Plantas medicinales que actúan sobre el sistema inmune / Medicinal plants that act on the immune System

Introducción: El sistema inmune puede verse afectado por distintos factores, por lo que en ocasiones el empleo de plantas medicinales es un remedio efectivo para estimular las defensas y prevenir resfriados. Con la llegada actual de la pandemia de COVID-19 se ha incrementado notablemente la demanda de estos medicamentos a base de plantas medicinales, por lo que se hace necesario su conocimiento por parte de los farmacéuticos comunitarios entre otros profesionales de la salud. Método: Se ha realizado una revisión bibliográfica sobre distintas plantas que actúan a nivel del sistema inmune en distintas bases de datos, revistas especializadas y libros. Resultados: Echinacea purpurea (L.) Moench, Panax ginseng C.A. Meyer, Eleutherococcus senticosus Rupr. y Maxim. y Pelargonium sidoides DC. han demostrado su actividad inmunoestimulante, indicadas para la prevención de afecciones respiratorias leves. Por otro lado, se distinguen distintas plantas poseedoras de vitaminas y minerales que pueden ejercer efectos inmunomoduladores, así como distintos estudios recientes intentan verificar posibles efectos preventivos frente al SARS-CoV-2 por parte de algunas drogas vegetales como el bulbo de Allium sativum L. (ajo), el bulbo de Allium cepa L. (cebolla), el rizoma de Curcuma longa L. o la corteza de Uncaria tomentosa (Will.) DC. Conclusiones: Aunque algunas plantas han demostrado su acción sobre el sistema inmune, aún son necesarias más investigaciones que permitan incrementar el conocimiento sobre las distintas propiedades y mecanismos implicados en la actuación sobre el sistema inmune. (AU)

Introduction: The immune system can be affected by different factors, so sometimes the use of medicinal plants is an effective remedy to stimulate the defenses and prevent colds. With the arrival of the current COVID-19 pandemic, the demand for these herbal medicines has increased significantly, making it necessary for community pharmacists and other health professionals to be aware of them. Method: A bibliographic review has been carried out on different plants that act at the level of the immune system in different databases, specialized journals and books. Results: Echinacea purpurea (L.) Moench, Panax ginseng C.A. Meyer, Eleutherococcus senticosus Rupr. y Maxim. and Pelargonium sidoides DC. have demonstrated their immunostimulating activity, indicated for the prevention of mild respiratory diseases. On the other hand, different plants possessing vitamins and minerals that can exert immunomodulatory effects are distinguished, as well as different recent studies on possible preventives against SARS-CoV-2 by some plant drugs such as the bulb of Allium sativum L. (garlic), the bulb of Allium cepa L. (onion), the rhizome of Curcuma longa L. or the bark of Uncaria tomentosa (Will.) DC. Conclusions: Although some plants have demonstrated their action on the immune system, more research is still needed to learn more about the different properties and mechanisms involved in acting on the immune system. (AU)

Prevalence of advanced heart failure and use of palliative care in admitted patients: Findings from the EPICTER study.

INTRODUCTION AND AIM: Palliative care in patients with advanced heart failure is strongly recommended by Clinical Practice Guidelines. We aimed to calculate the prevalence of advanced heart failure in admitted patients, to describe their management, and to analyse the factors that influence their referral to specialised palliative care. PATIENTS AND METHODS: Cross-sectional, multicentre study that consecutively included patients admitted for heart failure in 74 Spanish hospitals. If they met criteria for advanced heart failure, their treatment, complications and procedures were recorded. RESULTS: A total of 3153 patients were included. Of them, 739 (23%) met criteria for advanced heart failure. They were more likely to be women, older and to have a history of anaemia, chronic kidney disease and cognitive impairment. For their management, furosemide infusions (30%) and vasodilators (21%) were used. Refractory symptoms were treated with opioids (47%) and benzodiazepines (44%). Palliative care was only provided in the last hours of life in 48% of them. A multidisciplinary approach, involving palliative care specialists was sought in 15% of these patients. Treatment with furosemide infusions, an advanced New York Heart Association functional class, to meet advanced HF criteria and the presence of cancer were associated with the referral to specialised palliative care. CONCLUSIONS: Almost one in four patients admitted with HF met criteria of advanced disease. They were older and had more comorbidities. Specialist palliative care services were involved in only a minority of patients, mainly those who were highly symptomatic or had cancer.

