Rozprawy doktorskie na temat „Administration dosage”

The aim of my PhD work is to investigate the destiny of different kind of engineered colloidal nanoparticles (NPs) administered by different administration routes. The administration routes that I have investigated in my work are the topical, oral, inhalational and the intravenous administration. To investigate the topical route my purpose is to design and develop iron oxide nanoparticles coated with an amphiphilic polymer and formulated in highly stable suspensions or incorporated into semi-solids, to cross the skin in order to be used for loco-regional therapeutic treatments. Once the NPs suspension skin passage is assessed, the nanoparticles are loaded into different semi-solid formulations to test the possible NPs permeation improvement. In vitro experiments are performed on human abdominal skin and in vivo study in mice is set up to evaluate the NPs biodistribution after subcutaneous injection in comparison to topical administration. The results obtained in this study are promising for the development of nano-cream for the local skin treatment. As regard the second project several research studies have been focused on the development of novel formulations for the oral administration of insulin. I design insulin-containing nanoparticles that are loaded into pellet cores and orally administered to diabetic rats. The nanoparticles proposed are polyethylene imine-based nanoparticles and they are incorporated into pellets with two overlapping layers and a gastrointestinal film. The nanotechnology science and the knowledge of the solid pharmaceutical forms allow building a novel nanoformulation, multiple-unit colon release system, i.e. pellets, as a possible oral nanocarrier for insulin. The aim of the third project is a preliminary study of gold nanoparticles (GNPs) for the treatment of bronchiolitis obliterans syndrome (BOS). The GNPs are covered with an amphiphilic polymer and they are designed to be loaded with an immunosuppressant drug (everolimus) in the hydrophobic section and functionalized on the surface with a monoclonal antibody selective for the receptor expressed by mesenchymal cells, which are responsible of the pathology. This study confirms the capability of functionalized GNPs to be a selective and efficient drug delivery system and future perspectives interest the in vivo administration by inhalation of GNPs on animal models of obliterative bronchiolitis. As regard the last project I test iron oxide nanoparticles conjugated with a peptide by intravenous administration to improve the peptide passage to the central nervous system (CNS). It’s known that the blood brain barrier (BBB) is a poorly crossable endothelium by most drugs and for their inability to reach the CNS most are the neurodegenerative disorders, which don’t have effective therapies. For this reason iron oxide nanoparticles represent a promising vector for the peptide translocation across the BBB.
The aim of my PhD work is to investigate the destiny of different kind of engineered colloidal nanoparticles (NPs) administered by different administration routes. The administration routes that I have investigated in my work are the topical, oral, inhalational and the intravenous administration. To investigate the topical route my purpose is to design and develop iron oxide nanoparticles coated with an amphiphilic polymer and formulated in highly stable suspensions or incorporated into semi-solids, to cross the skin in order to be used for loco-regional therapeutic treatments. Once the NPs suspension skin passage is assessed, the nanoparticles are loaded into different semi-solid formulations to test the possible NPs permeation improvement. In vitro experiments are performed on human abdominal skin and in vivo study in mice is set up to evaluate the NPs biodistribution after subcutaneous injection in comparison to topical administration. The results obtained in this study are promising for the development of nano-cream for the local skin treatment. As regard the second project several research studies have been focused on the development of novel formulations for the oral administration of insulin. I design insulin-containing nanoparticles that are loaded into pellet cores and orally administered to diabetic rats. The nanoparticles proposed are polyethylene imine-based nanoparticles and they are incorporated into pellets with two overlapping layers and a gastrointestinal film. The nanotechnology science and the knowledge of the solid pharmaceutical forms allow building a novel nanoformulation, multiple-unit colon release system, i.e. pellets, as a possible oral nanocarrier for insulin. The aim of the third project is a preliminary study of gold nanoparticles (GNPs) for the treatment of bronchiolitis obliterans syndrome (BOS). The GNPs are covered with an amphiphilic polymer and they are designed to be loaded with an immunosuppressant drug (everolimus) in the hydrophobic section and functionalized on the surface with a monoclonal antibody selective for the receptor expressed by mesenchymal cells, which are responsible of the pathology. This study confirms the capability of functionalized GNPs to be a selective and efficient drug delivery system and future perspectives interest the in vivo administration by inhalation of GNPs on animal models of obliterative bronchiolitis. As regard the last project I test iron oxide nanoparticles conjugated with a peptide by intravenous administration to improve the peptide passage to the central nervous system (CNS). It’s known that the blood brain barrier (BBB) is a poorly crossable endothelium by most drugs and for their inability to reach the CNS most are the neurodegenerative disorders, which don’t have effective therapies. For this reason iron oxide nanoparticles represent a promising vector for the peptide translocation across the BBB.

