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Abstract Consumer demand for natural, chemical-free products has grown. Food industry residues, like coffee pulp, rich in caffeine, chlorogenic acid and phenolic compounds, offer potential for pharmaceutical and cosmetic applications due to their antioxidant, anti-inflammatory, and antibacterial properties. Therefore, the objective of this work was to develop a phytocosmetic only with natural products containing coffee pulp extract as active pharmaceutical ingredient with antioxidant, antimicrobial and healing activity. Eight samples from Coffea arabica and Coffea canephora Pierre were analyzed for caffeine, chlorogenic acid, phenolic compounds, tannins, flavonoids, cytotoxicity, antibacterial activity, and healing potential. The Robusta IAC—extract had the greatest prominence with 192.92 μg/mL of chlorogenic acid, 58.98 ± 2.88 mg GAE/g sample in the FRAP test, 79.53 ± 5.61 mg GAE/g sample in the test of total phenolics, was not cytotoxic, and MIC 3 mg/mL against Staphylococcus aureus. This extract was incorporated into a stable formulation and preferred by 88% of volunteers. At last, a scratch assay exhibited the formulation promoted cell migration after 24 h, therefore, increased scratch retraction. In this way, it was possible to develop a phytocosmetic with the coffee pulp that showed desirable antioxidant, antimicrobial and healing properties.

Although preliminary evidence suggests Cannabis’s efficacy in symptom control for anxiety and depression—psychiatric disorders that significantly impact mental health—much remains to be understood about its effects on the central nervous system (CNS) and how to optimize treatment for these disorders. This study aims to conduct a narrative review to evaluate pharmaceutical care in treating symptoms of anxiety and depression alongside Cannabis use, focusing on safety and therapeutic efficacy optimization. We seek to conceptualize anxiety and depression disorders, review evidence on Cannabis use, evaluate the evidence quality, and identify knowledge gaps. Twelve articles were identified, revealing a significant gap in the literature regarding the integration of pharmaceutical care with Cannabis-based therapies, specifically for anxiety and depression. Despite a growing interest in the relationship between Cannabis and mental health, current research is insufficient for a comprehensive understanding. The relationship between Cannabis use and anxiety and depression disorders requires further, more targeted investigations. This study underscores the importance of future research to fill existing gaps, providing informed insights and robust guidelines for the safe and effective use of Cannabis as part of the treatment for anxiety and depression. It is crucial that pharmaceutical care integrates these therapies responsibly to improve the overall well-being of patients.

Cannabis sativa is a plant of the Cannabaceae family, whose molecular composition is known for its vast pharmacological properties. Cannabinoids are the molecules responsible for Cannabis sativa potential effects, especially tetrahydrocannabinol and cannabidiol. Scientific development has shown interest in the potential of cannabidiol in various health conditions, as it has demonstrated lower adverse events and great pharmacological potential, especially when administered topically. The present study aims to carry out a scoping review, focusing on the use of cannabidiol, in vivo models, for topical administration. Thus, the methodological approach used by the Joanna Briggs Institute was applied, and the studies were selected based on previously established inclusion criteria. Even though more information regarding the dose to achieve pharmacological potential is still needed, cannabidiol demonstrated potential in treating and preventing different conditions, such as glaucoma, atopic dermatitis, epidermolysis bullosa, and pyoderma gangrenosum.

The mitigation of damaged hair conditions involves the application and penetration of substances to stabilize broken bond sites, restore lipids and proteins, reinstate hydrophobicity, and recover hair mechanical properties. Vegetable oils, in general, exhibit a list of advantageous characteristics much desired by consumers, given the associated benefits for hair fibers. While coconut oil is highly popular in the hair care market and extensively studied for its ability to diffuse through the hair cortex, the effects of avocado and argan oil on the internal structure of hair and their potential benefits remain underexplored. Tensile and fatigue tests, as well as Raman spectroscopy, were carried out to investigate the interaction of these three oils with virgin and bleached Caucasian hair. The oils were applied in sufficient amounts directly to hair tresses and maintained for 24 h at 25 °C. Our results show that the three oils successfully diffused and interacted with the cortical region of the hairs. Their impact on hair mechanical properties depends on the level of damage and humidity conditions. In virgin hair, coconut and avocado oil reinforce the hydrophobic barrier of the cellular membrane complex, preventing water from causing intense perturbation of the mechanical properties, leading to increased stiffness and break stress. Meanwhile, due to the high degree of unsaturation of its fatty acid chains, argan oil increases water absorption, resulting in losses in hair resistance. When bleached, the hydrophilicity of the hair fiber increases, determining more affinity for argan oil. Consequently, the affinity with water is also elevated, causing increased fragility to mechanical stress. The analyzed vegetable oils are not always beneficial for hair care. Their specific chemical characteristics and hair conditions will influence the final results and should be taken into consideration in hair care product development.

Black pepper, a commonly utilized culinary condiment, holds significant importance in Ayurvedic and Chinese medicinal practices due to its various biological benefits, including antioxidant, antimicrobial, and anti-inflammatory properties. To amplify these attributes and enhance their efficacy in formulations, the utilization of nanocarriers presents a promising approach. Thus, the objective of this study was to obtain a pepper extract, evaluate its constituents, and encapsulate it in polymeric nanoparticles. The ethanol extract of the grains powder had a higher concentration of piperine and better antioxidant activity when compared to whole grains. Pepper extract encapsulation efficiency in terms of piperine concentration was 84.8 ± 3.5%, and a sustained and prolonged release profile was observed, as well as other studies in the literature using polycaprolactone (PCL). The presence of the extract did not change the instability index and the sedimentation velocity of the nanoparticles, as well as the polydispersity index and the zeta potential of nanoparticles. However, there was a difference in the mean size and concentration of particles. This study highlights the potential of PCL nanoparticles as a promising delivery system for black pepper extract, which could have various applications in the cosmetic and pharmaceutical industries, maximizing the benefits of black pepper extract.

