66 resultados para Controle de qualidade - Avaliação
em Universidade Federal do Rio Grande do Norte(UFRN)
Resumo:
Compounded medicines have been reported by the ANVISA due to decreased of the therapeutic response or toxicity of these formulations. The aim of this work was to investigate the physicochemical quality control among naproxen sodium oral suspensions 25 mg/mL obtained from six compounding pharmacies (A, B, C, D, E and F) and the manufactured suspension (R). In the quality control test, the tests of pH, content, homogeneity, volume and physical and organoleptic characteristics were performed according to the Brazilian Pharmacopoeia. The analytical method for determination of naproxen in suspensions was validate. This method showed excellent precision, accuracy, linearity and specificity. In the content test the suspensions B, C and E showed lower value and the F suspension showed a high value of the content. The products C and E were disapproved in the description of the physical and organoleptic characteristics test. In the pH test, three suspensions were outside specifications (C, E and F). Only the products R, A and D showed satisfactory results in these tests and therefore they were approved for relative bioavailability test. The R, A and D suspensions were orally administered to Wistar rats and the blood samples were taken at time intervals of 10, 20, 40, 60 min, 3, 4, 6, 24 and 48 h. The plasma samples were immediately stored at 80 ºC until analysis of HPLC. The bioanalytical method validation showed specificity, linearity (R2 0.9987), precision, accuracy, good recovery and stability. The chromatographic conditions were: flow rate of 1.2 mL.min-1 with a mobile phase of acetonitrile : sodium phosphate buffer pH 4.0 (50:50, v/v) at 280 nm, using a C18 column. The confidence interval of 90% for the Cmax and AUCt ratio was within the range of 80 - 125% proposed by the FDA. Only one suspension, obtained from the compounding pharmacy D, was considered bioequivalent to the rate of absorption under the conditions proposed by this study. Thus, the results indicate the need for strict supervision from the relevant authorities to ensure the patient safety and the quality of compounded drugs by pharmacies
Resumo:
This study aimed to analyze the percentage of compliance, related to the requirements of Practice, achieved by 23 supermarkets in neighborhood after the deployment of Food Insurance Program. For its development research methodology adopted was the application start and end of a check-list (tool-specific SBP) in 23 supermarkets, target of this study. After the deployment of PAS was made a comparative study where it was possible to see that these companies need to improve conditions related to food safety, because according to the study, none of the 23 supermarkets evaluated met the criteria recommended by the SBP to 100% of compliance for the items critical of the check-list. Only 04 of the 23 supermarkets were in the range of 80 to 90% of the overall percentage of compliance, representing only 17.3% of the sample. Most of the sample submitted in a regular situation, according to the methodology of Cardoso (2001). Of the 23 supermarkets studied, 03 supermarkets were classified as poor (13.04%), 13 as scheduled (56.52%) as good and 07 (30.43%). You can see improvements in a small part of the sample, but the decline in the percentage of compliance of 02 companies after working for the implementation of the program, showing lack of responsibility and commitment of companies which should have as its top priority to food safety that market
Resumo:
This work was developed with the objective of proposing a simple, fast and versatile methodological routine using near-infrared spectroscopy (NIR) combined with multivariate analysis for the determination of ash content, moisture, protein and total lipids present in the gray shrimp (Litopenaeus vannamei ) which is conventionally performed gravimetrically after ashing at 550 ° C gravimetrically after drying at 105 ° C for the determination of moisture gravimetrically after a Soxhlet extraction using volumetric and after digestion and distillation Kjedhal respectively. Was first collected the spectra of 63 samples processed boiled shrimp Litopenaeus vannamei species. Then, the determinations by conventional standard methods were carried out. The spectra centered average underwent multiplicative scattering correction of light, smoothing Saviztky-Golay 15 points and first derivative, eliminated the noisy region, the working range was from 1100,36 to 2502,37 nm. Thus, the PLS models for predicting ash showed R 0,9471; 0,1017 and RMSEP RMSEC 0,1548; Moisture R was 0,9241; 2,5483 and RMSEP RMSEC 4,1979; R protein to 0,9201; 1,9391 and RMSEP RMSEC 2,7066; for lipids R 0,8801; 0,2827 and RMSEP RMSEC 0,2329 So that the results showed that the relative errors found between the reference method and the NIR were small and satisfactory. These results are an excellent indication that you can use the NIR to these analyzes, which is quite advantageous, since conventional techniques are time consuming, they spend a lot of reagents and involve a number of professionals, which requires a reasonable runtime while after the validation of the methodology execution using NIR reduces all this time to a few minutes, saving reagents, time and without waste generation, and that this is a non-destructive technique.
