drug substances and excipients. Levels higher than the recommended value by the USP were observed for Pb and the lowest for Cd, Co, Cr, and Cu, both in dried plant samples and their decoctions. In the decoctions prepared from these plants were found elements such as Cd, Co, Cr, Cu, Fe, Na, Zn, and Pb. In the decoction prepared from 40 g C. salicifolia leaves and 40 g C. alba wood, the content of Cd is above the oral daily exposure value set by the USP. Hazard index (HI) for decoctions prepared from these plants exceeded the threshold (1). Given the uncertainties associated with the estimates of toxicity values and exposure factors, futures researches should address the possible toxicity in humans. Uncontrolled selling and long-term ingestion of medicinal plants can cause toxicity and interfere with the effect of drugs. Limited knowledge on the interaction potential of medicinal plants poses a challenge and public health problem in Brazil and other countries.

Oxidative stress in coronary artery bypass surgery / Estresse oxidativo na cirurgia de revascularização miocárdica

AbstractObjective:The aim of this prospective study was to assess the dynamics of oxidative stress during coronary artery bypass surgery with cardiopulmonary bypass.Methods:Sixteen patients undergoing coronary artery bypass grafting were enrolled. Blood samples were collected from the systemic circulation during anesthesia induction (radial artery - A1), the systemic venous return (B1 and B2) four minutes after removal of the aortic cross-clamping, of the coronary sinus (CS1 and CS2) four minutes after removal of the aortic cross-clamping and the systemic circulation four minutes after completion of cardiopulmonary bypass (radial artery - A2). The marker of oxidative stress, malondialdehyde, was measured using spectrophotometry.Results:The mean values of malondialdehyde were (ng/dl): A1 (265.1), B1 (490.0), CS1 (527.0), B2 (599.6), CS2 (685.0) and A2 (527.2). Comparisons between A1/B1, A1/CS1, A1/B2, A1/CS2, A1/A2 were significant, with ascending values (P<0.05). Comparisons between the measurements of the coronary sinus and venous reservoir after the two moments of reperfusion (B1/B2 and CS1/CS2) were higher when CS2 (P<0.05). Despite higher values ​​after the end of cardiopulmonary bypass (A2), when compared to samples of anesthesia (A1), those show a downward trend when compared to the samples of the second moment of reperfusion (CS2) (P<0.05).Conclusion:The measurement of malondialdehyde shows that coronary artery bypass grafting with cardiopulmonary bypass is accompanied by increase of free radicals and this trend gradually decreases after its completion. Aortic clamping exacerbates oxidative stress but has sharper decline after reperfusion when compared to systemic metabolism. The behavior of thiobarbituric acid species indicates that oxidative stress is an inevitable pathophysiological component.

ResumoObjetivo:O objetivo deste estudo prospectivo foi avaliar a dinâmica do estresse oxidativo durante a cirurgia de revascularização miocárdica com circulação extracorpórea.Métodos:Participaram 16 pacientes submetidos à revascularização miocárdica. As amostras de sangue foram coletadas da circulação sistêmica, no momento da indução anestésica (artéria radial - A1), do retorno venoso sistêmico (B1 e B2), quatro minutos após a remoção do pinçamento aórtico, do seio coronariano (SC1 e SC2), quatro minutos após a remoção do pinçamento aórtico, e da circulação sistêmica, quatro minutos após finalização da circulação extracorpórea (artéria radial - A2). O marcador do estresse oxidativo, malondialdeído, foi dosado utilizando espectrofotometria.Resultados:Os valores médios de malondialdeído foram (ng/dl): A1 (265,1), B1 (490,0), SC1 (527,0), B2 (599,6), SC2 (685,0) e A2 (527,2). As comparações entre A1/B1, A1/SC1, A1/B2, A1/SC2, A1/A2 foram significativas, com valores ascendentes (P<0,05). As comparações entre as dosagens do seio coronário e reservatório venoso após os dois momentos de reperfusão (B1/SC1 e B2/SC2) foram mais elevadas no momento SC2 (P<0,05). Apesar dos valores mais elevados após o término da circulação extracorpórea (A2), quando comparadas às amostras da indução anestésica (A1), aqueles apresentam tendência de queda quando comparadas as amostras do segundo momento de reperfusão (SC2) (P<0,05).Conclusão:As dosagens de malondialdeído mostram que a revascularização miocárdica com circulação extracorpórea é acompanhada de aumento de radicais livres com tendência deste diminuir progressivamente após seu término. O pinçamento aórtico exacerba o estresse oxidativo, porém apresenta queda mais acentuada após a reperfusão quando comparadas ao do metabolismo sistêmico. O comportamento das espécies reativas ao ácido tiobarbitúrico indica que o estresse oxidativo é um componente patofisiológico inevitável.