Validation of a school-based amblyopia screening protocol in a kindergarten population.

PURPOSE: To validate a school-based amblyopia screening program model by comparing its outcomes to those of a state-of-the-art conventional ophthalmic clinic examination in a kindergarten population of children between the ages of 4 and 5 years. METHODS: An amblyopia screening protocol, which consisted of visual acuity measurement using Lea charts, ocular alignment test, ocular motility assessment, and stereoacuity with TNO random-dot test, was performed at school in a pediatric 4- to 5-year-old population by qualified healthcare professionals. The outcomes were validated in a selected group by a conventional ophthalmologic examination performed in a fully equipped ophthalmologic center. The ophthalmologic evaluation was used to confirm whether or not children were correctly classified by the screening protocol. The sensitivity and specificity of the test model to detect amblyopia were established. RESULTS: A total of 18,587 4- to 5-year-old children were subjected to the amblyopia screening program during the 2010-2011 school year. A population of 100 children were selected for the ophthalmologic validation screening. A sensitivity of 89.3%, specificity of 93.1%, positive predictive value of 83.3%, negative predictive value of 95.7%, positive likelihood ratio of 12.86, and negative likelihood ratio of 0.12 was obtained for the amblyopia screening validation model. CONCLUSIONS: The amblyopia screening protocol model tested in this investigation shows high sensitivity and specificity in detecting high-risk cases of amblyopia compared to the standard ophthalmologic examination. This screening program may be highly relevant for amblyopia screening at schools.

Engineering of Δ9-tetrahydrocannabinol delivery systems based on surface modified-PLGA nanoplatforms.

The objective of this work is to develop a nanoplatform that can potentiate the oral administration of Δ9-tetrahidrocannabinol, a highly lipophilic active agent with very promising antiproliferative and antiemetic activities. To that aim, colloidal carriers based on the biodegradable and biocompatible poly(D,L-lactide-co-glycolide) were investigated. Such delivery systems were prepared by nanoprecipitation, and nanoparticle engineering further involved surface modification with a poly(ethylene glycol), chitosan, or poly(ethylene glycol)-chitosan shells to assure the greatest uptake by intestinal cells and to minimize protein adsorption. Characterization of the nanoplatforms included particle geometry (size and shape), electrophoretic properties (surface charge). Δ9-tetrahydrocannabinol vehiculization capabilities (loading and release), blood compatibility, and cellular uptake and cytotoxicity. Results were satisfactorily used to define the optimum engineering conditions to formulate surface modified nanoparticles for the efficient oral administration of Δ9-tetrahydrocannabinol. To the best of our knowledge, this is the first time that biocompatible polymeric nanoparticles have been formulated for Δ9-tetrahydrocannabinoldelivery.

Enhanced cellular uptake and biodistribution of a synthetic cannabinoid loaded in surface-modified poly(lactic-co-glycolic acid) nanoparticles.

This article aimed to produce, characterize and evaluate different surface-modified naphthalen-1-yl-(4-pentyloxynaphthalen-1-yl)methanone (CB13) loaded poly(lactic-co-glycolic acid) nanoparticles in order to improve their oral absorption and in vivo biodistribution. Plain and surface-modified PLGA nanoparticles were successfully prepared using a nanoprecipitation method. Chitosan, Eudragit RS, lecithin and vitamin E were used as surface modifying agents. The NPs were evaluated in terms of mean diameter and size distribution, zeta potential, morphology, drug loading, drug release profiles, mucoadhesive properties, in vitro cell viability and uptake and in vivo biodistribution. Mean particle size distributions in the range of 253-344 nm, spherical shape and controlled zeta potential values were observed depending on the additive employed. High values of entrapment efficiency were obtained for all the formulations. Lecithin and vitamin E modified particles showed higher release rates when compared to the rest of formulations. A clear improvement in ex vivo mucoadhesion properties was observed in the case of chitosan- and Eudragit RS-modified nanoparticles. Chitosan-poly(lactic-co-glycolic acid) nanoparticles showed the highest uptake values on Caco-2 cells. Biodistribution assays proved that most of the particles were accumulated in liver and spleen. An important goal has been achieved in this investigation: CB13, a highly lipophilic drug with low water solubility, can reach the interior of cells more efficiently when it is included in these surface-modified polymeric carriers.