Abstract L-Asparaginase (L-ASNase) is a biopharmaceutical used for acute lymphoblastic leukaemia (ALL) treatment, dramatically increasing the patients’ chance of cure. However, its production and distribution in developing countries were disrupted because of its low profitability, which caused great concern among patients. This study evaluates the feasibility of combining fractional precipitation and aqueous two-phase systems (ATPS) to purify L-ASNase from a low-grade product, commercially known as Acrylaway® L. The ATPS purification results were not particularly expressive compared to the two-step purification process composed of ethanol precipitation and gel filtration, which was able to recover the target molecule with a purification factor over 5 fold. Thus, we studied a purification process capable of manufacturing pharmaceutical grade L-ASNase from a commercially available low-grade raw material; however, improvements regarding its throughput must be achieved, and high purity is the first step to apply it as a new biopharmaceutical product. The proposed process could pose as a short-time solution to mitigate its shortage while a cost-effective production plant is being developed.

Abstract For centuries, bromelain has been used to treat a range of ailments, even though its mechanism of action is not fully understood. Its therapeutic benefits include enzymatic debridement of the necrotic tissues of ulcers and burn wounds, besides anti-inflammatory, anti-tumor, and antioxidant properties. However, the protease is unstable and susceptible to self-hydrolysis over time. To overcome the stability issues of bromelain, a previous study formulated chitosan-bromelain nanoparticles (C-B-NP). We evaluated the optimized nanoformulation for in vitro antioxidant, cell antiproliferative activities and cell migration/proliferation in the scratch assay, comparing it with free bromelain. The antioxidant activity of free bromelain was concentration and time-dependent; after encapsulation, the activity level dropped, probably due to the slow release of protein from the nanoparticles. In vitro antiproliferative activity was observed in six tumor cell lines for free protein after 48 h of treatment (glioma, breast, ovarian, prostate, colon adenocarcinoma and chronic myeloid leukemia), but not for keratinocyte cells, enabling its use as an active topical treatment. In turn, C-B-NP only inhibited one cell line (chronic myeloid leukemia) and required higher concentrations for inhibition. After 144 h treatment of glioma cells with C-B-NP, growth inhibition was equivalent to that promoted by the free protein. This last result confirmed the delayed-release kinetics of the optimized formulation and bromelain integrity. Finally, a scratch assay with keratinocyte cells showed that C-B-NP achieved more than 90% wound retraction after 24 h, compared to no retraction with the free bromelain. Therefore, nanoencapsulation of bromelain with chitosan conferred physical protection, delayed release, and wound retraction activity to the formulation, properties that favor topical formulations with a modified release. In addition, the promising results with the glioma cell line point to further studies of C-B-NP for anti-tumor treatments.

Abstract Objective The objective of the present study was to analyze the reasons that led to hormone therapies (HTs) regimen changes in women with breast cancer. Methods This was a retrospective cross-sectional study from a single-institution Brazilian cancer center with patient records diagnosed with breast cancer between January 2012 and January 2017. Results From 1,555 women who were in treatment with HT, 213 (13.7%) women had HT switched, either tamoxifen to anastrozole or vice-versa. Most women included in the present study who switched HT were > 50 years old, postmenopausal, Caucasian, and had at least one comorbidity. From the group with therapy change, ‘disease progression’ was reason of change in 124 (58.2%) cases, and in 65 (30.5%) patients, ‘presence of side effects’ was the reason. From those women who suffered with side effects, 24 (36.9%) had comorbidities. Conclusion The present study demonstrated a low rate of HT switch of tamoxifen to anastrozole. Among the reasons for changing therapy, the most common was disease progression, which includes cancer recurrence, metastasis or increased tumor. Side effects were second; furthermore, age and comorbidities are risk factors for side effects.

Resveratrol is a polyphenolic phytoalexin, whose main natural sources are red grapes, red wine, berries, and peanuts. When applied to the skin, resveratrol evidences a good penetrating capacity and low degradation compared to the oral route, allowing for a longer and improved topical effect. This bioactive molecule has been gaining interest in dermo-pharmacy and cosmetics for the prevention and treatment of skin alterations. Its inherent meritorious biomedical potentials, including anti-aging, photoprotective, estrogen-like, skin-whitening, anti-acne, wound healing, anti-scarring, antimicrobial, and anti-skin cancer properties are the most evident. However, resveratrol evidences stability hurdles, becoming an unstable molecule when exposed to ultraviolet radiation. Several technological strategies have been developed to improve its stability, efficacy, and safety. We have described the main topical properties of resveratrol, and the involved mechanisms of action, and a great focus was placed on the technological strategies for the efficient application of resveratrol in dermatological and cosmetic formulations, including nanotechnology.