Oxidative stress in coronary artery bypass surgery.

OBJECTIVE: The aim of this prospective study was to assess the dynamics of oxidative stress during coronary artery bypass surgery with cardiopulmonary bypass. METHODS: Sixteen patients undergoing coronary artery bypass grafting were enrolled. Blood samples were collected from the systemic circulation during anesthesia induction (radial artery--A1), the systemic venous return (B1 and B2) four minutes after removal of the aortic cross-clamping, of the coronary sinus (CS1 and CS2) four minutes after removal of the aortic cross-clamping and the systemic circulation four minutes after completion of cardiopulmonary bypass (radial artery--A2). The marker of oxidative stress, malondialdehyde, was measured using spectrophotometry. RESULTS: The mean values of malondialdehyde were (ng/dl): A1 (265.1), B1 (490.0), CS1 (527.0), B2 (599.6), CS2 (685.0) and A2 (527.2). Comparisons between A1/B1, A1/CS1, A1/B2, A1/CS2, A1/A2 were significant, with ascending values (P<0.05). Comparisons between the measurements of the coronary sinus and venous reservoir after the two moments of reperfusion (B1/B2 and CS1/CS2) were higher when CS2 (P<0.05). Despite higher values after the end of cardiopulmonary bypass (A2), when compared to samples of anesthesia (A1), those show a downward trend when compared to the samples of the second moment of reperfusion (CS2) (P<0.05). CONCLUSION: The measurement of malondialdehyde shows that coronary artery bypass grafting with cardiopulmonary bypass is accompanied by increase of free radicals and this trend gradually decreases after its completion. Aortic clamping exacerbates oxidative stress but has sharper decline after reperfusion when compared to systemic metabolism. The behavior of thiobarbituric acid species indicates that oxidative stress is an inevitable pathophysiological component.

Structural modeling of djenkolic acid with sulfur replaced by selenium and tellurium.

The comparative structural modeling of djenkolic acid and its derivatives containing selenium and tellurium in chalcogen sites (Ch=Se, Te) has provided detailed information about the bond lengths and bond angles, filling the gap in what we know about the structural characteristics of these aminoacids. The investigation using the molecular mechanics technique with good approximation confirmed the available information on X-ray refinements for the related compounds methionine and selenomethionine, as well as for an estimate made earlier for telluromethionine. It was shown that the Ch-C(3) and Ch-C(4) bond lengths grow in parallel with the increasing anionic radii. Although the distances C-C, C-O, and C-N are very similar, the geometry of conformers is quite different owing to the possibility of rotation about four carbon atoms, hence the remarkable variability observed in dihedral angles. It was shown that the compounds contain a rigid block with two Ch atoms connected through a methylene group. The standard program Gaussian 03 with graphical interface Gaussview 4.1.2 has proved to be satisfactory tool for the structural description of less-common bioactive compositions when direct X-ray results are absent.

Computerized modeling of adenosine triphosphate, adenosine triarsenate and adenosine trivanadate.

