Avaliação do comportamento físico e microbiológico da incorporação de diacetato de clorexidina a resinas acrílicas a base de PMMA

Neste trabalho, objetivou-se avaliar as propriedades físicas e microbiológicas de resinas acrílicas a base de polimetilmetacrilato após a incorporação de sal de diacetato de clorexidina (CDA) às mesmas. Para tal, foram confeccionados corpos de prova (CDPs) com as resinas VIPI COR e Duralay, sem e com incorporação de 0,5%; 1,0% e 2,0% de CDA, totalizando 8 grupos. A cromatografia líquida foi utilizada para mensurar a liberação de CDA pelas resinas acrílicas, e ainda, mensurar sua lixiviação de monômeros residuais.Para isso, os CDPs foram armazenados individualmente em placas para cultura celular de 24 poços contendo 1 ml de água destilada estéril em cada poço. Após tempo de armazenagem de 2 horas, 7 dias, 14 dias, 21 dias e 28 dias, a 37oC, a solução foi retirada e a liberação de clorexidina ou monômeros residuais foi avaliada utilizando-se HPLC associado a espectrometria ultravioleta. A atividade antifúngica para C. albicans foi avaliada utilizando teste de difusão em ágar, no qual os CDPs foram colocados em placas de BHI previamente inoculadas com C. albicans, com medição do halo de inibição após 48 horas de incubação a 37C. A análise do grau de conversão das resinas se deu através da técnica de espectroscopia de infravermelho transformada de Fourier FTIR utilizando-se uma amostra de resina não polimerizada de cada grupo e realizados 4 scans de absorbância. Para a mensuração da sorção de água por parte das resinas contendo CDA, foram confeccionados 10 corpos de prova para cada grupo, que foram posicionados em suporte dentro de dessecador a 37C para remoção de umidade intrínseca (m1) e depois imersos em 100 ml de água deionizada por 7 dias a 37C, tendo a água trocada diariamente. Após este intervalo, os corpos foram secos para obter a nova massa da resina (m2). As massas obtidas foram incluídas em fórmula matemática para obtenção do grau de sorção. Após obtenção dos resultados, quando comparou-se o halo inibição entre os grupos testados e de mesma marca, apenas as análises entre grupo CDA 2% x grupo CDA 1% e entre CDA 1% x CDA 0,5% não apresentaram diferenças significantes. Quanto a liberação de CDA, a análise de variância demonstrou que dois dos três fatores avaliados (concentração do fármaco e tempo de armazenagem) alteram de maneira significativa a taxa de liberação da clorexidina (p<0,0001), entretanto a marca do material pareceu não influenciar de maneira significativa na liberação do fármaco. Quanto ao grau de conversão, os valores obtidos não foram significantes e apresentou-se menor apenas nos grupos com CDA 2% . Para ambas a sorção de água aumentou conforme a incorporação do sal cresceu e houve aumento significativo nas concentrações de 1.0% e 2.0%. Podemos concluir que a incorporação da clorexidina às resinas a base de PMMA: é capaz de inibir o crescimento de C. albicans; não alterou o grau de conversão das resinas testadas; não altera a liberação de monômeros residuais; e, altera a sorção de água das resinas acrílicas a base de PMMA quando concentrações maiores de CDA são adicionadas.

Avaliação in vitro de duas resinas macias para reembasamento de próteses modificadas pela incorporação de clorexidina