Variation in drug disposition genes might contribute to susceptibility to toxicities and interindividual differences in clinical management on chemotherapy for epithelial ovarian cancer (EOC). This study was designed to explore the association of GST and ABCB1 genetic variation with hematologic and neurologic toxicity, changes in chemotherapy, and disease prognosis in Brazilian women with EOC. A total of 112 women with a confirmed histological diagnosis of EOC treated with carboplatin/paclitaxel were enrolled (2014–2019). The samples were analyzed by multiplex polymerase chain reaction (PCR) for the deletion of GSTM1 and GSTT1 genes. GSTP1 (c.313A>G/rs1695) and ABCB1 (c.1236C>T/rs1128503; c.3435C>T/rs1045642; c.2677G>T>A/rs2032582) single nucleotide polymorphisms (SNPs) were detected by real‐time PCR. Subjects with the GSTP1 c.313A>G had reduced risk of anemia (odds ratio (OR): 0.17, 95% confidence interval (CI): 0.04–0.69, P = 0.01, dominant model) and for thrombocytopenia (OR: 0.27, 95% CI: 0.12–0.64, P G AG genotype was associated with a lower risk of dose delay (OR: 0.35, 95% CI: 0.13–0.90, P = 0.03). The ABCB1 c.1236C>T was associated with increased risk of thrombocytopenia (OR: 0.15, 95% CI: 0.03–0.82, P = 0.03), whereas ABCB1 c.3435C>T had increased risk of grade 2 and 3 neurotoxicity (OR: 3.61, 95% CI: 1.08–121.01, P = 0.03) in recessive model (CC + CT vs. TT). This study suggests that GSTP1 c.313A>G, ABCB1 c.1236C>T, and c.3435C>T SNP detection is a potential predictor of hematological toxicity and neurotoxicity and could help predict the clinical management of women with EOC.

The use of materials and products that improve appearance and provide comfort and well-being goes back to the beginning of civilization. Cosmetics is an evolving market that has increasingly focused on innovative technological approaches. Nanotechnology is one of the most revolutionary and promising fields for the development of novel and enhanced cosmetic products, owing to the remarkable multifunctional characteristics and effects of nanomaterials (NMs). Their application, however, also raises potential safety concerns. Some of these concerns can be addressed by determining the type of NMs used, as well as their stability, potential for skin absorption, route of exposure, and how they are formulated into cosmetic products. To guarantee such safety, cosmetic products containing NMs, must comply with European regulatory provisions, particularly the European Regulation (EC) n.° 1223/2009 of the European Parliament and of the Council. Hence, this review comprises all the particularities of NMs, their influence on human health, challenges towards environmental sustainability, and strategies to harmonize policies with the aim to normalize their application in cosmetics.

A poloxamer 407 (P407)—Casein hydrogel was chosen to carry polycaprolactone nanoparticles carrying terbinafine (PCL-TBH-NP). In this study, terbinafine hydrochloride (TBH) was encapsulated into polycaprolactone (PCL) nanoparticles, which were further incorporated into a poloxamer-casein hydrogel in a different addition order to evaluate the effect of gel formation. Nanoparticles were prepared by the nanoprecipitation technique and characterized by evaluating their physicochemical characteristics and morphology. The nanoparticles had a mean diameter of 196.7 ± 0.7 nm, PDI of 0.07, negative ζ potential (−0.713 mV), high encapsulation efficiency (>98%), and did not show cytotoxic effects in primary human keratinocytes. PCL-NP modulated terbinafine was released in artificial sweat. Rheological properties were analyzed by temperature sweep tests at different addition orders of nanoparticles into hydrogel formation. The rheological behavior of nanohybrid hydrogels showed the influence of TBH-PCL nanoparticles addition in the mechanical properties of the hydrogel and a long-term release of the nanoparticles from it.

Many plants are used by the population through popular knowledge passed from generation to generation for the treatment of various diseases. However, there is not always any scientific content supporting these uses, which is very important for safety. One of these plants is the fruit of the Spondias genus, which during its processing generates various residues that are discarded, but which also have pharmacological properties. The focus of this review is to survey the pharmacological activities that Spondias genus shows, as well as which part of the plant is used, since there is a lot of richness in its by-products, such as leaf, bark, resin, seed, and peel, which are discarded and could be reused. The main activities of this genus are antioxidant, anti-inflammatory, antidiabetic, antifungal, and antiviral, among others. These properties indicate that this genus could be used in the treatment of several diseases, but there are still not many products available on the market that use this genus as an active ingredient.

Achieving the best possible outcome for the therapy is the main goal of a medicine. Therefore, nanocarriers and co-delivery strategies were invented to meet this need, as they can benefit many diseases. This approach was applied specifically for cancer treatment, with some success. However, these strategies may benefit many other clinical issues. Skin is the largest and most exposed organ of the human body, with physiological and psychological properties. Due to its exposition and importance, it is not difficult to understand how many skin diseases may impact on patients’ lives, representing an important burden for society. Thus, this review aims to summarize the state of the art in research concerning nanocarriers and co-delivery strategies for topical agents’ applications targeting skin diseases. The challenge for the medicine of the future is to deliver the drug with spatial and temporal control. Therefore, the co-encapsulation of drugs and the appropriate form of administration for them are so important and remain as unmet needs.

Objectives: The pregnancy period, with its peculiarities and specific symptoms that may or may not be physiological, can lead to medication use through prescription or even self-medication. This study aimed to assess self-medication practices among pregnant women, the most used medications, symptoms reported, and factors associated with this practice.Methods: This was a cross-sectional study conducted with pregnant women with an antenatal care (ANC) appointment in a tertiary teaching hospital referral in women’s health. From April 2019 to February 2020, 297 pregnant women were interviewed. Self-medication was considered as the use of any medicine (including medicinal plants (MPs), herbal products, and vitamins) without a medical or dental prescription. The period considered to assess self-medication practice was the last 60 days prior to the study interview.Results: Among the 297 women interviewed, 107 (36.0%) had practiced self-medication in the previous 60 days. Acetaminophen was the most used medication, and headache was the most frequent symptom reported by self-medicated pregnant women. Pregnant women with high-school (73 (68.2%) (OR = 2.52; 95% CI 1.17–5.43; p = 0.018)) or university-level (23 (21.5%) (OR = 2.82; 95% CI 1.15–6.94; p = 0.024)) education had a higher risk of practicing self-medication when compared to women with lower education. Women in the first gestational trimester (35 (32.7%) (OR = 3.61; 95% CI 1.64–7.96; p = 0.002)) and with two or more pregnancies (87 (81.2%) (OR = 1.96; 95% CI 1.07–3.60; p = 0.029)) were more likely to practice self-medication than pregnant women in the second or third gestational trimester and in the first pregnancy, respectively.Conclusion: Self-medication was practiced by a considerable proportion of our sample, with the majority being OTC drugs. The factors associated with self-medication can help to improve prevention strategies regarding self-medication during pregnancy.