Computerized molecular models of adenosine triphosphate, adenosine tri-arsenate and adenosine trivanadate have been generated using the molecular mechanics technique. The analysis of structural parameters indicated that, at least theoretically, adenosine triarsenate is a realistic candidate for replacement of adenosine triphosphate in biochemical pathways. On the contrary, the structural arrangement of the inorganic segment of adenosine trivanadate does not seem to be capable of withstanding a swift hydrolytical splitting in aqueous milieu. It was shown that the universal force field as implemented in Gaussian software packages is an appropriate tool for the optimization of less-common bioactive compositions.

Comparação entre suplementos homólogos do leite humano e um suplemento comercial para recém-nascidos de muito baixo peso / Comparison between homologous human milk supplements and a commercial supplement for very low birth weight infants

OBJETIVOS: Descrever a metodologia de preparo de dois aditivos, líquido e em pó, derivados do leite humano e comparar a constituição com aditivo comercial FM85®. MÉTODOS: Foram utilizadas 40 amostras de leite humano para o preparo dos suplementos líquido e em pó. Ambos passaram por três fases de preparo: desnate, evaporação e retirada da lactose. Após essas fases, o suplemento líquido está pronto, e o em pó necessita da quarta fase - a liofilização. Em cada amostra dos suplementos líquido e em pó, foram adicionados, respectivamente, 80 mL (grupo I) e 100 mL (grupo II) de pool de leite humano de banco. Para comparação, 20 amostras de 100 mL do pool foram acrescidas de 5 g do suplemento FM85® (Nestlé) (grupo III). Realizaram-se análises de hidratos de carbono, proteína, lipídios, cálcio, fósforo, sódio, osmolalidade e conteúdo calórico, considerando diferença significativa p < 0,05. RESULTADOS: Os grupos I, II e III mostraram, respectivamente, os seguintes resultados: proteínas = 1,81, 2,38 e 1,96 g/dL (p < 0,001); hidratos de carbono = 6,70, 7,25 e 10,06 g/dL (p = 0,006); gordura = 3,75, 3,75 e 3,73 g/dL (p = 0,96); cálcio = 36,92, 44,75 e 79,37 mg/dL (p = 0,001); fósforo = 20,02, 23,28 e 56,30 mg/dL (p = 0,02); sódio = 14,32, 14,40 e 20,33 mEq/L (p = 0,143); osmolalidade = 391,45, 412,47 e 431, 00 mOsmol/kgH2O (p = 0,074); e conteúdo calórico = 67,78, 72,27 e 81,65 kcal (p = 0,001). CONCLUSÃO: Os aditivos estudados diferem significativamente do aditivo comercial FM85® em alguns de seus constituintes, e a sua constituição pode ou não atender às quantidades de nutrientes propostas pelas recomendações mais recentes.

OBJECTIVES: To describe the methodology for the preparation of two additives derived from human milk, liquid and powdered, and to compare this composition with the commercial additive FM85®. METHODS: For the preparation of the liquid and powdered supplements, 40 samples of human milk were used. Both supplements have been through three preparation phases: skimming, evaporation and lactose removal. After these phases, the liquid supplement is ready, and the powdered requires a fourth phase - lyophilization. To each sample of the liquid and powdered supplements were added, respectively, 80 mL (group I) and 100 mL (group II) of pooled banked human milk. For comparison, 20 samples of 100 mL of the pool were added to 5 g of the FM85® supplement (Nestlé) (group III). Analyses of carbohydrates, protein, lipids, calcium, phosphorus, sodium, osmolality and caloric content were performed, considering a significant difference p < 0.05. RESULTS: Groups I, II, and III showed, respectively, the following results: protein = 1.81, 2.38 and 1.96 g/dL (p < 0.001); carbohydrates = 6.70, 7.25 and 10.06 g/dL (p = 0.006); fat = 3.75, 3.75 and 3.73 g/dL (p = 0.96); calcium = 36.92, 44.75 and 79.37 mg/dL (p = 0.001); phosphorus = 20.02, 23.28 and 56.30 mg/dL (p = 0.02); sodium = 14.32, 14.40 and 20.33 mEq/L (p = 0.143); osmolality = 391.45, 412.47 and 431.00 mOsmol/kgH2O (p = 0.074); and caloric content = 67.78, 72.27 and 81.65 kcal (p = 0.001). CONCLUSION: The studied additives differ significantly from the commercial additive FM85® in some of its components, and its composition may or may not meet the quantity of nutrients suggested by the most recent recommendations.

