Controlo de qualidade de formas farmacêuticas estéreis

Com o avanço da tecnologia cada vez mais acessível, torna-se imprescindível acompanhar este mesmo desenvolvimento e adotá-lo para a obtenção de um melhor produto. Sendo as formas farmacêuticas estéreis alvo de uma rigorosa avaliação dos seus requisitos, é uma grande vantagem conhecer quais as orientações atuais para o fabrico destes produtos. Uma vez que estamos na era da “aldeia global”, é inquestionável a necessidade de conhecer documentos de outros países, isto porque na indústria farmacêutica, tal como em muitas outras, há o objetivo de expandir a comercialização de produtos para outros países, continentes, mas há que ter em atenção que para esses países os requisitos de qualidade desses produtos podem não ser iguais aos do nosso país. Ao conhecer e aplicar os principais e mais rígidos controlos e normas, é certo que todos os outros serão cumpridos. Como principais documentos que regulam e orientam o processo de fabrico destes produtos existem as Good Manufacturing Practices, as normas da Internactional Standardization Organization e as Farmacopeias de vários países. Na indústria farmacêutica, principalmente no fabrico das formas farmacêuticas estéreis, há controlo não só do processo de fabrico e produto final, como também de todo o ambiente e intervenientes que envolvem a produção. Dentro das formas farmacêuticas em estudo encontram-se as de uso oftálmico, de aplicação nasal, de aplicação auricular e de uso parenteral. Todas estas têm o principal requisito de ser estéreis, variando nos outros parâmetros, como tonicidade e pH de acordo com a localização da administração. Os ensaios realizados tanto em In Process Control como no produto final, estão presentes nas Farmacopeias, que serão discutidos e comparados entre si.

Determinação da utilidade do exame radiográfico na avaliação da morfologia e patologia do trato gastrointestinal

Atualmente a radiografia é um exame complementar de diagnóstico presente na grande maioria dos centros clínicos veterinários, estando assim facilmente acessível, motivo pelo qual deverá na maioria das vezes ser o primeiro exame auxiliar de diagnóstico por imagem a ser empregue em estudos do abdómen. A radiografia convencional do trato gastrointestinal permite avaliar a posição do mesmo, o seu conteúdo e tamanho, não sendo no entanto o meio de diagnóstico mais eficaz para a avaliação da integridade da sua mucosa. Devido ao seu potencial diagnóstico, o exame radiográfico deve ser realizado para diagnóstico de patologia do TGI sempre que o animal se apresente à consulta com sinais clínicos compatíveis com patologia do mesmo, como: vómito, regurgitação, tenesmo, diarreia, disquézia, etc Assim, tendo em conta o referido tornou-se pertinente determinar qual a utilidade do exame radiográfico na prática clínica. Deste modo, o presente estudo retrospetivo tem como objetivo determinar a utilidade do exame radiográfico na avaliação da morfologia e patologia do trato gastrointestinal. Para tal foi utilizada uma amostra composta por 44 indivíduos, 35 da espécie canina e 9 da espécie felina, que realizaram consulta no Hospital Veterinário do Baixo Vouga, apresentando sintomatologia compatível com afeção do trato gastrointestinal e que realizaram exame radiográfico abdominal. No exame radiográfico avaliaram-se vários parâmetros da morfologia do estômago (conteúdo e tamanho), intestino delgado (conteúdo, diâmetro luminal e distribuição pela cavidade abdominal) e intestino grosso (conteúdo, diâmetro luminal). Com base nas observações registadas, pôde concluir-se que a observação dos órgãos do trato gastrointestinal é o fator que condiciona a avaliação morfológica radiográfica, pois sempre que estes são radiograficamente visíveis todos os fatores são passíveis de serem avaliados. Quanto à utilidade do exame radiográfico na avaliação da patologia do trato gastrointestinal, pôde concluir-se que este possui uma sensibilidade de 63,89% e especificidade de 25%, pelo que, apresenta razoável utilidade na prática clínica, justificando-se a sua realização.