Resinas macias para reembasamento de próteses são largamente utilizadas após cirurgias para estabilizarem a prótese e condicionarem o tecido, aguardando a completa cicatrização. É importante que o material não seja facilmente colonizado por biofilme oral e se possível, evite a contaminação do sítio cirúrgico. Objetivou-se avaliar o efeito da incorporação de clorexidina às resinas acrílicas macias para o reembasamento de próteses totais, através de análises de liberação, citotoxicidade e efeito inibitório de um biofilme de C. albicans. Foram confeccionados corpos de provas (CDPs) com as resinas Trusoft e Coe-soft, com incorporação de 0%, 0,5%, 1,0% e 2,0% de clorexidina, totalizando 8 grupos. A liberação de clorexidina foi avaliada através da mensuração da mudança na densidade óptica da solução de armazenamento, na qual ficaram imersos os CDPs, por espectrometria UV, a cada 48 horas, durante 40 dias. A citotoxicidade celular foi avaliada em fibroblastos (linhagem L929), que ficaram 24 horas em contato com meio de cultura no qual os CDPs ficaram previamente imersos, pela técnica de absorção de corante vermelho neutro após 24, 48 e 72 horas e semanalmente até o 28 dia. E, por fim, a atividade antifúngica contra a C. albicans (ATCC 10231) foi avaliada de duas maneiras: (1) teste de difusão em ágar, no qual os CDPs foram colocados em placas de BHI previamente inoculadas com C. albicans, com medição do halo de inibição após 48 horas de incubação a 37C; (2) a avaliação da inibição da formação de um biofilme de C. albicans sobre a superfície dos CDPs pela quantificação por metil tetrazólio (MTT) a cada 48 horas, durante 22 dias, com leitura feita em espectrofotômetro de UV. Os dados obtidos foram inseridos no programa SigmaStat (versão 3.1, USA) para realizar as análises estatísticas. As diferenças estatísticas foram determinadas por análises de variâncias do tipo ANOVA e todos os procedimentos para comparações múltiplas pareadas foram feitos utilizando-se o método Holm-Sidak, com nível de significância global igual a 0,05. A clorexidina adicionada às resinas testadas foi capaz de ser liberada para o meio de armazenagem, proporcionalmente à quantidade de clorexidina incorporada, porém com diferentes cinéticas de liberação entre as resinas, visto que a Trusoft libera até 71% do total de clorexidina liberada nas primeiras 48 horas e a Coe-soft, até 44%. Ambas as resinas com incorporação de clorexidina apresentaram efeito citotóxico adicional, se comparadas às resinas sem clorexidina, porém para a Coe-soft não houve diferença estatística dos valores, apenas para a Trusoft (p<0,001). Ocorreu formação de halo de inibição proporcionalmente às concentrações de resinas adicionadas, com maiores halos para a resina Trusoft (p<0,001), e sem formação de halo para as resinas sem clorexidina; a inibição da formação de biofilme, realizada somente com a resina Coe-soft, mostrou total inibição durante 8, 12 e 16 dias, para a incorporação de 0,5%, 1,0% e 2,0% respectivamente, sendo uma diminuição estatisticamente significativa (p<0,001) em relação à resina sem incorporação de clorexidina, que não apresentou inibição do biofilme.

Vacinas Anticárie

Projeto de Pós-Graduação/Dissertação apresentado à Universidade Fernando Pessoa como parte dos requisitos para obtenção do grau de Mestre em Ciências Farmacêuticas

Medicação Intracanalar em Endodontia

Projeto de Pós-Graduação/Dissertação apresentado à Universidade Fernando Pessoa como parte dos requisitos para obtenção do grau de Mestre em Medicina Dentária

Efeitos provocados pelos irrigantes endodônticos na estrutura do canal radicular

Projeto de Pós-Graduação/Dissertação apresentado à Universidade Fernando Pessoa como parte dos requisitos para obtenção do grau de Mestre em Medicina Dentária

Pharmacological targeting of the mitochondrial phosphatase PTPMT1.

The dual-specificity protein tyrosine phosphatases (PTPs) play integral roles in the regulation of cell signaling. There is a need for new tools to study these phosphatases, and the identification of inhibitors potentially affords not only new means for their study, but also possible therapeutics for the treatment of diseases caused by their dysregulation. However, the identification of selective inhibitors of the protein phosphatases has proven somewhat difficult. PTP localized to mitochondrion 1 (PTPMT1) is a recently discovered dual-specificity phosphatase that has been implicated in the regulation of insulin secretion. Screening of a commercially available small-molecule library yielded alexidine dihydrochloride, a dibiguanide compound, as an effective and selective inhibitor of PTPMT1 with an in vitro concentration that inhibits response by 50% of 1.08 microM. A related dibiguanide analog, chlorhexidine dihydrochloride, also significantly inhibited PTPMT1, albeit with lower potency, while a monobiguanide analog showed very weak inhibition. Treatment of isolated rat pancreatic islets with alexidine dihydrochloride resulted in a dose-dependent increase in insulin secretion, whereas treatment of a pancreatic beta-cell line with the drug affected the phosphorylation of mitochondrial proteins in a manner similar to genetic inhibition of PTPMT1. Furthermore, knockdown of PTPMT1 in rat islets rendered them insensitive to alexidine dihydrochloride treatment, providing evidence for mechanism-based activity of the inhibitor. Taken together, these studies establish alexidine dihydrochloride as an effective inhibitor of PTPMT1, both in vitro and in cells, and support the notion that PTPMT1 could serve as a pharmacological target in the treatment of type II diabetes.