Dans le contexte du traitement du kératocône, une formulation contenant de la riboflavine, un principe actif hydrosoluble, deux tensio-actifs (le poloxamère 407 et la monooléine) et de l'eau a été préparée par un processus d'homogénéisation. Un plan factoriel fractionnaire a été utilisé pour estimer les effets principaux et les interactions de cinq paramètres sur deux réponses pertinentes, à savoir la taille des particules et l'efficacité d'encapsulation. Les cinq paramètres étudiés étaient la température des deux phases, la durée de l'émulsification, la présence du chauffage pendant l'homogénéisation, le nombre de cycles et la pression. Il a ainsi été montré que les paramètres les plus influents sont la présence du chauffage pendant l'homogénéisation et la pression qui ont conduit à l'obtention de nanoparticules d'une taille moyenne de 145 nm et une efficacité d'encapsulation moyenne de 46%. La détermination des paramètres optimaux du procédé de fabrication a conduit à l'optimisation de la formulation par le biais de plans d'expériences. L'influence combinée de trois composants a été étudiée dans une partie du diagramme de phase. Ainsi, douze formules décrivant l'espace de conception ont été préparées. Les résultats obtenus par diffraction des rayons X aux petits angles et par cryo-microscopie électronique en transmission ont mis en évidence la présence de nano-objets de structure éponge et/ou hexagonale inverse. Le pourcentage de chacun des composants a été déterminé pour obtenir à la fois une grande efficacité d'encapsulation et une petite taille de particules. Deux formulations très proches dans le diagramme de phase ternaire, ont répondu à ces exigences
In the context of the keratoconus treatment, a formulation containing riboflavin a water-soluble drug, two surfactants (poloxamer 407 and mono acyl glycerol) and water was optimized and prepared by emulsification and a homogenization process. A fractional factorial design was applied to estimate the main effects and interaction effects of five parameters on two relevant responses, namely particle size and encapsulation efficiency. The five parameters studied were the temperature of the two phases, the duration of emulsification, the presence of heating during homogenization, the number of passes and pressure. It has been shown that the most influent parameters are the presence of heating during the homogenization and the pressure that led to the production of nanoparticles with an average size of 145 nm and an average encapsulation efficiency of 46 %. The determination of the optimal parameters of the process led to an optimization of the formulation by using experimental design. The combined influence of three factor variables (or components) of the formulation that are water, monoolein and poloxamer 407 were, studied. In this way, twelve formulas describing the design space were prepared. Results obtained using SAXS and cryo-TEM evidenced the presence of nano-objects with either sponge or hexagonal inverted structure. In the zone of interest, the percentage of each component was determined to obtain both high encapsulation efficiency and small size of particles. Two formulations are very close in the ternary phase diagram, and have responded to these requirements

The purpose of this study was to evaluate the chemical stability of six medications in two types of unit-dose packaging, one was Webster-Package and another was a plastic seal unit-dose package. Stability was observed in terms of the drugs’ active ingredients and appearance of tablets and/or capsules. The study was commenced under condition of 35 ºC and 90% RH that related to temperature and humidity of tropical climate areas. A period of sixty days was chosen as the time period since unit-dose packages have to be delivered to patients and patients have to use the medications for up to one month. Six medications tested in this study were aspirin tablets 100mg (DBL Aspirin®), atorvastatin 40mg (Lipitor®), gliclazide 30mg MR (Diamicron MR®, and Oziclide®), metformin (GenRx Metformin® 500mg, and Formet® 1000mg), omeprazole 20mg (Omeprazole Winthrop®, and Omepral®), and ramipril 10mg (Ramipril Winthrop®, Ramipril Sandoz®).Each medication was transferred from an original package into eighteen different wells of small size Webster-Package. All six medications were also