L'utilisation des anticoagulants oraux directs chez les patients âgés : les limites de la médecine fondée sur les preuves [The use of the new direct oral anticoagulants among older subjects: The limits of the evidence-based medicine?].

The growing use of direct oral anticoagulants, in particular among older subjects, raises questions about the limits of the evidence-based medicine. The phase III studies that have validated the efficacy and the safety profile of these molecules (dabigatran, rivaroxaban, apixaban, edoxaban) in their both indications, the venous thromboembolic disease and the non-valvular atrial fibrillation raise concerns in four major fields: the financial support of pharmaceutical companies, the links of interest for many authors with the industry, the study design (exclusively non-inferiority studies), and the poor representativeness of the older subjects included. All these points are discussed, using data of sub-groups studies, post-marketing studies and recent meta-analysis. The lack of data for the very old subjects, with frailty or comorbidities, remains the main concern from these phase III studies.

Indications et limites de la thoracoscopie en 1994. [Indications and limits of thracoscopy in 1994.]

Reléguée au rang de moyen diagnostique occasionnel avec l'avènement de la streptomycine dès 1945, la thoracoscopie a repris depuis trois à cinq ans un rôle prépondérant dans l'armement du chirurgien thoracique, comme moyen diagnostique et surtout comme outil thérapeutique. Dans cet article, nous faisons le point quant à la place actuelle de la thoracoscopie face aux différentes pathologies thoraciques, pulmonaires, médiastinales et oesophagiennes. Dans certaines indications (pneumothorax, infiltrats pulmonaires diffus, nodule pulmonaire isolé), cette technique en pleine expansion a déjà clairement démontré sa supériorité. Dans d'autres cas, en particulier dans les affections néoplasiques, son application est encore le sujet de controverses.

Ressonância magnética para avaliação dos limites dos campos clássicos de radioterapia em pacientes portadoras de neoplasia maligna de colo uterino

OBJETIVO: Avaliar os limites de campo padronizados para radioterapia de neoplasia maligna de colo uterino com o uso de ressonância magnética e verificar a importância deste exame na redução de possíveis erros de planejamento com técnica convencional. MATERIAIS E MÉTODOS: Foram analisados, retrospectivamente, exames de ressonância magnética do planejamento de 51 pacientes tratadas devido a neoplasia de colo uterino. Os parâmetros estudados foram limites anterior e posterior no corte sagital. RESULTADOS: Observou-se, no corte sagital das ressonâncias magnéticas, que o limite de campo anterior apresentou-se inadequado em 20 (39,2%) pacientes e que houve perda geográfica em 37,3% dos casos no limite posterior. A inadequação de ambos os limites de campo não se relacionou com parâmetros clínicos como idade das pacientes, estadiamento, tipo e grau histológico. CONCLUSÃO: A avaliação dos limites de campo padronizados pela literatura com o uso de ressonância magnética mostrou altos índices de inadequação dos limites do campo lateral, assim como a importância do uso deste exame no planejamento radioterápico de pacientes portadoras de câncer de colo uterino com a finalidade de reduzir a perda geográfica no volume alvo de tratamento.

Xerogel p-anisidinapropilsílica: estudo da estabilidade térmica e da resistência à lixiviação com solventes

The xerogel p-anisidinepropylsilica was obtained. This solid presents some residual paraffin and also a small fraction of high organofunctionalized material that was leached in polar solvent. The xerogel purification could be achieved by exhaustively washing with hexane and dichloromethane solvents, or submitting the xerogel to thermal treatment up to 300 ºC, in vacuum. The resulting purified xerogel material present an appreciable thermal stability and resistance to leaching by solvents.

Caracterização e estabilidade físico-química de sistemas poliméricos nanoparticulados para administração de fármacos

Polymeric nanoparticle systems such as nanocapsules and nanospheres present potential applications for the administration of therapeutic molecules. The physico-chemical characteristics of nanoparticle suspensions are important pre-requisites of the success of any dosage form development. The purpose of this review is to present the state of the art regarding the physico-chemical characterization of these drug carriers, in terms of the particle size distribution, the morphology, the polymer molecular weight, the surface charge, the drug content and the in vitro drug release profiles. Part of the review is devoted to the description of the techniques to improve the stability of colloidal systems.

Estabilidade relativa de alcenos: análise dos critérios encontrados nos livros textos de graduação e uma proposta de explicação operacional para alcenos dissubstituídos

Despite of being used as thermodynamic criterion to rank alkene stability in a number of undergraduate textbooks, the heat of hydrogenation does not describe adequately the relative stability of disubstituted alkenes. In this work, both the heat of formation and the heat of combustion were used as thermodynamic criteria to rank correctly the stability of alkenes according to the degree of alkyl substitution and also in the disubstituted series (geminal > trans > cis). An operational model based on molecular orbital and valence bond representations of hyperconjugation is proposed to show how this effect can explain the order of stability of this class of compounds.