Prevalência da Automedicação nos alunos do Mestrado Integrado em Ciências Farmacêuticas da ULHT

A automedicação é uma prática cada vez mais comum em todo o mundo e quando praticada de forma responsável oferece diversos benefícios, nomeadamente uma maior autonomia das populações na gestão da sua saúde. No entanto, o consumo de medicamentos não deve ser banalizado e a orientação e aconselhamento por parte de um profissional de saúde como o farmacêutico será sempre uma mais-valia, na medida em que proporciona uma automedicação responsável, eficaz e segura. O presente trabalho teve como principais objectivos, determinar a prevalência da automedicação nos alunos do Mestrado Integrado em Ciências Farmacêuticas da Universidade Lusófona de Humanidades e Tecnologias e avaliar os factores associados a esta prática. Nesse sentido, foi desenvolvido um estudo descritivo transversal, com base num questionário aplicado a esta população. Os dados recolhidos foram posteriormente sujeitos a tratamento estatístico através do programa SPSS®. Considerando uma amostra de 138 indivíduos, os resultados mostraram que a prevalência da automedicação foi de 95,7%. Os principais sintomas que motivaram o recurso à automedicação foram os estados gripais e constipações (14,2%), as dores menstruais (11,1%), a tosse/rouquidão (10,2%), cefaleias (9,5%), febre (8.6%), rinorreia e congestão nasal (6,7%) e a rinite alérgica (5,1%). Os medicamentos mais usados, nos últimos dois anos, foram os anti-inflamatórios não esteróides (19,4%), os analgésicos e antipiréticos (19,2%), os descongestionantes nasais (12,8%), os antitússicos e expectorantes (11,8%), os anti-histamínicos (9,5%) e as vitaminas e sais minerais (7,9%). A grande maioria dos inquiridos (89,9%) mostrou-se consciente dos possíveis riscos inerentes à automedicação. Ainda assim, 29% afirmou já se ter automedicado, usando medicamentos sujeitos a receita médica.

Efeitos agudos do tratamento de radioterapia em doentes com carcinoma de cabeça e pescoço: IMRT vs RapidArc

A Radioterapia é parte integrante, standart, da abordagem multidisciplinar do tratamento de Carcinomas de Cabeça e Pescoço (CPP). A perceção e descrição dos efeitos provocados pelo tratamento ao nível dos tecidos normais é importante para avaliação clínica do doente, já que com o aparecimento de efeitos agudos severos/graves ao tratamento, este é interrompido, o que afetando diretamente a sobrevida do doente. Este estudo incidiu na avaliação de 6 semanas de tratamento de 46 doentes, contemplando a avaliação dos efeitos agudos do tratamento em cinco áreas anatómicas distintas: Pele, Mucosa, Glândulas Salivares, Faringe/Esófago e Laringe. Fundamentada nos critérios de classificação do Acute Radiation Morbidity Scoring Criteria da Radiation Therapy Oncology Group (RTOG). Após a avaliação e análise dos dados, verificou-se que os efeitos agudos obtidos com a técnica de RapidArcTM surgiram mais precocemente, quando comparados com técnica de IMRT. Por outro lado, com a técnica de IMRT registaram-se efeitos mais exacerbados, de alto Grau.

Reacções imunológicas associadas aos anti-inflamatórios não-esteróides

As reacções de hipersensibilidade relacionadas com os anti-inflamatórios não-esteróides (AINEs) são muito comuns na população, sendo consideradas como a segunda causa para o aparecimento deste tipo de reacções. Os AINEs podem desencadear reacções de hipersensibilidade alérgicas (imediatas e tardias) e reacções não alérgicas. Clinicamente, esta hipersensibilidade pode ser manifestada a nível respiratório, cutâneo e sistémico. O diagnóstico, in vivo (testes cutâneos e testes de provocação oral, nasal e de inalação) ou teste in vitro (BAT, CAST, ASPIteste e TTL), é um passo importante para prevenir o aparecimento de novas reacções e encontrar uma terapêutica alternativa para o paciente. Quando o paciente apresenta hipersensibilidade a um único AINE pode ser prescrito um AINE de outra família. Enquanto que se a hipersensibilidade for cruzada é mais seguro optar-se pelos inibidores selectivos da COX-2.