Nanomaterials use in cosmetics is markedly enhancing, so their exposure and toxicity are important parameters to consider for their risk assessment. This review article provides an overview of the active cosmetic ingredients used for cosmetic application, including dermal cosmetics and also hair dye cosmetics, as well as their safety assessment, enriched with a compilation of the safety assessment tests available to evaluate the different types of toxicity. In fact, despite the increase in research and the number of papers published in the field of nanotechnology, the related safety assessment is still insufficient. To elucidate the possible effects that nanosized particles can have on living systems, more studies reproducing similar conditions to what happens in vivo should be conducted, particularly considering the complex interactions of the biological systems and active cosmetic ingredients to achieve newer, safer, and more efficient nanomaterials. Toward this end, ecological issues and the toxicological pattern should also be a study target.

Rosmarinus officinalis belongs to the Lamiaceae family, and its constituents show antioxidant, anti-inflammatory, antidepressant, antinociceptive, and antibacterial properties. The aim of this study was to develop a topical formulation with R. officinalis extract that had antimicrobial and antioxidant activity. Maceration, infusion, Soxhlet, and ultrasound were used to produce rosemary extracts, which were submitted to antioxidant, compound quantification, cell viability, and antimicrobial assays. Infusion and Soxhlet showed better results in the DPPH assay. During compound quantification, infusion showed promising metabolite extraction in phenolic compounds and tannins, although maceration was able to extract more flavonoids. The infusion and ultrasound extracts affected more strains of skin bacteria in the disk diffusion assays. In the minimum inhibitory concentration assay, the infusion extract showed results against S. aureus, S. oralis, and P. aeruginosa, while ultrasound showed effects against those three bacteria and E. coli. The infusion extract was chosen to be incorporated into a green emulsion. The infusion extract promoted lower spreadability and appropriated the texture, and the blank formulation showed high levels of acceptance among the volunteers. According to the results, the rosemary extract showed promising antioxidant and antimicrobial activity, and the developed formulations containing this extract were stable for over 90 days and had acceptable characteristics, suggesting its potential use as a phytocosmetic. This paper reports the first attempt to produce an oil-in-water emulsion using only natural excipients and rosemary extract, which is a promising novelty, as similar products cannot be found on the market or in the scientific literature.

Introdução: O número de casos de carcinoma cutâneo tem aumentado cada vez mais e vem determinando a necessidade de aprimorar estratégias de saúde economicamente eficazes para prevenir a doença e suas complicações. Objetivo: Realizar estudo transversal, tendo os dados sido coletados diretamente com os participantes, por meio da aplicação de questionário. Métodos: Com os dados coletados realizou-se o cálculo da regressão logística bivariada, obtendo-se a razão de chances (OR) e o intervalo de confiança (IC) 95% entre as variáveis independentes e o comportamento de risco, o qual foi determinado pela não utilização diária de filtro solar e/ou outros meios de fotoproteção. A amostra foi composta por 200 estudantes, 50% da área de exatas e 50% da área biológica. Resultados: Não foi constatada diferença significativa entre o comportamento dos graduandos nas diferentes áreas analisadas. Mulheres apresentaram menor comportamento de risco em relação aos homens (OR=0,07; IC95%: 0,01-0,56). Conclusões: A maior parte dos universitários não se protege da exposição solar adequadamente, sendo esse comportamento de risco inferior nas mulheres. Ações de fotoeducação são importantes entre os estudantes

Background: Highly active antiretroviral therapy (HAART) is complex and many factors contribute to a patient’s response to initial therapy including adherence, drug effectiveness, and tolerance. Close HAART follow-up is needed, particularly when there are concurrent therapies such as prophylactic antibiotics and medications for the treatment of comorbidities. Objective: To assess the effectiveness of pharmacist intervention in reducing drug related problems in HIV/AIDS outpatients (intervention group) and in improving clinical parameters in the intervention group compared to the control group. Methods: We conducted a prospective controlled intervention study with patients paired by gender and initial T CD4+ lymphocyte (CD4) count. HIV-infected patients of a public outpatient service were enrolled for the study by consecutive and convenience sampling. Patients selected for the study were divided into a control group and an intervention group. Both groups were followed for one year; however, only the intervention group received pharmaceutical care. The primary outcome was the drug related problem (DRP) analysis for the intervention group. Secondary outcomes were CD4 count and viral load evaluation for both groups. Results: There was a total of 143 patients enrolled in this study, with 53 (37.06%) patients in the control group and 90 (62.94%) patients in the intervention group. A total of 202 pharmacist interventions with 193 pharmacist-patient and 9 pharmacist-physician interventions were proposed. After one year of pharmaceutical care, a reduction of 38.43% between the initial and final DRP was found (p = 0.0001). The most common DRPs found were related to medication safety. The intervention group showed a mean increase of 84% for the CD4 count in comparison with that observed in the control group. The viral load was not significantly different between the final and initial mean values for both groups. Conclusion: Pharmacist appointments enabled identification, prevention, and solving of drug related problems, especially those related to drug safety. Also, pharmacist interventions improved adherence and increased HAART effectiveness as suggested by the higher elevation in the CD4 count seen in the intervention group in comparison with the control group.