Efeito da composição do solvente sobre a estabilidade de proteínas em soluções aquosas

A protein presents a native (N) macro state, which is functionally active, in equilibrium with the denatured (D) macro state, which is devoid of biological activity. An ensemble of microstates forms each macrostate. The denatured state comprises a greater ensemble of microstates than the native macrostate. The N-D equilibrium can be affected by several factors, that comprise the purity of the water, temperature, pH and solute concentration. This work discusses the influence of osmolytes and chaotropics on the N-D equilibrium in aqueous solutions.

Avaliação do teor e da estabilidade de vitaminas do complexo B e vitamina C em bebidas isotônicas e energéticas

Vitamin C stability and concentration was evaluated in isotonic beverages and B group vitamins (B1, B2, B3, B5 and B6) in power beverages. The amount of vitamins was found to be above of that declared on the labels, even after the shelf life had been exceeded. A small decrease in the amount of B group vitamins was observed during the shelf life of the products. In the case of vitamin C this decrease was slightly higher. The present research shows the need of increased quality control and inspection.

Influência do pH sobre a estabilidade de suspensões de alumina estabilizadas eletroestericamente

In this work, aqueous suspensions of aluminas with different particle sizes were evaluated. The effect of pH on the electrosteric stabilization using PMAA-NH4 (ammonium polymethacrylate) as deflocculant was studied. The amount of deflocculant was optimized and rheologic properties were determined at four different pH values. Sedimentation was also evaluated. For suspensions with pH 4, an electrostatic mechanism of stabilization was observed, probably due to a flat adsorption of PMMA- on the alumina surface, leading to a small efficiency in relation to steric stabilization. For a suspension with pH 12, the steric mechanism of stabilization prevails. Suspensions with pH 7 and 9 present a higher flocculation degree. In relation to particle size, A-1000 samples present a smaller particle size, leading to a smaller interparticle distance (IPS), making stabilization more difficult.

Validação de metodologia analítica por cromatografia líquida para doseamento e estudo da estabilidade de pantoprazol sódico

Pantoprazole is a proton pump inhibitor used in the treatment of digestive ulcers, gastro-esophageal reflux disease and in the eradication of Helicobacter pylori. In this work, an analytical method was developed and validated for the quantification of sodium pantoprazole by HPLC. The method was specific, linear, precise and exact. In order to verify the stability of pantoprazole during dissolution assays, pantoprazole solution in phosphate buffer pH 7.4 was kept at room temperature and protected from light for 22 days. Pantoprazole presented less than 5% of degradation in 6 hours and the half live of the degradation was 124 h.

Avaliação da estabilidade do marcador plasmático do estresse oxidativo: malondialdeído

Malondialdehyde (MDA) is one of the lipid peroxidation products widely used as indicator of cellular injury. However, the short-term and the long-term stability of this biomarker remain unclear. The objective of this work was to evaluate the stability of plasmatic MDA at -20 ºC, utilizing thiobarbituric acid (TBA) as derivative in spectrophotometric and chromatographic analysis. The results showed that MDA was stable for 24 h after blood collection, was not stable when stored after alkaline hydrolysis, remained stable for 30 days after TBA derivatization and was stable for 3 days when stored after n-butanol extraction, all at -20 ºC.

Purificação e caracterização da beta-lapachona e estudo de estabilidade dos cristais em diferentes condições de armazenamento

The beta-lapachone is a product obtained from the Ipê Roxo tree [Tabebuia avellandae], which has proved its excellent antineoplasic potential acting through a particular mechanism of apoptosis against various cancer types. This study aims at determining the identity card of beta-lapachone by means of physico-chemical and pharmaco-technical characterization. A purifying process has been performed, as well as the isolation of a contaminant, its isomer alpha-lapachone. A stability study was also performed, determining the ideal storing conditions for beta-lapachone, essential for the ongoing pre-formulation studies for obtaining the different classic pharmaceutical forms and modified release systems.

Quantificação de TBHQ (terc butil hidroquinona) e avaliação da estabilidade oxidativa em óleos de girassol comerciais

Sunflower oil is one of the vegetable oils most susceptible to oxidative reaction. Therefore the presence of natural (tocopherol) and/or synthetic (TBHQ) antioxidants is a prerequisite to secure the stability of this oil during its shelf life, especially with the increased use of PET packaging. On determining the total tocopherol content in 10 samples of deodorized sunflower oils, high losses in total tocopherol during deodorization were identified. In order to facilitate researche involving oxidative stability of vegetable oils, a method for isolated quantification of TBHQ using the isocratic elution system was developed.