Multilayered hydrogel coatings covalently-linked to glass surfaces showing a potential to mimic mucosal tissues

Multilayered hydrogel coatings can be developed on the surface of glass slides via layer-by-layer deposition of hydrogen-bonded interpolymer complexes formed by poly(acrylic acid) and methylcellulose. Chemical modification of the glass surface with (3-aminopropyl)triethoxysilane with subsequent layer-by-layer deposition and cross-linking of interpolymer complexes by thermal treatment allows fabrication of ultrathin hydrogel coatings, not detachable from the substrate. The thickness of these coatings is directly related to the number of deposition cycles and cross-linking conditions. An unusual dependence of the hydrogel swelling properties on the sample thickness is observed and can be interpreted by gradual transitions between two- and three-dimensional networks. The hydrogels exhibit pH-responsive swelling behaviour, achieving higher swelling degrees at pH > 6.0. These coatings can be used as model substrates to study the adhesive properties of pharmaceutical tablets and can potentially mimic the total work of adhesion observed for the detachment of mucoadhesives from porcine buccal mucosa but fail to exhibit identical detachment profiles.

Iron-regulated surface determinant protein a mediates adhesion of staphylococcus aureus to human corneocyte envelope proteins

The ability of Staphylococcus aureus to colonize the human nares is a crucial prerequisite for disease. IsdA is a major S. aureus surface protein that is expressed during human infection and required for nasal colonization and survival on human skin. In this work, we show that IsdA binds to involucrin, loricrin, and cytokeratin K10, proteins that are present in the cornified envelope of human desquamated epithelial cells. To measure the forces and dynamics of the interaction between IsdA and loricrin (the most abundant protein of the cornified envelope), single-molecule force spectroscopy was used, demonstrating high-specificity binding. IsdA acts as a cellular adhesin to the human ligands, promoting whole-cell binding to immobilized proteins, even in the absence of other S. aureus components (as shown by heterologous expression in Lactococcus lactis). Inhibition experiments revealed the binding of the human ligands to the same IsdA region. This region was mapped to the NEAT domain of IsdA. The NEAT domain also was found to be required for S. aureus whole-cell binding to the ligands as well as to human nasal cells. Thus, IsdA is an important adhesin to human ligands, which predominate in its primary ecological niche.

The staphylococcus aureus surface protein IsdA mediates resistance to the innate defenses of human skin

Resistance to human skin innate defenses is crucial for survival and carriage of Staphylococcus aureus, a common cutaneous pathogen and nasal colonizer. Free fatty acids extracted from human skin sebum possess potent antimicrobial activity against S. aureus. The mechanisms by which S. aureus overcomes this host defense during colonization remain unknown. Here, we show that S. aureus IsdA, a surface protein produced in response to the host, decreases bacterial cellular hydrophobicity rendering them resistant to bactericidal human skin fatty acids and peptides. IsdA is required for survival of S. aureus on live human skin. Reciprocally, skin fatty acids prevent the production of virulence determinants and the induction of antibiotic resistance in S. aureus and other Gram-positive pathogens. A purified human skin fatty acid was effective in treating systemic and topical infections of S. aureus suggesting that our natural defense mechanisms can be exploited to combat drug-resistant pathogens.