Comparison between homologous human milk supplements and a commercial supplement for very low birth weight infants.

OBJECTIVES: To describe the methodology for the preparation of two additives derived from human milk, liquid and powdered, and to compare this composition with the commercial additive FM85®. METHODS: For the preparation of the liquid and powdered supplements, 40 samples of human milk were used. Both supplements have been through three preparation phases: skimming, evaporation and lactose removal. After these phases, the liquid supplement is ready, and the powdered requires a fourth phase - lyophilization. To each sample of the liquid and powdered supplements were added, respectively, 80 mL (group I) and 100 mL (group II) of pooled banked human milk. For comparison, 20 samples of 100 mL of the pool were added to 5 g of the FM85® supplement (Nestlé) (group III). Analyses of carbohydrates, protein, lipids, calcium, phosphorus, sodium, osmolality and caloric content were performed, considering a significant difference p < 0.05. RESULTS: Groups I, II, and III showed, respectively, the following results: protein = 1.81, 2.38 and 1.96 g/dL (p < 0.001); carbohydrates = 6.70, 7.25 and 10.06 g/dL (p = 0.006); fat = 3.75, 3.75 and 3.73 g/dL (p = 0.96); calcium = 36.92, 44.75 and 79.37 mg/dL (p = 0.001); phosphorus = 20.02, 23.28 and 56.30 mg/dL (p = 0.02); sodium = 14.32, 14.40 and 20.33 mEq/L (p = 0.143); osmolality = 391.45, 412.47 and 431.00 mOsmol/kgH(2)O (p = 0.074); and caloric content = 67.78, 72.27 and 81.65 kcal (p = 0.001). CONCLUSION: The studied additives differ significantly from the commercial additive FM85® in some of its components, and its composition may or may not meet the quantity of nutrients suggested by the most recent recommendations.

Trace elements in fruit juices.

Fruit juices are widely consumed in tropical countries as part of habitual diet. The concentrations of several minerals in these beverages were evaluated. Four commercially available brands of juices were analyzed for cadmium, lead, copper, zinc, aluminum, iron, chromium, manganese, and molybdenum. The levels ranged from 0.02 to 0.08 mg/L for copper, from 0.05 to 0.23 mg/L for zinc, from 0.1 to 0.4 mg/L for aluminum, from 0.02 to 0.45 mg/L for iron, and from 0.01 to 0.22 mg/L for manganese. The levels of cadmium, lead, and chromium in all samples were very low or undetectable. The metal contents of fruit juices depend on a number of factors, including the soil composition, the external conditions during fruit growing and fruit harvesting, as well as on details of the fruit juice manufacturing processes employed. The concentrations of none of the metals in juice samples analyzed exceeded the limits imposed by local legislation.

Nível de entendimento de prescrições medicamentosas pediátricas em Unidades Básicas de Saúde / The level of understanding of pediatric prescription medicines at Basic Health Units