Abstract Introduction In the pregnancy-puerperal cycle, women may develop complications that require admission to the Intensive Care Unit (ICU). Thus, special attention to pharmacotherapy is necessary, particularly to potential drug interactions (PDIs) and to the effect of the drugs on the fetus and newborn. Objective The aim of this study was to determine the profile of PDIs and the potential risk of drugs used during pregnancy and breastfeeding among patients admitted to the ICU. Methods We conducted an observational, cross-sectional and prospective study, including pregnant and breastfeeding women admitted to the ICU at the Women’s Hospital of a university in the city of Campinas, Brazil, for one year. Online databases were used to identify and classify the PDIs and the potential risk of the drugs used during pregnancy and breastfeeding. Results We evaluated 305 prescriptions of 58 women, 31 pregnant and 27 breastfeeding, and 284 (91%) prescriptions presented PDIs. A total of 175 different combinations of PDIs were identified in the prescriptions, and adverse effects caused by the simultaneous use of drugs were not actually observed in the clinical practice. A total of 26 (1.4%) PDIs were classified as contraindicated. We identified 15 (13.8%) drugs prescribed with risk D, and 2 (1.8%) with risk X for pregnant women, as well as 4 (4.9%) drugs prescribed with high risk for breastfeeding women. Conclusions This study demonstrates that there is a high incidence of PDIs in prescriptions. Most drugs used by pregnant and breastfeeding women at the ICU did not present serious risks to their fetus and newborns, but sometimes drugs with risk D or X are necessary in the course of the treatment.

Objetivos: demonstrar a influência das intervenções farmacêuticas (IFs) na evolução clínica e na economia dos pacientes HIV positivos de um hospital universitário no interior do estado de São Paulo. Métodos: os pacientes foram separados aleatoriamente em grupo controle (GC; n=26) e grupo intervenção (GI; n=26). O GI recebeu acompanhamento farmacoterapêutico por meio de método próprio baseado no método PWDT e, foram realizadas IFs durante 1 ano com este grupo. A análise da evolução clínica foi baseada na identificação, resolução e prevenção de problemas farmacoterapêuticos (PFTs) e nos resultados dos exames de hemoglobina (Hb), CD4 e carga viral (CV); os aspectos econômicos foram avaliados por meio dos custos de consultas médicas, atendimentos da enfermagem, exames laboratoriais, procedimentos e internação no hospital. Resultados: noventa e uma IFs foram realizadas durante 1 ano no GI. PFTs diminuíram aproximadamente 16%. Depois de 1 ano, as variações de Hb e CD4 foram estatisticamente significativas para o GI (95% e 90% de confiança, respectivamente); 50% do GC e 77,78% do GI tiveram CV

Objetivos: O objetivo deste estudo foi avaliar a existência de interações medicamentosas potenciais teóricas em prescrições feitas na Unidade de Terapia Intensiva (UTI) de um hospital da rede pública de saúde (Hospital de Clínicas – UNICAMP), quantificá-las e classificá-las quanto ao seu grau de severidade, traçando com isso um perfil das prescrições deste setor. Métodos: No período de janeiro a junho de 2011 foram avaliadas prescrições de 195 pacientes, todos maiores de 18 anos, internados por mais de 24 horas na UTI adulto do HC. Resultados: Foram prescritos no período avaliado 172 diferentes tipos de medicamentos, média de 12,9 ± 4,3 por prescrição. Entre as prescrições avaliadas 88,2% apresentaram interações medicamentosas potenciais teóricas, obtendo-se uma média por prescrição de 4,7± 4,9. As 915 IMPT observadas nas prescrições foram classificadas, utilizando a base de dados Micromedex®, em contra-indicadas (20), maiores (257), moderadas (516) e menores (122), e sinalizadas à equipe médica de acordo com a sua severidade e necessidade de manejo clínico. Conclusão: Este estudo colabora com o delineamento do perfil da farmacoterapia utilizada em terapia intensiva, demonstrando que há nela uma elevada incidência de interações medicamentosas potenciais em prescrições. Ressalta-se com ele a necessidade de atuação do farmacêutico clínico nesta área, a fim de contribuir com a equipe multidisciplinar na redução de riscos provenientes da terapia medicamentosa.

Topical application is an important administration route for drugs requiring local action on the skin, thereby avoiding their systemic absorption and adverse side effects. Rosmarinus officinalis L. (syn. Salvia rosmarinus Spenn.), popularly known as rosemary, is an aromatic plant with needle-like leaves belonging to the Lamiaceae family. Rosemary has therapeutic properties and has been used in the folk medicine, pharmaceutical, and cosmetics industries, mainly for its antioxidant and anti-inflammatory properties, which are attributed to the presence of carnosol/carnosic and ursolic acids. The therapeutic use of rosemary has been explored for the treatment of inflammatory diseases; however, other uses have been studied, such as wound healing and skin cancer and mycoses treatments, among others. Besides it therapeutic uses, rosemary has potential applications in cosmetic formulations and in the treatment of pathological and non-pathological conditions, such as cellulite, alopecia, ultraviolet damage, and aging. This review aims to critically discuss the topical applications of rosemary found in the literature while also offering relevant information for the development of topical formulations of its bioactive compounds.