Effect of circulating forms of soy isoflavones on the oxidation of low density lipoprotein

Soy isoflavones are thought to have a cardioprotective effect that is partly mediated by an inhibitory influence on the oxidation of low density lipoprotein (LDL). However, the aglycone forms investigated in many previous studies do not circulate in appreciable quantities because they are metabolised in the gut and liver. We investigated effects of various isoflavone metabolites, including for the first time the sulphated conjugates formed in the liver and the mucosa of the small intestine, on copper-induced LDL oxidation. The parent aglycones inhibited oxidation, although only 5% as well as quercetin. Metabolism increased or decreased their effectiveness. Equol inhibited 2.65-fold better than its parent compound daidzein and 8-hydroxydaidzein, not previously assessed, was 12.5-fold better than daidzein. However, monosulphated conjugates of genistein, daidzein and equol were much less effective and disulphates completely ineffective. Since almost all isoflavones circulate as conjugates, these data suggest that despite the increased potency produced by some metabolic changes, isoflavones may not be effective antioxidants in vivo unless they are deconjugated again.

Effect of circulating forms of soy isoflavones on the oxidation of low density lipoprotein

Soy isoflavones are thought to have a cardioprotective effect that is partly mediated by an inhibitory influence on the oxidation of low density lipoprotein (LDL). However, the aglycone forms investigated in many previous studies do not circulate in appreciable quantities because they are metabolised in the gut and liver. We investigated effects of various isoflavone metabolites, including for the first time the sulphated conjugates formed in the liver and the mucosa of the small intestine, on copper-induced LDL oxidation. The parent aglycones inhibited oxidation, although only 5% as well as quercetin. Metabolism increased or decreased their effectiveness. Equol inhibited 2.65-fold better than its parent compound daidzein and 8-hydroxydaidzein, not previously assessed, was 12.5-fold better than daidzein. However, monosulphated conjugates of genistein, daidzein and equol were much less effective and disulphates completely ineffective. Since almost all isoflavones circulate as conjugates, these data suggest that despite the increased potency produced by some metabolic changes, isoflavones may not be effective antioxidants in vivo unless they are deconjugated again.

Mobilisation of enterocyte fat stores by oral glucose in humans

Background and aims: When a high fat oral load is followed several hours later by further ingestion of nutrients, there is an early postprandial peak in plasma triacylglycerol (TG). The aim of this study was to investigate the location and release of lipid from within the gastrointestinal tract. Methods: Ten healthy patients undergoing oesopho-gastro-duodenoscopy (OGD) were recruited. At t=0, all patients consumed a 50 g fat emulsion and at t=5 hours they consumed either water or a 38 g glucose solution. OGD was performed at t=6 hours and jejunal biopsy samples were evaluated for fat storage. A subgroup of five subjects then underwent a parallel metabolic study in which postprandial lipid and hormone measurements were taken during an identical two meal protocol. Results: Following oral fat at t=0, samples from patients that had subsequently ingested glucose exhibited significantly less staining for lipid within the mucosa and submucosa of the jejunum than was evident in patients that had consumed only water (p=0.028). There was also less lipid storage within the cytoplasm of enterocytes (p=0.005) following oral glucose. During the metabolic study, oral glucose consumed five hours after oral fat resulted in a postprandial peak in plasma TG, chylomicron-TG, and apolipoprotein B48 concentration compared with oral water. Conclusion: After a fat load, fat is retained within the jejunal tissue and released into plasma following glucose ingestion, resulting in a peak in chylomicron-TG which has been implicated in the pathogenesis of atherosclerosis.