OBJETIVOS: avaliar o nível de entendimento das prescrições medicamentosas pediátricas, pelos responsáveis das crianças, em Unidades Básicas de Saúde (UBS), município de Campo Grande, Mato Grosso do Sul. MÉTODOS: estudo transversal e descritivo, realizado entre maio de 2007 e junho de 2008. Foram entrevistados 336 acompanhantes de crianças, atendidas em UBS municipais, que receberam prescrição de medicamentos dispensados pela farmácia. Foram avaliados mediante questionário o nível de escolaridade e fatores relacionados à compreensão da prescrição como legibilidade, nome, dose, freqüência de administração, tempo de uso de medicamentos, bem como a compreensão das informações verbais complementares. RESULTADOS: dos entrevistados, 80,4 por cento (270) eram mães, 55 por cento-(185) cursaram ensino fundamental e 90,2 por cento (303) receberam informações verbais complementares à prescrição. Das prescrições apresentadas 87,5 por cento (294) foram consideradas legíveis. Dos entrevistados, 47 por cento (158) tiveram entendimento insuficiente da prescrição. O entendimento insuficiente da prescrição foi associado à baixa escolaridade, ao não recebimento de informação verbal complementar e ao maior número de medicamentos presentes na prescrição. CONCLUSÕES: é necessário que os responsáveis pela criança e profissionais envolvidos na prescrição e dispensação estejam conscientes da importância da informação sobre o medicamento, para a segurança das crianças.

OBJECTIVES: to evaluate the level of understanding of pediatric prescription medicines by those responsible for the children at Basic Health Units (BHUs) in the municipality of Campo Grande, in the Brazilian State of Mato Grosso do Sul. METHODS: a cross-sectional description study was carried out between May 2007 and June 2008. Three hundred and thirty-six of the individuals accompanying children attending municipal BHUs who received prescription medicine dispensed by the pharmacy were interviewed. A questionnaire was applied to evaluate level of education and factors relating to understanding of the prescription, such as legibility, name, dose, frequency of dose, duration of use, and understanding of complementary verbal information. RESULTS: of those interviewed, 80.4 percent (270) were mothers, 55 percent-(185) had completed basic education and 90.2 percent (303) had received complementary verbal information about the prescription. Of the prescriptions filled in, 87.5 percent (294) were considered to be legible. Of those interviewed, 47 percent (158) had insufficient understanding of the prescription. This was associated with low levels of education, not having received complementary verbal information and the number of different medicines on the prescription. CONCLUSIONS: those responsible for children and the professionals involved in the prescription and dispensation of medicines need to be aware of the importance of providing information on the medicine for the safety of the children.

Trace elements in different brands of yerba mate tea.

Yerba mate (Ilex paraguariensis), a widely consumed beverage in South America, contains various biochemically active substances, among them are several minerals. This paper reports on the results of a survey of trace elements in the yerba mate infusions. Three different commercially available trademarks of I. paraguariensis were evaluated, simulating the popular mode of preparation. Atomic absorption analyses for cadmium, lead, copper, zinc, aluminum, iron, chromium, manganese, molybdenum, and silver were performed using a graphite furnace. The levels ranged from 0.03 to 0.06 mg/L for copper, from 0.41 to 1.0 mg/L for zinc, from 0.32 to 1.7 mg/L for aluminum, from 0.12 to 0.23 mg/L for iron, from 2.3 to 7.0 mg/L for manganese, and from 0.01 to 0.03 mg/L for silver. The levels of chromium did not exceed 0.005 mg/L, while molybdenum, cadmium, and lead were lower than <0.01 mg/L. Metal content in mate tea infusions depends on a number of factors, some of which are controllable and others not, but the differences among various sources are admissible. Trace elements in mate plants seem to be weakly bounded to the substrate. The concentration of biometals does not exceed the limits accepted by Brazilian and international legislation when available.

Clinical effects of cesium intake.

The knowledge about cesium metabolism and toxicity is sparse. Oral intake of cesium chloride has been widely promoted on the basis of the hypothesis referred to as "high pH cancer therapy", a complimentary alternative medicine method for cancer treatment. However, no properly confirmed tumor regression was reported so far in all probability because of neither theoretical nor experimental grounds for this proposal. The aim of the present review was to resume and discuss the material currently available on cesium salts and their applications in medicine. The presence of cesium in the cell does not guarantee high pH of its content, and there is no clinical evidence to support the claims that cancer cells are vulnerable to cesium. Cesium is relatively safe; signs of its mild toxicity are gastrointestinal distress, hypotension, syncope, numbness, or tingling of the lips. Nevertheless, total cesium intakes of 6 g/day have been found to produce severe hypokalemia, hypomagnesemia, prolonged QTc interval, episodes of polymorphic ventricular tachycardia, with or without torsade de pointes, and even acute heart arrest. However, full information on its acute and chronic toxicity is not sufficiently known. Health care providers should be aware of the cardiac complications, as a result of careless cesium usage as alternative medicine.