Abstract Patients in intensive care unit are prescribed large numbers of drugs, highlighting the need to study potential Drug-Drug Interactions in this environment. The aim of this study was to delineate the prevalence and risk of potential drug-drug interactions between medications administered to patients in an ICU. This cross-sectional observational study was conducted during 12 months, in an adult ICU of a teaching hospital. Inclusion criteria were: prescriptions with 2 or more drugs of patients admitted to the ICU for > 24 hours and age of ≥18 years. Potential Drug-Drug Interactions were quantified and classified through MicromedexTM database. The 369 prescriptions included in this study had 205 different drugs, with an average of 13.04 ± 4.26 (mean ± standard deviation) drugs per prescription. Potential Drug-Drug Interactions were identified in 89% of these, with an average of 5.00 ± 5.06 interactions per prescription. Of the 405 different pairs of potentially interacting drugs identified, moderate and major interactions were present in 74% and 67% of prescriptions, respectively. The most prevalent interaction was between dipyrone and enoxaparin (35.8%), though its clinical occurrence was not observed in this study. The number of potential Drug-Drug Interactions showed significant positive correlations with the length of stay in the intensive care unit, and with the number of prescribed drugs. Acknowledging the high potential for Drug-Drug Interactions in the ICU represents an important step toward improving patient safety and best therapy results.

The high toxicity and narrow therapeutic window of antineoplastic agents makes pharmacovigilance studies essential in oncology. The objectives of the current study were to analyze the pattern of spontaneous notifications of adverse drug reactions (ADRs) in oncology patients and to analyze the incidence of ADRs reported by outpatients on antineoplastic treatment in a tertiary care teaching hospital. To compose the pattern of ADR, the notification forms of reactions in oncology patients in 2010 were reviewed, and the reactions were classified based on the drug involved, mechanism, causality, and severity. To evaluate the incidence of reactions, a questionnaire at the time of chemotherapy was included, and the severity was classified based on the Common Terminology Criteria. The profiles of the 10 responses reported to the Pharmacovigilance Sector were type B, severe, possible, and they were primarily related to platinum compounds and taxanes. When the incidence of reactions was analyzed, it was observed that nausea, alopecia, fatigue, diarrhea, and taste disturbance were the most frequently reported reactions by oncology patients, and the grade 3 and 4 reactions were not reported. Based on this analysis, it is proposed that health professionals should be trained regarding notifications and clinical pharmacists should increasingly be brought on board to reduce under-reporting of ADRs.

Enzyme stability is critical in biotechnology, pharmaceutical and cosmetic industries. Investigations on this subject have drawn attention because of its practical application. Bromelain is a thiol-endopeptidase, obtained from pineapple (Ananas comosus), known for its clinical and therapeutic applications, particularly to selective burn debridement and improvement of antibiotic action and anti-inflammatory activities. To date, the use of bromelain in pharmacological or industrial applications is limited, due to commercial availability, costs, and sensitivity to pH and temperature. Therefore, a better understanding of enzyme stability would be of great interest. The aim of this study was to evaluate bromelain activity and stability in several pH (2.0 to 8.0) and in polyethylene glycol and polyacrylic acid solutions. We observed that bromelain was able to maintain its stability at pH 5.0 for the temperatures studied. PEG solutions increased bromelain stability, but PAA solutions had the opposite effect.

The aim of this study was to validate a HPLC method for the assay of flavonoids in extracts obtained from natural sources, i.e., from Dirmophandra mollis Benth, Ginkgo biloba L., Ruta graveolens L., and Vitis vinífera L. The potential sun protecting effect, antioxidant activity, and cell viability of the extracts were also determined. Individual extracts (obtained from each individual species) and a mixed extract (containing the four extracts) were analyzed by the validated HPLC method for the identification of flavonoids and quantification of rutin and quercetin. An in vitro cell viability study was carried out using the neutral red method. The in vitro sun protection factor was determined by spectral transmittance and in vitro antioxidant efficacy was evaluated against DPPH, ABTS, and AAPH radicals. The HPLC method used for the identification and quantification of flavonoids in extracts exhibited linearity, precision, accuracy, and robustness. Detection and quantification limits were, respectively, 2.881 ± 0.9 μg·mL−1 and 0.864 ± 0.9 μg·mL−1 for quercetin, and 30.09 ± 1 μg·mL−1 and 9.027 ± 1.1 μg·mL−1 for rutin. All extracts did not affect cell viability at the evaluated concentration range and exhibited a sun protection effect and antioxidant activity. Among the evaluated extracts, Ginkgo biloba L. and the mixed extract depicted the most expressive antioxidant activity. The mixed extract exhibited sunscreen protection against ultraviolet A (UVA) and ultraviolet B (UVB) and a critical wavelength of 372.7 ± 0.1. Our results translate the enhanced flavonoids’ composition of the mixed extract, which may be a potential alternative over sunscreens and antioxidants in pharmaceutic/cosmetic formulations.

The aim of this study was to develop a phytocosmetic sunscreen emulsion with antioxidant effect, containing a blend of flavonoid-enriched plant extracts. In vitro sun protection factor, antioxidant activity, skin irritation, photostability, cutaneous permeation, and retention of flavonoids were evaluated. Thermodynamically stable emulsions were obtained and tested for sensorial analysis after loading the blend of extracts. The selected emulsion was stable when stored at low temperatures (5 °C), for which after 120 days the concentration of quercetin and rutin were above their limit of quantification, i.e., 2.8 ± 0.39 μg/mL and 30.39 ± 0.39 μg/mL, respectively. Spreadability, low rupture strength and adhesiveness were shown to be similar to a conventional topical product. Higher brittleness, pseudo-plastic, and viscoelastic behaviors were also recorded for the developed phytocosmetic sunscreen. The product presented a critical wavelength of 387.0 nm and ultraviolet rays A and B (UVA/UVB) rate of 0.78, confirming that the developed formulation shows capacity for UVA/UVB protection, protecting skin against damages caused by ultraviolet (UV) radiation. Rutin was shown to permeate the skin barrier and was also quantified in the stratum corneum (3.27 ± 1.92 μg/mL) by tape stripping and retention test (114.68 ± 8.70 μg/mL). The developed flavonoid-enriched phytocosmetic was shown to be non-irritant to skin by an in vitro assay. Our results confirm the antioxidant activity, sun protection, and physical properties of the developed phytocosmetic for topical application.