Effect of polydextrose on intestinal microbes and immune functions in pigs

Dietary fibre has been proposed to decrease risk for colon cancer by altering the composition of intestinal microbes or their activity. In the present study, the changes in intestinal microbiota and its activity, and immunological characteristics, such as cyclo-oxygenase (COX)-2 gene expression in mucosa, in pigs fed with a high-energy-density diet, with and without supplementation of a soluble fibre (polydextrose; PDX) (30 g/d) were assessed in different intestinal compartments. PDX was gradually fermented throughout the intestine, and was still present in the distal colon. Irrespective of the diet throughout the intestine, of the four microbial groups determined by fluorescent in situ hybridisation, lactobacilli were found to be dominating, followed by clostridia and Bacteroides. Bifidobacteria represented a minority of the total intestinal microbiota. The numbers of bacteria increased approximately ten-fold from the distal small intestine to the distal colon. Concomitantly, also concentrations of SCFA and biogenic amines increased in the large intestine. In contrast, concentrations of luminal IgA decreased distally but the expression of mucosal COX-2 had a tendency to increase in the mucosa towards the distal colon. Addition of PDX to the diet significantly changed the fermentation endproducts, especially in the distal colon, whereas effects on bacteria] composition were rather minor. There was a reduction in concentrations of SCFA and tryptamine, and an increase in concentrations of spermidine in the colon upon PDX supplementation. Furthermore, PDX tended to decrease the expression of mucosal COX-2, therefore possibly reducing the risk of developing colon cancer-promoting conditions in the distal intestine.

Comparative composition of bacteria in the human intestinal microflora during remission and active ulcerative colitis

Ulcerative colitis is a severe, relapsing and remitting disease of the human large intestine characterised by inflammation of the mucosa and submucosa. The main site of disease is the sigmoid/rectal region of the large bowel but the aetiology remains unknown. There is considerable evidence to indicate that the components of the resident colonic microflora can play an important role in initiation of the disease. The present study was aimed at characterising the faecal microflora of ulcerative colitis patients in remission and active phases to determine profile differences. Faecal samples were obtained from 12 patients, 6 with active colitis and 6 in remission. The samples were analysed for populations of lactobacilli, bifidobacteria, clostridia, bacteroides, sulphate-reducing bacteria (SRB) and total bacteria using culture independent fluorescence in situ hybridisation (FISH). Lactobacillus-specific denaturing gradient gel electrophoresis (DGGE) was then performed to compare the species present. Numbers of lactobacilli were significantly lower (p<0.05) during the active phase of the disease but the other populations tested did not differ. DGGE analysis revealed that Lactobacillus salivarus, Lactobacillus manihotivorans and Pediococcus acidilactici were present in remission, but not during active inflammation. These results imply that a reduction in intestinal Lactobacillus species may be important in the initiation of ulcerative colitis.

Mucoadhesive and elastic films based on blends of chitosan and hydroxyethylcellulose

Mucoadhesive polymeric films have been prepared based on blends of chitosan and hydroxyethylcellulose. The blends have been characterized by IR spectroscopy, DSC, WAXD, TGA, SEM, and mechanical testing. It is demonstrated that the mechanical properties of chitosan are improved significantly upon blending with hydroxyethylcellulose. An increase in hydroxyethylcellulose content in the blends makes the materials more elastic. The thermal treatment of the blends at 100 degrees C leads to partial cross-linking of the polymers and formation of water-insoluble but swellable materials. The adhesion of the films towards porcine buccal mucosa decreases with increasing hydroxyethylcellulose content in the blends.

Design of mucoadhesive polymeric films based on blends of poly(acrylic acid) and (hydroxypropyl)cellulose

Mixing of aqueous solutions of poly(acrylic acid) and (hydroxypropyl) cellulose results in formation of hydrogen-bonded interpolymer complexes, which precipitate and do not allow preparation of homogeneous polymeric films by casting. In the present work the effect of pH on the complexation between poly(acrylic acid) and (hydroxypropyl)cellulose in solutions and miscibility of these polymers in solid state has been studied. The pH-induced complexation-miscibility-immiscibility transitions in the polymer mixtures have been observed. The optimal conditions for preparation of homogeneous polymeric films based on blends of these polymers have been found, and the possibility of radiation cross-linking of these materials has been demonstrated. Although the gamma-radiation treatment of solid polymeric blends was found to be inefficient, successful cross-linking was achieved by addition of N, N'- methylenebis(acrylamide). The mucoadhesive potential of both soluble and cross-linked films toward porcine buccal mucosa is evaluated. Soluble films adhered to mucosal tissues undergo dissolution within 30-110 min depending on the polymer ratio in the blend. Cross-linked films are retained on the mucosal surface for 10-40 min and then detach.