Characterization of the physicochemical, antimicrobial, and drug release properties of thermoresponsive hydrogel copolymers designed for medical device applications

In this study, a series of hydrogels was synthesized by free radical polymerization, namely poly(2-(hydroxyethyl) methacrylate) (pHEMA), poly(4-(hydroxybutyl)methacrylate) (pHBMA), poly(6-(hydroxyhexyl)methacrylate) (pHHMA), and copolymers composed of N-isopropylacrylamide (NIPAA), methacrylic acid (MA), NIPAA, and the above monomers. The surface, mechanical, and swelling properties (at 20 and 37 degrees C, pH 6) of the polymers were determined using dynamic contact angle analysis, tensile analysis, and thermogravimetry, respectively. The T-g and lower critical solution temperatures (LCST) were determined using modulated DSC and oscillatory rheometry, respectively. Drug loading of the hydrogels with chlorhexidine diacetate was performed by immersion in a drug solution at 20 degrees C (

Textural analysis and flow rheometry of novel, bioadhesive antimicrobial oral gels

Purpose. This study examined the rheological and textural characteristics (hardness, compressibilty, adhesiveness and cohesiveness) of bioadhesive oral gels containing the antimicrobial agent chlorhexidine.

THE EFFECTS OF 3 NON-ANTIBIOTIC, ANTIMICROBIAL AGENTS ON THE SURFACE HYDROPHOBICITY OF CERTAIN MICROORGANISMS EVALUATED BY DIFFERENT METHODS

The effects of three non-antibiotic, antimicrobial agents (taurolidine, chlorhexidine acetate and providone-iodine) on the surface hydrophobicity of the clinical strains Escherichia coli, Staphylococcus saprophyticus, Staphylococcus epidermidis and Candida albicans were examined. Three recognized techniques for hydrophobicity measurements, Bacterial Adherence to Hydrocarbons (BATH), the Salt Aggregation Test (SAT) and Hydrophobic Interaction Chromatography (HIC) were compared. At concentrations reported to interfere with microbial-epithelial cell adherence, all three agents altered the cell surface hydrophobicity. However, these effects failed to exhibit a uniform relationship. Generally, taurolidine and povidone-iodine treatments decreased the hydrophobicity of the strains examined whereas chlorhexidine acetate effects depended upon the micro-organism treated. Subsequently, the exact contribution of altered cell surface hydrophobicity to the reported microbial anti-adherence effects is unclear. Comparison of the three techniques revealed a better correlation between the results obtained with the BATH test and HIC than the results obtained with the BATH and SAT or SAT and HIC. However, these differences may be due to the inaccuracy associated with the visual assessment of results employed by the SAT.

Efficacy of Biocides Used in the Modern Food Industry To Control Salmonella enterica, and Links between Biocide Tolerance and Resistance to Clinically Relevant Antimicrobial Compounds

Biocides play an essential role in limiting the spread of infectious disease. The food industry is dependent on these agents, and their increasing use is a matter for concern. Specifically, the emergence of bacteria demonstrating increased tolerance to biocides, coupled with the potential for the development of a phenotype of cross-resistance to clinically important antimicrobial compounds, needs to be assessed. In this study, we investigated the tolerance of a collection of susceptible and multidrug-resistant (MDR) Salmonella enterica strains to a panel of seven commercially available food-grade biocide formulations. We explored their abilities to adapt to these formulations and their active biocidal agents, i.e., triclosan, chlorhexidine, hydrogen peroxide, and benzalkonium chloride, after sequential rounds of in vitro selection. Finally, cross-tolerance of different categories of biocidal formulations, their active agents, and the potential for coselection of resistance to clinically important antibiotics were investigated. Six of seven food-grade biocide formulations were bactericidal at their recommended working concentrations. All showed a reduced activity against both surface-dried and biofilm cultures. A stable phenotype of tolerance to biocide formulations could not be selected. Upon exposure of Salmonella strains to an active biocidal compound, a high-level of tolerance was selected for a number of Salmonella serotypes. No cross-tolerance to the different biocidal agents or food-grade biocide formulations was observed. Most tolerant isolates displayed changes in their patterns of susceptibility to antimicrobial compounds. Food industry biocides are effective against planktonic Salmonella. When exposed to sublethal concentrations of individual active biocidal agents, tolerant isolates may emerge. This emergence was associated with changes in antimicrobial susceptibilities.