Resumo:
The pulps are products that add economic value enjoy the fruits of the surplus productions of the same. Have good market acceptance because of its practicality and diversity of flavors available year round. In order to assess the quality of the fruit pulp through the physical and chemical parameters and the characteristics of manufacturing industry, we analyzed 36 samples of frozen fruit pulp of three brands marketed in RIO Grande do Norte, 14 brand A, 12 of 10 brand B and brand C, which corresponded to 14 different flavors, of which 10 have identity Standards and Quality (ISQ S) established by the Ministério da Agricultura, Pecuária e Abastecimento (MAPA), totaling 27 samples with ISQ s. We conducted the following physicalchemical analyzes on samples of fruit pulp: Total solids, total soluble solids, pH, titratable acidity, total sugars and the determination of ascorbic acid. The percentage of failure for each parameter evaluated was 37, 04% in total soluble solids, 22,22% for total solids and titratable acidity, 7,40% in relation to pH. The total sugars were within the requirements demanded by the MAPA and ascorbic acid content, determined only in the pulp of acerola and cashew, presented a non compliance in the pulp of brand B. The percentage of failures of the pulps with ISQ S was 59% with brand A, B and C accounted for 3,70%, 33,33% and 22,22% respectively. The pulps which have no established atandards such as pineapple pulp, showed similar values between brands and literature data unlike the pulp of plum, jackfruit and tamarind which diverged greatly in parameters such as total solids and total soluble solids. The study demonstrates the need for greater quality control by the producers with respect to raw materials, processing, packing, stored and the importance of ISQ S to establish the flavors have not yet covered by existing legislation, but already highly commercialized
Resumo:
The evaluation of seed vigor is an important factor for detection of lots of high quality seeds, so that development of procedures to evaluate the physiological potential has been an important tool in quality control programs seeds. In this sense the study aimed to adapt the methodologies of accelerated aging, electrical conductivity and potassium leaching to evaluate Moringa oleifera seed vigor LAM.. Therefore, four lots of moringa seeds were subjected to the germination tests, seedling emergence, speed of emergence index, emergence first count, length and dry mass of seedlings and cold test for their physiological characterization, in addition to accelerated aging, electrical conductivity and potassium leaching. The experimental design was completely randomized with four replications of 50 seeds and the means compared by Tukey test at 5% probability. For accelerated aging the periods were studied aging 12, 24 and 72 hours at 40, 42 and 45°C. For the electrical conductivity test was used to a temperature of 25°C for periods of 4, 8, 12, 16 and 24 hours of immersion in 75 to 125 mL of distilled water, using 25 to 50 seeds, and for potassium leaching test samples were used 25 to 50 seeds, placed in plastic cups containing 70 and 100 mL of distilled water at 25°C for periods of 1, 2, 3, 4, 5 and 6 hours. From the results obtained, it can be inferred that the methods best fit for the accelerated aging test Moringa seeds were a temperature of 40°C for 12 to 72 hours, 42°C 72 hours 45°C 24 hours . In the electrical conductivity test Moringa seeds, the combination of 50 seeds in 75 mL distilled water for a period of immersion of 4 hours and 50 seeds in 125 mL of 4 hours were efficient for the differentiation of lots of Moringa seeds as to vigor and for potassium leaching test moringa seeds, the combination of 50 seeds in 100mL of distilled water allowed the separation of lots of four levels of vigor, at 2 hours of immersion, showing promise in evaluate the quality of moringa seeds.