Zinc and copper concentrations in human preterm milk.

Zinc and copper are important trace elements in the nutrition of preterm infants. This study determined and compared the concentrations of zinc and copper in preterm milk of mothers receiving and not receiving zinc supplementation diets. The effects of maternal supplementation on the blood levels and anthropometric parameters were evaluated. Thirty-eight mothers and their preterm infants were enrolled in the study. Eighteen mothers were given a daily supplementation of 50 mg zinc, whereas the other 20 were not. Zinc and copper levels in milk were determined at 15-day intervals, as were blood zinc levels along with anthropometric parameters. Zinc and copper contents were determined by atomic absorption spectrophotometry. No significant differences were found between groups either for zinc values in maternal milk and infant blood or for anthropometric measurements. A pronounced decrease in copper levels was observed in mothers receiving supplemental zinc. Zinc supplementation given to mothers who were breastfeeding preterm infants had no significant effect on zinc secretion in milk.

Antimony containing drug and ECG abnormalities in children with visceral leishmaniasis.

The objective of the paper was to evaluate the influence of antimony (5+) on electrocardiographic changes in children with visceral leishmaniasis. The study was based on weekly ECGs analysis of 87 children treated, from April 2001 to May 2006, with antimoniate N-methyl glucamine. Eligible subjects included children from 6 months to 12 years of age with weight of 6-34 kg. Forty-five children (52%) were males and forty-two (48%) were females. The cardiac response to antimony was significantly milder compared to the adult populations, so the usage of meglumine antimoniate is safer. Thus, during treatment sinus rhythm was maintained without ectopic beats. No changes were observed in the P wave and in PR interval. The QRS complex remained unaltered during the treatment, the amplitude being increased. The Sokolow's indexes exceeded normal values in one child on the first week and in eight children on the fourth. The prolongation of QTc occurred in ten patients. The T wave flattening was observed in seven children on the first week. In total, ECG abnormalities were detected in 34.4% of treatment courses, while in adults they were reported in 53.8%. Antimony therapy needs ECG monitoring of the cardiac function in order to prevent complications.

Copper and ceruloplasmin in children undergoing heart surgery with cardiopulmonary bypass.

Heart surgery with cardiopulmonary bypass (CPB) nowadays has become a routine procedure. However, under nonadequate hemodynamic conditions and because of the changes related to ischemia-reperfusion, there is a possibility to provoke oxidative stress with all undesirable consequences. Copper (Cu) is closely related to this stress, taking part in the formation of the hazardous-free radicals. Meanwhile, at least in the pediatric area, little is known about Cu kinetics during cardiac surgery. The purpose of the present work was to study Cu and ceruloplasmin (Cp) dynamics during surgery with CPB in children. Twenty-one patients of both genders from Campo Grande, Brazil with congenital heart conditions were enrolled in the investigation. Blood samples were collected before the surgery and during and 24 h after it. Cu and Cp levels were measured at selected moments and the influence of hemodilution studied. It was concluded that serum Cu dynamics during cardiopulmonary bypass reflects the protective effects of this trace element. Ceruloplasmin levels correlate positively with copper.

[Peripheral nervous system and grounds for the neural insult in leprosy]. / Sistema nervoso periférico e pressupostos da agressão neural na hanseníase.

The mechanism of interaction between Mycobacterium leprae and neural cells has not been elucidated so far. No satisfactory interpretation exists as to the bacterium tropism to the peripheral nervous system in particular. The present study is a review of the micro-physiology of the extracellular apparatus attached to Schwann cells, as well as on the description of morphological units probably involved in the process of the binding to the bacterial wall.