packed together into an other eighteen different wells of large size Webster-Package. To test the stability of the medicines in the Webster-Package, all of the packs were stored at 35 °C and 90% humidity for 60 days. Ramipril and omeprazole were also examined in another test condition (30°C and 90% RH) for 28 days. In addition, unit-dose packages from the Northern Territory of South Australia were tested. Medications were packed into clear sealed plastic bags by Stuart Park Pharmacy and tested using the same control condition. Time points for analysis were undertaken at day 0, 7, 14, 21, 28, and 60. Three samples were collected and triplicate tests were done for each sample. Shape and colour of the tablets were evaluated. Quantitative results were gained by using High Performance Liquid Chromatography (HPLC). Results of the stability testing at each time point were compared with their standard curves. Visual stability alterations were found in aspirin tablets (DBL Aspirin®), omeprazole tablets (Omeprazole Winthrop®, and Omepral®), and ramipril capsules (Ramipril Winthrop®, Ramipril Sandoz®) in both groups of Webster-Packages and unit-dose packages. Fading of ramipril capsules’ colour and sealing of cap and body of the capsules were found in both test conditions. Film-coatings of omeprazole tablets were cracked in both test conditions. Chemical stability alterations were found in omeprazole tablets used in unit-dose package. The results showed that in both experimental conditions omeprazole active ingredient was detected at levels of less than 90% of the active ingredient in the control tablets at Day 14 of the experiment.It may be concluded that not all of these medications can be repackaged into Webster-Packaging and unit-dose packaging. Pharmacists should be concerned about chemical properties of drugs, especially hydrolysis, photosensitivity, and heat resistance properties, before deciding to repackage them.

Background: There is a lack of commercially-available, age-appropriate formulations designed for administration to babies and children. This means that medicines may need to be manipulated to achieve the dose that is required in paediatric practice. This raises concerns about the dose accuracy and safety of the manipulated product. Though this is known and accepted as necessary, to date there has been no assessment of the evidence relating to these manipulations, the extent and nature of manipulations or of any associated practice issues. Objective: This thesis aimed to determine whether there is an evidence base for drug manipulations, to investigate the nature of manipulations, at the point of administration, in current clinical practice in neonatal and paediatric settings in the UK and to explore drug manipulations in the context of long-term medication administration by parents. Methods: Several methods were used to explore drug manipulations: a wide-ranging systematic review, an observation based study of drug manipulations in in-patient neonatal and paediatric areas, a UK wide survey of paediatric nurses and an interview based study with parents of children taking long-term medications. Outcomes: Manipulations to administer the required dose occur throughout practice and are not supported by evidence. Drug manipulation is intrinsic in neonatal and paediatric practice. Manipulations were identified more often in high dependency areas but were found throughout all clinical areas. Manipulations occurred more commonly with certain dosage forms, notably with tablets, but were found involving many dosage forms. Manipulations were identified involving drugs that are commonly prescribed and for prescriptions that had been written for babies and children of all ages and with a wide variety of diagnoses. Concerns relating to drug manipulations have been raised by those working in these areas. Parents described undertaking manipulations prior to administering medications to children, though undertaking these manipulations did not appear to cause undue concern. Conclusions: This thesis has reviewed the limited evidence, scoped out the nature of manipulations used in practice and by parents and suggested areas where future work would be appropriate. In exploring drug manipulation this thesis has added to ongoing discussion about the need for appropriate medication for paediatric use.