Endodontic 'Solutions'. Part 2:An audit comparing current practice in Belfast with UK and Republic of Ireland Dental Schools

Endodontic lubricants, irrigating solutions and medicaments help reduce the microbial load within root canals. Primary and secondary cases involve different microbes. Each'solution'or combinations thereof could play a significant role but no detailed guidelines exist on their use. An audit was undertaken to compare current practice in Belfast Dental School to the others across the UK and Republic of Ireland (ROI). This audit highlighted three main differences between Belfast and other dental schools. Many other institutions utilized other irrigants besides sodium hypochlorite (NaOCl), different intracanal medicaments, including calcium hydroxide, and higher concentrations of NaOCl. Having gathered this information, we ask, 'Is there sufficient evidence to change the endodontic regime currently used at Belfast Dental School?'. Using the findings from the literature review (Part 1), we introduce new evidence-based protocols for primary and secondary cases for use in Belfast Dental School. Clinical Relevance: In the absence of detailed clinical guidelines on the use of endodontic lubricants, irrigants and medicaments in primary and secondary cases, it is important to be aware of current practice in UK and ROI dental schools where dentists and specialists are trained.

Improving antimicrobial release kinetics from hydrophobic polymer implants via ion pairing to combat biomedical-device related infection

Purpose The aim of this study is to improve the drug release properties of antimicrobial agents from hydrophobic biomaterials using using an ion pairing strategy. In so doing antimicrobial agents may be eluted and maintained over a sufficient time period thereby preventing bacterial colonisation and subsequent biofilm formation on medical devices. Methods The model antimicrobial agent was chlorhexidine and the selected fatty acid counter ions were capric acid, myristic acid and stearic acid. The polymethyl methacrylate films were loaded with 2% of fatty acid:antimicrobial agent at the following molar ratios; 0.5:1M, 1:1M and 2:1M and thermally polymerized using azobisisobutyronitrile initiator. Drug release experiments were subsequently performed over a 3-month period and the mass of drug released under sink conditions (pH 7.0, 37oC) quantified using a validated HPLC-UV method. Results In all platforms, a burst of chlorhexidine release was observed over the initial 24-hour period. Similar release kinetics were observed between the formulations during the initial 28 days. However, as time progressed, the chlorhexidine baseline plateaued after 56 days whereas formulations containing the counterions appeared to continuously elute linearly with time. As can be observed in figure 1, the rank order of total chlorhexidine release in the presence of 0.5M fatty acid was myristic acid (40%) > capric acid (35%) > stearic acid (30%)> chlorhexidine baseline (15%). Conclusion The incorporation of fatty acids within the formulation significantly improved chlorhexidine solubility within both the monomer and the polymer and enhanced the drug release kinetics over the period of study. This is attributed to the greater diffusivity of chlorhexidine through PMMA in the presence of fatty acids. In th absence of fatty acids, chlorhexidine release was facilitated by dissolution of surface associated drug particles. This study has illustrated the ability of fatty acids to modulate chlorhexidine release from a model biomaterial through enhanced diffusivity. This strategy may prove advantageous for improved medical devices with enhanced resistance to infection.

Elucidation of a mechanism of cell lysis by chorhexidine : a biophysical approach

Chlorhexidine is an effective antiseptic used widely in disinfecting products (hand soap), oral products (mouthwash), and is known to have potential applications in the textile industry. Chlorhexidine has been studied extensively through a biological and biochemical lens, showing evidence that it attacks the semipermeable membrane in bacterial cells. Although extremely lethal to bacterial cells, the present understanding of the exact mode of action of chlorhexidine is incomplete. A biophysical approach has been taken to investigate the potential location of chlorhexidine in the lipid bilayer. Deuterium nuclear magnetic resonance was used to characterize the molecular arrangement of mixed phospholipid/drug formulations. Powder spectra were analyzed using the de-Pake-ing technique, a method capable of extracting both the orientation distribution and the anisotropy distribution functions simultaneously. The results from samples of protonated phospholipids mixed with deuterium-labelled chlorhexidine are compared to those from samples of deuterated phospholipids and protonated chlorhexidine to determine its location in the lipid bilayer. A series of neutron scattering experiments were also conducted to study the biophysical interaction of chlorhexidine with a model phospholipid membrane of DMPC, a common saturated lipid found in bacterial cell membranes. The results found the hexamethylene linker to be located at the depth of the glycerol/phosphate region of the lipid bilayer. As drug concentration was increased in samples, a dramatic decrease in bilayer thickness was observed. Differential scanning calorimetry experiments have revealed a depression of the DMPC bilayer gel-to-lamellar phase transition temperature with an increasing drug concentration. The enthalpy of the transition remained the same for all drug concentrations, indicating a strictly drug/headgroup interaction, thus supporting the proposed location of chlorhexidine. In combination, these results lead to the hypothesis that the drug is folded approximately in half on its hexamethylene linker, with the hydrophobic linker at the depth of the glycerol/phosphate region of the lipid bilayer and the hydrophilic chlorophenyl groups located at the lipid headgroup. This arrangement seems to suggest that the drug molecule acts as a wedge to disrupt the bilayer. In vivo, this should make the cell membrane leaky, which is in agreement with a wide range of bacteriological observations.