Resumo:
The evaluation of seed vigor is an important factor for detection of lots of high quality seeds, so that development of procedures to evaluate the physiological potential has been an important tool in quality control programs seeds. In this sense the study aimed to adapt the methodologies of accelerated aging, electrical conductivity and potassium leaching to evaluate Moringa oleifera seed vigor LAM.. Therefore, four lots of moringa seeds were subjected to the germination tests, seedling emergence, speed of emergence index, emergence first count, length and dry mass of seedlings and cold test for their physiological characterization, in addition to accelerated aging, electrical conductivity and potassium leaching. The experimental design was completely randomized with four replications of 50 seeds and the means compared by Tukey test at 5% probability. For accelerated aging the periods were studied aging 12, 24 and 72 hours at 40, 42 and 45°C. For the electrical conductivity test was used to a temperature of 25°C for periods of 4, 8, 12, 16 and 24 hours of immersion in 75 to 125 mL of distilled water, using 25 to 50 seeds, and for potassium leaching test samples were used 25 to 50 seeds, placed in plastic cups containing 70 and 100 mL of distilled water at 25°C for periods of 1, 2, 3, 4, 5 and 6 hours. From the results obtained, it can be inferred that the methods best fit for the accelerated aging test Moringa seeds were a temperature of 40°C for 12 to 72 hours, 42°C 72 hours 45°C 24 hours . In the electrical conductivity test Moringa seeds, the combination of 50 seeds in 75 mL distilled water for a period of immersion of 4 hours and 50 seeds in 125 mL of 4 hours were efficient for the differentiation of lots of Moringa seeds as to vigor and for potassium leaching test moringa seeds, the combination of 50 seeds in 100mL of distilled water allowed the separation of lots of four levels of vigor, at 2 hours of immersion, showing promise in evaluate the quality of moringa seeds.
Resumo:
All medicine, whether allopathic or homeopathic, must go through strict quality control, which must ratify their characteristics throughout the period of validity. During the time of preparation and storage, solutions of the drugs are in permanent contact with packaging materials that can release undesirable substances to the solution. Several factors may influence the release of packing materials, and factorial design (FD) is a useful tool for analyzing the phenomenon. The aim of this study was the determination of quality parameters for Homeopathic solid (globules) and liquid (drops) dosage forms. It was carried out analysis in homeopathic globules for weight variation, mechanical strength, and moisture content uniformity. For liquid preparations, standard solutions were prepared from natural rubber bulbs, which were subjected to exhaustive extraction with two ethanol solutions (30 and 70%) in the ultrasonic bath for 20 minutes at 25°C and 50°C in three successive cycles. Studies of transfer have been made within five days, by spectrophotometric analysis in the UV region at 312 nm with λmáx and 323 nm for samples in 70% ethanol and 30% respectively. PH values were analyzed. We also conducted two FD studies, where the first, the three-level variables were solvent (chloroform, ethanol and nhexane), sample mass (30, 60 and 90mg), particle size (large disk, small disk and powder sample). In the second study, the solvent level variables were different ethanolic degrees (EtOH 30%, 70% and pure). The percentage of lending in the solutions was 5.5%, 12.4%, 24.2% and 41% of the total estimated in the reference solution. The values of rate constants of transfer were determined in the order of 0.0134 days-1 and 0.0232 days-1 in absorbance values, the solutions in ethanol at 30% and 70% respectively. These results suggest that the speed of transfer of materials from rubber is affected both by the nature of the vehicle as by the temperature
Resumo:
Homeopathic medicines have been used for over two hundred years without the examination of their effects on in vivo and in vitro assays, due to the peculiarity of homeopathic preparations, the high dilution, which creates a challenge for the use of usual analytical techniques of quality control of medicine.Although there is scarcity of literature and variety of experiments, recently there have been some studies with few in vitro assays which have shown positive responses when evaluating the mechanism of action of homeopathic medicines which are able to act on a specific system.The present study aims to evaluate the efficacy of homeopathic products containing Momordica charantia through bioassays.Homeopathic products were tested by the MTT to assess cytotoxicity in RAW 264.7 (macrophage-like cells) and in tumor cells HeLa (human cervical adenocarcinoma cells), CHO K1 (Chinese hamster ovary cells), PANC-1 (human pancreas cancer cells) and PC-3 (human prostate cancer cells), dosage of inflammatory mediators NO, TNF-α and IL-6 released by RAW 264.7 cells, analysis of the death process and cell cycle changes of PC-3 by flow cytometry. The data demonstrate that homeopathic products of Momordica charantia did not show cytotoxicity to RAW 264.7, increased the production of inflammatory mediators by RAW 264.7 synergistically with LPS, showed cytotoxicity to PC-3 with change in its cell cycle inhibiting its proliferation, being the 30CH the most potent sample. Correlation studies were conducted in order to evaluate the possible in vitro applicable models to the quality control of homeopathic products with Momordica charantia. The data showed that the best applicable models in assessing the quality are the MTT to assess cytotoxicity in RAW 264.7 and PC-3 in 24 hours for Momordica charantia fruit products and dosage of NO production by RAW 264.7 with and without LPS
Resumo:
Mimosa caesalpiniaefolia Benth. is a forest species of the Mimosaceae family, recommended for recovery of degraded areas. The evaluation of vigor by biochemical tests have been an important tool in the control of seed quality programs, and the electrical conductivity and potassium leaching the most efficient in the verifying the physiological potential. The objective, therefore, to adjust the methodology of the electrical conductivity test for seeds of M. caesalpiniaefolia, for then compare the efficiency of this test with the potassium in the evaluation of seed vigor of different lots of seeds M. caesalpiniaefolia. To test the adequacy of the electrical conductivity were used different combinations of temperatures , 25 °C and 30 ºC, number of seeds , 25 and 50, periods of imbibition , 4 , 8 , 12 , 16 and 24 hours , and volumes deionized water, 50 mL and 75mL. For potassium leaching test, which was conducted from the results achieved by the methodology of the adequacy of the electrical conductivity test, to compare the efficiency of both tests , in the classification of seeds at different levels of vigor, and the period 4 hours also evaluated because the potassium leaching test can be more efficient in the shortest time . The best combination obtained in experiment of electrical conductivity is 25 seeds soaked in 50 mL deionized or distilled water for 8 hours at a temperature of 30 ° C. Data were subjected to analysis of variance, the means were compared with each other by F tests and Tukey at 5 % probability, and when necessary polynomial regression analysis was performed. The electrical conductivity test performed at period eight hour proved to be more efficient in the separation of seed lots M. caesalpiniaefolia at different levels of vigor compared to the potassium test
Resumo:
The study that resulted in this dissertation was developed at OU RNCE PETROBRAS, in Natal, which implemented a project of rational use and reuse of water, including use of wastewater from a Sewage Treatment Plant (STP) already in place, diluted with water from own wells for irrigation of green area of the building complex corporate enterprise. Establish a methodology that can serve as guidelines for future projects controlled reuse of water like this was the objective of this research. Been proposed, implemented and evaluated three instruments of sanitary and environmental control: 1) adaptation of sewage treatment plant and quality control of the treated effluent 2) analysis of soil-nutrient interaction in the irrigated area, 3) knowledge of the local hydrogeology, especially with regard to the direction of flow of the aquifer and location of collection wells of Companhia de Águas e Esgotos do Rio Grande do Norte (CAERN) situated in the surroundings. These instruments have proven sufficient and appropriate to ensure the levels of sanitary and environmental control proposed and studied, which were: a) control of water quality off the STP and the output of the irrigation reservoir, b) control of water quality sub surface soil and assessment of progress on soil composition, c) assessment of water quality in the aquifer. For this, we must: 1) establishing the monitoring plan of the STP and its effluent quality sampling points and defining the parameters of analysis, improve the functioning of that identifying the adequacy of flow and screening as the main factors of operational control, and increase the efficiency of the station to a relatively low cost, using additional filters, 2) propose, implement and adapt simple collectors to assess the quality of water percolating into the soil of the irrigated area, 3) determine the direction of groundwater flow in the area study and select the wells for monitoring of the aquifer.