Les dispersions aqueuses de polymère sont couramment utilisées dans l'industrie pharmaceutique pour pelliculer les formes galéniques destinées à la voie orale et permettre une libération contrôlée du principe actif. Il est nécessaire de faire attention à la stabilité à long terme des films au cours du stockage et d'éviter une diminution des taux de principe actif libéré par continuation de la coalescence des particules de polymère. L'idée de ce travail était d'ajouter un second composant approprié aux dispersions aqueuses d'éthyle cellulose afin d'améliorer la formation du film et la stabilité à long terme et d'ajuster facilement les cinétiques de libération désirées. Les objectifs de cette étude sont : (i) de préparer et de caractériser en détail différents types de formes solides pelliculées ainsi que des films libres polymériques de composition identique aux pelliculages, (ii) de mieux comprendre les mécanismes de libération sous-jacents aux différentes formes solides pelliculées avec les dispersions aqueuses d'éthyle cellulose (EC) additionnées de petites quantités d'un second composant, et (iii) de proposer un moyen facile pour obtenir les cinétiques de libérations souhaitées et restant stables à long terme pour différents types de principes actifs et de noyaux de départ. Différents types de noyaux de départ ont été étudiés : (i) des noyaux matriciels de principe actif avec un haute teneur en principe actif ; (ii) des noyaux de sucre montés avec du principe actif, qui peuvent générer une pression hydrostatique significative à l'intérieur du système une fois en contact avec des milieux aqueux ; (iii) des noyaux de cellulose microcristalline (MCC) (un matériau inerte) montés avec du principe actif, et (iv) des noyaux de sucre pelliculés avec de l'EC et montés ensuite avec du principe actif. Différents types de principe actif de différents solubilités aqueuses ont été étudiés : la théophylline, le paracétamol, le succinate de métoprolol et le chlorhydrate de diltiazem. Ces derniers ont été soit montés sur des noyaux de sucre, de MCC et de sucre pelliculés avec de l'EC, soit inclus dans des noyaux matriciels à différentes teneurs. Pour maîtriser la libération du principe actif à partir de minigranules pelliculés avec de l'EC, des polymères hydrophiles tels que l'alginate de propylène glycol, le -carraghénane et le copolymère d'acide polyvinylique et de polyéthylène glycol ont été ajoutés. Tous ont montrés une bonne compatibilité avec la dispersion aqueuse d'EC ; Aquacoat ECD 30. Les minigranules ont été pelliculés en lit d'air fluidisé, l'Aquacoat ECD étant plastifié avec 25 % m/m (basé sur le poids sec du polymère) de triéthyle citrate ou de dibutyl sébaçate. Après pelliculage, les minigranules sont soumis a un traitement thermique à différents temps, températures, et humidités relatives afin d'assurer une formation complète du film et d'obtenir une stabilité à long terme sous des conditions ambiantes ainsi que des conditions stress (suivant les recommandations ICH). Les cinétiques de libération sont réalisées dans un appareil à palettes dans des milieux simulant le contenu de l'estomac et de l'intestin grêle à température corporelle. Le mélange de la dispersion aqueuse d'EC avec les différents types de polymère hydrophile permet de fournir des cinétiques de libération contrôlées avec des conditions de pelliculage et de traitement thermique appropriés, et ce quelque soit le type de principe actif et de noyau de départ. Des cinétiques de libération d'ordre zéro ont notamment pu être obtenus dans le cas de matrices de théophylline pelliculés avec un mélange d'EC: copolymère de PVA-PEG à un ratio de 85:15. L'ajout d'alginate de propylène glycol conduit à des profils de libération du principe actif pH-dépendant. Ceci peut-être très utile pour compenser la diminution de solubilité pH-dépendante de bases faibles le long du tractus gastro-intestinal. Des profils de libération stables à long terme peuvent être obtenus avec des conditions de traitement thermique appropriées. Les mécanismes de libération sous-jacents ont pu être élucidés en utilisant des solutions adéquates de la seconde loi de diffusion de Fick considérant les conditions respectives initiales et de « boundary ». De fins films polymériques ont été caractérisés