The aim of this work was to isolate and purify bromelain extracted from the pineapple peel by ammonium sulfate precipitation (40-80%), followed by desalting and freeze-drying with a 75% activity recovery and 2.2 fold increased specific activity. Ion exchange chromatography on DEAE-Sepharose was able to separate the polysaccharides from the enzyme, which was recovered in the elution step, maintaining its enzymatic activity. The batch adsorption of bromelain was evaluated in terms of total protein and enzymatic activity using Langmuir and Langmuir-Freundlich models. Results showed that the process could be suitable for the recovery and purification of the enzyme, maintaining its specific activity.

The aim of the present study was to quantify drug interactions in prescriptions for women undergoing supportive therapy in an oncology setting at a women’s hospital in Brazil and compare the information provided by different databases regarding these drug interactions. A convenience sample was selected of prescriptions for patients diagnosed with breast or gynecological tumors hospitalized in the clinical oncology and surgery wards from April to June 2009. DRUGDEX/Micromedex (Thomson Micromedex) was the main database used for the identification of drug interactions and was compared with two other databases: Drugs.com and Lexicomp. The search was performed by inputting all drug combinations found in the prescriptions in Micromedex and Drugs.com. All interactions identified and classified by Micromedex and/or Drugs.com as of major severity were then checked in Lexicomp. A total of 152 interactions were identified by Micromedex (61 major, 69 moderate and 22 minor). In Drugs.com, 614 interactions were identified (85 major, 464 moderate and 65 minor). Forty-four were classified as major drug interactions in at least one of the databases: 30 in Micromedex, 26 in Drugs. com and 14 in Lexicomp. The present findings reveal discrepancies among the three databases analyzed. Thus, standardization should be proposed. Moreover, both the pharmacist and multidisciplinary team should perform a critical analysis of prescriptions to promote safe practices in the use of medications and minimize potential complications caused by drug interactions.

Parenteral solutions (PS) are one of the most commonly used drug delivery vehicles. Interactions among the drug, components in the drug's formulation, and the PS can result in the formation of inactive complexes that limit efficacy or increase side effects. The aim of this work was to evaluate possible interactions between the drugs and PS, assess drug stability and to identify degradation products after 20 h at room temperature. Furosemide (FSM) and Aminophylline (APN) were added to PS containing either 20% mannitol or 0.9% NaCl at pH 6.5-7.5 and 10-11. Their behavior was studied individually and as an admixture, after 1 h oxidation with H2O2, using a spectrophotometer and HPLC. Individually, FSM and APN added to 20% mannitol and 0.9% NaCl solutions had the highest stability at pH 10-11. When FSM and APN were combined, the behavior of FSM was similar to the behavior observed for the drug individually in the same solutions. With the drugs combined in 20% mannitol pH 10-11, HPLC showed that both drugs were stable after a 20 h period yielding two distinct peaks; in oxidized samples, the elution profile showed four peaks with retention times unrelated to the untreated samples.Soluções parenterais de grande volume são frequentemente utilizadas no ambiente hospitalar para a veiculação de fármacos. No entanto, possíveis incompatibilidades entre as estruturas dos fármacos, em diferentes veículos de administração, podem gerar possíveis associações antagônicas ou sinérgicas, resultando em alterações das propriedades físico-químicas, consequentemente, dos efeitos farmacológicos e das respostas clínicas esperadas. Este artigo avaliou a estabilidade e a possível formação de produtos de degradação entre os fármacos furosemida e aminofilina quando estes foram veiculados em soluções parenterais, após o preparo e após o período de 20 h. Furosemida e aminofilina foram adicionadas às soluções de 20% manitol e 0,9% NaCl nos valores de pH 6,5-7,5 e 10-11. A estabilidade dos fármacos foi avaliada individualmente, combinada e após degradação com peróxido de hidrogênio através de espectrofotometria de UV e HPLC. Furosemida e aminofilina individualmente avaliadas mostraram alta estabilidade em ambas as soluções estudadas nos valores de pH 10-11. Quando os fármacos foram combinados o comportamento da furosemida foi similar ao observado na ausência de aminofilina. Os fármacos combinados em 20% manitol pH10-11 por HPLC foram estáveis após o período de 20 h. Após degradação o perfil de cromatograma encontrado foi diferente do observado na ausência de degradação mostrando que o método é indicativo de estabilidade.

Interação medicamentosa (IM) é um evento clínico em que os efeitos de um fármaco são alterados pelo uso concomitante ou anterior de outro fármaco, alimento ou bebida. O estudo teve como objetivo identificar IM em prescrições da Unidade de Terapia Intensiva (UTI) e Alojamento Conjunto (AC). Foram avaliadas 36 prescrições da UTI e 271 do AC. As IM foram listadas como graves, moderadas e menores. A base utilizada foi o site Drugs. Identificou-se 105 interações graves, 171 moderadas, 18 menores. Para as IM classificadas como graves, realizou-se estudo comparativo com a base DrugDex/Micromedex e com o software O Pharmacêutico, constatando-se que a IM de metoclopramida com tramadol que representava 63,16% das IM da UTI e 100% das IM do AC não são classificadas como graves. A identificação das IM de relevância clínica e o seu monitoramento permite tratamentos mais efetivos com o menor número possível de complicações causadas por IM. Palavras-chave: Interações medicamentosas. Análise de prescrição. Uso racional de medicamentos. ABSTRACT Drug interaction (DI) is a common clinical occurrence, in which the effects of one drug are altered by the simultaneous or previous use of another drug, food or drink. The aim of this study was to identify DI in medical prescriptions issued in the intensive care unit (ICU) and common shelter (CS) at a public women’s hospital in Brazil. Thirty-six prescriptions from the ICU and 271 prescriptions from the CS were analyzed and the DIs classified as “major”, “moderate” and “minor”, based on the database at the website Drugs.com. At the ICU, 105 “major”, 171 “moderate” and 18 “minor” DIs were identified, while at the CS, the numbers found were 64, 64 and 4, respectively. For major DIs, a comparative analysis was carried out with another database, DrugDex/MicromedexTM, and the program OPharmaceuticoTM, revealing a lack of standardization and conflicting information in the different databases. Pharmacosurveillance in the wards, carried out by a pharmacist to identify the clinically relevant DIs and monitor their clinical manifestations, would enable more effective treatments to be given, with the smallest possible number of complications due to DIs, thus reducing lengths of stay and hospital costs. Keywords: Drug interactions. Drug prescription analysis. Rational use of drugs.