Bacteriemia asociada a catéter epicutáneo en la unidad de cuidado intensivo neonatal de la Fundación Cardioinfantil

La bacteriemia asociada a catéter afecta a pacientes en las unidades de cuidado intensivo con una alta morbilidad, mortalidad y aumento de los costos al sistema de salud. Los recién nacidos son la población de más alto riesgo por el mayor uso de catéteres centrales. Objetivo: Caracterizar factores de riesgo para bacteriemia asociada a catéter en la Unidad de Cuidado Intensivo Neonatal de la Fundación Cardioinfantil entre 2005 - 2010 Materiales y método: Estudio descriptivo de corte transversal, incluyó todos los recién nacidos con diagnostico de bacteriemia asociada a catéter. Se analizó la información utilizando frecuencias y medidas de tendencia central. Resultados: Se encontraron 50 pacientes con diagnostico de bacteriemia asociada a catéter. 50% de género masculino, 52% con edad gestacional al nacimiento menor a 36 semanas y 24% con peso menor a 1500 gramos al momento de la inserción del catéter. La edad fue de 24.2 días al momento de la inserción del catéter. En el 66% de los pacientes el sitio de inserción fue el miembro superior, siendo el Sthaphylococcus Epidermidis el germen con el 50% de las bacteriemias. Conclusión: La bacteriemia asociada a catéter afecta paciente prematuros, de bajo peso sin diferencias en genero. La manipulación de dichos dispositivos, el sitio de inserción, el uso previo de antibióticos, la duración del catéter y el uso de nutrición parenteral son factores que están asociados al mayor riesgo de infección. Siendo el Staphylococcus Epidermidis el germen mas frecuente.

Eficacia de la limpieza corporal con clorhexidina en prevenir la sepsis neonatal en cuidado intensivo revisión sistemática

ANTECEDENTES. La mortalidad neonatal se debe principalmente a procesos infecciosos y a prematurez. Se ha sugerido que el lavado corporal total con clorhexidina podría reducir la mortalidad neonatal relacionada con infección. No existen revisiones sistemáticas que exploren la eficacia de esta intervención. Objetivo. Evaluar la eficacia y seguridad de la limpieza corporal total con clorhexidina en la prevención de las infecciones asociadas al cuidado de la salud en neonatos de alto riesgo hospitalizados en cuidado intensivo neonatal. Metodología. Se realizó una revisión sistemática de la literatura. La búsqueda se hizo a través de las bases de datos Medline, Embase, LilaCS, Cochrane library y el registro de ensayos clínicos del Instituto Nacional de Salud de Estados Unidos. Se incluyeron ensayos clínicos publicados en los últimos 15 años hasta el 30 de enero del 2015. Las variables cualitativas se estimaron mediante OR o RR con sus IC95%. Las variables cuantitativas mediante diferencias de promedios o diferencias estandarizadas de promedios con sus IC95%. Resultados: Se incluyeron 3 estudios en el análisis cualitativo y cuantitativo. No se encontró evidencia concluyente que permita recomendar el uso de la limpieza corporal total con clorhexidina en los recién nacidos hospitalizados en cuidado intensivo neonatal. Conclusión: No existe evidencia que permita concluir que la limpieza corporal total con clorhexidina al 0.25% es mejor respecto a otras intervenciones en la prevención de sepsis neonatal asociada al cuidado de la salud . Es una intervención segura sin efectos adversos significativos.