Resumo:
The aim of this study is to characterize and evaluate the Macro System of Regional Water Distribution Natal North (RNN) and Southern Regional Natal (RNS), covering 35% and 65% respectively of the Natal-RN City. The terms of the quality and quantity of water (surface and groundwater) were also evaluated in order to adjust the parameters that contribute to proper distribution and control in water reserves. The methodology of the work took place from collecting volumetric data of production capacity and distribution of the two treatment plants for Regional as well as the flow rates of wells. Yet the quantitative capacity of reservation, distribution and consumption of the main reservoirs, population numbers and consumption of members neighborhoods were collected. Data were tabulated and used in computational simulator EPANET to diagnose possible through the water balance, the offers and demands on the water supply system in the neighborhoods of the capital, linking them to specific distribution points. We also evaluated the wells in the levels of nitrate in water consumed. As a result it was found that some neighborhoods in the South Regional Natal, was ranked as critical supply situation: City of Hope, Lagoa Nova and Nova Descoberta, where demand exceeds supply. While in most Northern Regional Natal present deficiency in the supply system as: Lagoa Azul, the Parque dos Coqueiros, igapó, Amarante and Salinas. The rates of nitrate in the city were significant, but manageable with corrective and preventive measures. The averages were 12 mg /l-N in Candelária, 10 mg/l-N in Lagoa Nova, 9 mg/l-N in Satelite, 20 mg/l-N in Gramore and 15 mg/l-N in N. Sra. Apresentação. Therefore proper distribution of water abstracted and implementation of quality control ensures the supply required by the system, associated with preservation of Water Resources of the Metropolitan Region of Natal
Resumo:
Spondias tuberosa Arruda (Anacardiaceae) is a fruitful tree popularly known as umbuzeiro, tapereba or umbu. It is a native and endemic species from Brazil, widespread in Brazilian Northeast. The species is important in folk medicine of the semi-arid Northeast, where it is mainly used to treat various inflammatory conditions, digestive problems as well as viral and bacterial infections. However, despite the common use in folk medicine, there are scarce pharmacological and phytochemicals studies that afford scientific evidence to its popular use. Therefore, this study aimed to characterize the chemical markers in S. tuberosa leaves extract, obtained by maceration ethanol:water (70:30, [v/v]), and evaluate its anti-inflammatory potential in vivo. The phytochemical profile in TLC analysis suggested the occurence of the flavonoids rutin and isoquercitrin. HPLC analysis enabled us to confirm the presence of flavonoids and also, were detected the phenolic acids, chlorogenic acid and caffeic acid. In addition was developed and validated a HPLC method to evaluate the content of the identified compounds in S. tuberosa leaves extract according to RDC 899/2003 of ANVISA and ICH Guidelines 2005. In order to evaluate the anti-inflammatory potential of S. tuberosa leaves extract, the peritonitis and paw edema models induced by carrageenan were used, administration i.p. in mice. The results highlighted the anti-inflammatory property in vivo at 125, 250 and 500 mg/kg since a decrease in leukocyte influx to the site of inflammation, diameter of the edema and the level of myeloperoxidase were observed when compared to the drug control dexamethasone (2 mg/kg, i.p. route). Taken together, the results pointed out S. tuberosa as a potential species for developing phytotherapic derivatives in according to its popular use. With regard to the characterization markers, chlorogenic acid, caffeic acid, rutin and isoquercitrin were identified and quantified in Spondias tuberosa leaves extract so they could be used in quality control analyses of the raw material and extracts of this species.
Resumo:
Diesel fuel is one of leading petroleum products marketed in Brazil, and has its quality monitored by specialized laboratories linked to the National Agency of Petroleum, Natural Gas and Biofuels - ANP. The main trial evaluating physicochemical properties of diesel are listed in the resolutions ANP Nº 65 of December 9th, 2011 and Nº 45 of December 20th, 2012 that determine the specification limits for each parameter and methodologies of analysis that should be adopted. However the methods used although quite consolidated, require dedicated equipment with high cost of acquisition and maintenance, as well as technical expertise for completion of these trials. Studies for development of more rapid alternative methods and lower cost have been the focus of many researchers. In this same perspective, this work conducted an assessment of the applicability of existing specialized literature on mathematical equations and artificial neural networks (ANN) for the determination of parameters of specification diesel fuel. 162 samples of diesel with a maximum sulfur content of 50, 500 and 1800 ppm, which were analyzed in a specialized laboratory using ASTM methods recommended by the ANP, with a total of 810 trials were used for this study. Experimental results atmospheric distillation (ASTM D86), and density (ASTM D4052) of diesel samples were used as basic input variables to the equations evaluated. The RNAs were applied to predict the flash point, cetane number and sulfur content (S50, S500, S1800), in which were tested network architectures feed-forward backpropagation and generalized regression varying the parameters of the matrix input in order to determine the set of variables and the best type of network for the prediction of variables of interest. The results obtained by the equations and RNAs were compared with experimental results using the nonparametric Wilcoxon test and Student's t test, at a significance level of 5%, as well as the coefficient of determination and percentage error, an error which was obtained 27, 61% for the flash point using a specific equation. The cetane number was obtained by three equations, and both showed good correlation coefficients, especially equation based on aniline point, with the lowest error of 0,816%. ANNs for predicting the flash point and the index cetane showed quite superior results to those observed with the mathematical equations, respectively, with errors of 2,55% and 0,23%. Among the samples with different sulfur contents, the RNAs were better able to predict the S1800 with error of 1,557%. Generally, networks of the type feedforward proved superior to generalized regression.