Efforts to diminish the transmission of infections include programs in which disinfectants play a crucial role. Hospital surfaces and medical devices are potential sources of cross contamination, and each instrument, surface or area in a health care unit can be responsible for spread of infection. The decimal reduction time was used to study and compare the behavior of selected strains of microorganisms. The highest D-values for various bacteria were obtained for the following solutions: (i) 0.1% sodium dichloroisocyanurate (pH 7.0) - E. coli and A. calcoaceticus (D = 5.9 min); (ii) sodium hypochlorite (pH 7.0) at 0.025% for B. stearothermophilus (D = 24 min), E. coli and E. cloacae (D = 7.5 min); at 0.05% for B. stearothermophilus (D = 9.4 min) and E. coli (D = 6.1 min). The suspension studies were an indication of the disinfectant efficacy on a surface. The data in this study reflect the formulations used and may vary from product to product. The expected effectiveness from the studied formulations shows that the tested agents can be recommended for surface disinfection as stated in present guidelines and emphasize the importance and need to develop routine and novel programs to evaluate product utility.Esforços para diminuir o risco de transmissões de infecções incluem programas nos quais os desinfetantes desempenham papel crucial. As superfícies de materiais médico-hospitalares, se não estiverem diretamente ligados à transmissão de doenças, podem contribuir, potencialmente, para uma contaminação cruzada secundária. Cada instrumento ou superfície do estabelecimento do ambiente de saúde que entra em contato com um paciente é um disseminador potencial de infecção. Para estudar e comparar o comportamento dos microrganismos selecionados foram realizados ensaios de determinação do tempo de redução decimal. Os maiores valores D determinados, foram: (i) 0,1% dicloroisocianurato de sódio (NaDCC) (pH 7.0) - E. coli e A. calcoaceticus (D = 5,9 min); (ii) hipoclorito de sódio (pH 7,0) à 0,025% para B. stearothermophilus (D = 24 min), E. coli e E. cloacae (D = 7,5 min); e à 0,05% para B. stearothermophilus (D = 9,4 min) e E. coli (D = 6,1 min). Este estudo estabelece que as suspensões estudadas são indicação da eficácia de desinfecção recomendada pela legislação, mas os resultados podem variar de produto para produto. Para desinfecção de mãos clorexidina pode ser utilizada, pois apresentou valores D baixos. Para desinfecção de nível intermediário de equipamentos e instrumentos recomenda-se a utilização de NaDCC, devido à estabilidade e baixo efeito corrosivo para equipamentos e materiais. Glutaraldeído, apesar de muito aceito para processos esterilizantes, tem eficácia comparável a soluções de formaldeído.

Due to the growing number of outbreaks of infection in hospital and nurseries, it becomes essential to set up a sanitation program that indicates that the appropriate chemical agent was chosen for application in the most effective way. Validating the effectiveness of decontamination and disinfection is an important and often challenging task. In order to study and compare the behavior of selected microorganisms, they were submitted to minimal inhibitory concentration (MIC). The MIC intervals, which reduced bacteria populations over 6 log10, were: 59 to 156 mg/L of quaternary ammonium compounds (QACs); 63 to 10000 mg/L of chlorhexidine; 1375 to 3250 mg/L of glutaraldehyde; 39 to 246 mg/L of formaldehyde; 43750 to 87500 mg/L of ethanol; 1250 to 6250 mg/L of iodine in polyvinyl-pyrolidone complexes, 150 to 4491 mg/L of chlorine-releasing-agents (CRAs) and 469 to 2500 mg/L of hydrogen peroxide. Chlorhexidine showed non inhibitory activity over germinating spores. A. calcoaceticus showed resistance to the majority of the agents tested, followed by E. cloacae and S. marcescens.Devido ao número crescente de surtos de infecção hospitalar, torna-se proeminente o estabelecimento de um programa de sanitização que liste os agentes químicos a serem empregados e o modo de aplicação mais efetivo. Validação da eficácia de descontaminação é uma tarefa ao mesmo tempo importante e desafiadora. Para estudar e comparar o comportamento dos microrganismos selecionados foram realizados ensaios de concentração inibitória mínima (CIM). A CIM capaz de reduzir o bioburden inicial (>6 log10) foi: 59 - 156 mg/L de quartenários de amônia; 63 - 10000 mg/L de clorexidina, 1375 - 3250 mg/mL de glutaraldeído, 39 - 246 mg/L de formaldeído, 43750 - 87500 mg/L de etanol 1250 - 6250 mg/L de PVPI, 150 - 4491 mg/L de compostos liberadores de cloro e 469 -2500 mg/L de peróxido de hidrogênio.