Heart failure mortality according to acute variations in N-terminal pro B-type natriuretic peptide and cystatin C levels.

AIM: Changes in N-terminal pro B-type natriuretic peptide (NT-proBNP) levels and cystatin C (CysC) are predictors of adverse outcomes in acute heart failure. This study assess whether NT-proBNP variations might provide independent information in addition to that obtained from CysC levels. METHODS: NT-proBNP levels were assessed in patients admitted due to acute heart failure using an observational study. Patients were classified as follows: group 1, those with a decrease in NT-proBNP levels of at least 30% from admission to 4 weeks after discharge; group 2, those with no significant changes in levels; and group 3, those who showed an increase in NT-proBNP of 30%. A multivariable Cox regression model and c-statistics were used. The primary end-point was all-cause mortality at 1-year follow-up. RESULTS: A total of 195 patients completed the follow-up. The mortality rate reached 20.5% (40 patients); 14 out of the 32 in group 3. The cumulative incidence of death, according to the change in NT-proBNP and Kaplan-Meier analysis, showed a significant increase in group 3 (log-rank P = 0.004). In the multivariable analysis, NT-proBNP variation for group 3 (hazard ratio 4.27; P <0.001) and for group 2 (hazard ratio 2.19; P = 0.043) in comparison with group 1 were independently associated with all-cause mortality, as well as anemia, hyponatremia, and admission CysC levels. Patients in group 3, and those with levels of serum CysC above the median, were also associated with slight increase in mortality. CONCLUSION: An increase of at least 30% in NT-proBNP levels after hospitalization is related to all-cause mortality in patients with acute heart failure and provides supplementary prognostic information in patients with high levels of CysC. A decrease in NT-proBNP of at least 30% is a desirable target to achieve.

Prognostic value of cystatin C on admission in heart failure with preserved ejection fraction.

BACKGROUND: Cystatin C has emerged as a new biomarker of renal function that has been found to predict adverse cardiovascular outcomes, especially heart failure (HF). Evidence of the usefulness of cystatin C in patients with heart failure with preserved ejection fraction (HFPEF) remains sparse. It is hypothesized that serum cystatin C levels in HFPEF has prognostic value. METHODS AND RESULTS: Cystatin C, urea nitrogen, creatinine, and N-terminal proBNP-type natriuretic peptide levels were measured on admission in 218 consecutive patients with HF and left ventricular ejection fraction >45%, as measured by Doppler echocardiography. The primary end point was all-cause mortality and/or readmission at 1 year. We determined the adjusted hazard ratio (HR) by Cox regression model. During the 1-year follow-up period, 70 patients (32.2%) died, and 126 patients (57.8%) died and/or required rehospitalization. Serum cystatin C levels by quartiles were associated with increased risk for adverse events. Kaplan-Meier survival curves showed significantly increased primary end point with each quartile of cystatin C (log rank <0.001). Patients in the highest quartile of cystatin C level were at increased adjusted risk for the primary end point (HR 3.40; 95% confidence interval [CI] 1.86-6.21; P < .0001) and all-cause mortality (HR 8.14; 95% CI 1.21-23.26; P < .01). Furthermore, high serum cystatin C levels were also associated with poor prognosis despite normal or mildly reduced renal function. CONCLUSIONS: Serum cystatin C level on admission in patients with HFPEF is a strong and independent predictor of an unfavorable outcome. This relationship remains in patients without advanced renal dysfunction.