Resumo:
The State and Public Administration have gone through several reforms in search of a quick operation and the provision of services with quality. With the democratization of the country and the issue of the Constitution in 1988, further reform of the State and Public Administration, joined the government agenda in 1995 and included among its objectives, the principles of participation and social control. In view of this, it raises the Public Ombudsman in order to be a channel for the participation of users in the management of public affairs, social control, transparency of administrative actions, improving the quality of service and meeting the needs of the community. The aim of this study is to assess whether the Ombudsman of the State Department of Public Health to contribute to the period 2006-2008, for the improvement of specialized consulting services. The research is characterized as descriptive, qualitative approach. The collection technique used was the interview, conducted with 37 service users and two servants of the Ombudsman. The analysis was developed based on the perception of users and servers in the opinion of the Ombudsman. The most relevant results of the research showed that 41% of users search the Ombudsman because they believed that solve the problem presented. However, even with this level of public acceptance, the Ombudsman reached average index of resolvability of 53% in the period. In his role has not developed mechanisms for quality control of services, which is mentioned by 67% of users. It turned out the same fact in relation to popular participation, which is confirmed by 84% of users. For 24% of users, the problems raised were resolved, and of these, 56% believe that the Ombudsman has contributed to the positive outcome. As a result of the search results, it appears that the Ombudsman's SESPA / PA, is not fulfilling its role to ensuring the democratization of articipation in management, social control and has limited contribution to solving the problems of users and to improve the quality of services
Resumo:
Human multipotent mesenchymal stromal cells (MSCs), also known as mesenchymal stem cells, have become an important and attractive therapeutic tool since they are easily isolated and cultured, have in vitro expansion potential, substantial plasticity and secrete bioactive molecules that exert trophic effects. The human umbilical cord as a cell source for cell therapy will help to avoid several ethical, political, religious and technical issues. One of the main issues with SC lines from different sources, mainly those of embryonic origin, is the possibility of chromosomal alterations and genomic instability during in vitro expansion. Cells isolated from one umbilical cord exhibited a rare balanced paracentric inversion, likely a cytogenetic constitutional alteration, karyotype: 46,XY,inv(3)(p13p25~26). Important genes related to cancer predisposition and others involved in DNA repair are located in 3p25~26. Titanium is an excellent biomaterial for bone-implant integration; however, the use can result in the generation of particulate debris that can accumulate in the tissues adjacent to the prosthesis, in the local bone marrow, in the lymph nodes, liver and spleen. Subsequently may elicit important biological responses that aren´t well studied. In this work, we have studied the genetic stability of MSC isolated from the umbilical cord vein during in vitro expansion, after the cryopreservation, and under different concentrations and time of exposition to titanium microparticles. Cells were isolated, in vitro expanded, demonstrated capacity for osteogenic, adipogenic and chondrogenic differentiation and were evaluated using flow cytometry, so they met the minimum requirements for characterization as MSCs. The cells were expanded under different concentrations and time of exposition to titanium microparticles. The genetic stability of MSCs was assessed by cytogenetic analysis, fluorescence in situ hybridization (FISH) and analysis of micronucleus and other nuclear alterations (CBMN). The cells were able to internalize the titanium microparticles, but MSCs preserve their morphology, differentiation capacity and surface marker expression profiles. Furthermore, there was an increase in the genomic instability after long time of in vitro expansion, and this instability was greater when cells were exposed to high doses of titanium microparticles that induced oxidative stress. It is necessary always assess the risks/ benefits of using titanium in tissue therapy involving MSCs, considering the biosafety of the use of bone regeneration using titanium and MSCs. Even without using titanium, it is important that the therapeutic use of such cells is based on analyzes that ensure quality, security and cellular stability, with the standardization of quality control programs appropriate. In conclusion, it is suggested that cytogenetic analysis, FISH analysis and the micronucleus and other nuclear alterations are carried out in CTMH before implanting in a patient