part rapport à leur prise en eau et perte de masse sous exposition à différents milieux de libération et ont été utilisés pour déterminer le coefficient de diffusion apparent. La pression osmotique du milieu de libération a été variée afin d'évaluer l'impact de plus faible pressions osmotiques entre l'intérieur et l'extérieur des minigranules. Le gonflement du système a été également suivi au cours du temps sous ces conditions. Les cinétiques de libération à partir de minigranules individuels ont été menées et comparées à la libération d'un ensemble de minigranules. Le diamètre des minigranules restait environ constant au cours des 8 h d'observation, et ce quelque soit le type de noyau de départ. La pénétration continue de l'eau au sein des minigranules devrait générer une augmentation de la pression hydrostatique dans le système. Ceci pourrait alors conduire à une augmentation continue du diamètre des minigranules jusqu'à ce qu'une certaine valeur critique soit atteinte où la formation de fissures dans le pelliculage survient et le liquide interne est expulsé du système et le diamètre du minigranule diminue soudainement. On notera que ce type de comportement n'a pas été observé. Les cinétiques à partir des minigranules individuels étaient très similaires à l'ensemble de minigranules, indépendamment du type de noyau de départ et de milieu de libération. Ceci peut ne pas être nécessairement le cas, la cinétique finale observée peut être la somme de profils de libération de minigranules individuels très différents. Ainsi, il semble n'y avoir qu'un mécanisme de libération uniforme et la formation de fissures au cours du temps est improbable avec les systèmes étudiés. Cette hypothèse a été confortée par des images de microscopie électronique à balayage montrant des surfaces de minigranules lisses après exposition aux milieux de libération. La modélisation mathématique des cinétiques de libération à partir de fins films libres ainsi qu'à partir de minigranules pelliculés a révélé que les cinétiques de libération sont contrôlées par diffusion à travers une membrane polymérique intacte, ce qui est en bonne concordance avec les résultats expérimentaux. L'étape de traitement thermique nécessaire à la formation de pelliculages stables à long terme a pu être minimisée pour les différents types de système, contenant des principes actifs peu et très solubles et pour différents types de noyaux. L'addition de petites quantités d'un polymère hydrophile approprié à la dispersion aqueuse d'EC est un outil très efficace pour obtenir aisément les cinétiques de libération désirées et restant stables au cours du stockage et ce, même dans des conditions stress

Infusões prolongadas de 5-fluorouracil são mais seguras e potencialmente mais efetivas no tratamento do câncer de cólon metastático do que infusões rápidas da mesma medicação. No entanto, infusões prolongadas requerem a disponibilidade de um acesso venoso central, bem como de bombas de infusão dispendiosas. O desenvolvimento de fluoropirimidinas orais permitiu que pacientes fossem expostos ao 5-fluorouracil por longo tempo, com maior conveniência. UFT e leucovorin administrados três vezes ao dia demonstraram previamente uma eficácia equivalente, com menor toxicidade, quando comparados a um regime convencional de infusão rápida de 5- fluorouracil e leucovorin. Este estudo com 98 pacientes foi desenhado e conduzido com objetivo de demonstrar equivalência no tempo de progressão com o uso de UFT e leucovorin administrados duas vezes ao dia, com o uso da mesma combinação administrada três vezes ao dia. Objetivos secundários incluíram análise de toxicidade, resposta objetiva e sobrevida global. O tempo mediano de progressão foi de 3,8 meses, comparado com 3,5 meses observados com o uso da medicação três vezes ao dia e a taxa de resposta foi de 11%, com uma sobrevida mediana de 12,8 meses, sendo comparável aos resultados de 12% e 12,4 meses obtidas com o uso da combinação três vezes ao dia. A incidência de diarréia com graus 3 e 4 foi de 30% no regime de administração duas vezes ao dia, e 21% no de três vezes ao dia. Esses resultados sugerem que o uso de UFT e leucovorin duas vezes ao dia tem eficácia e toxicidade similares àquelas obtidas com o uso da mesma medicação três vezes ao dia.
Prolonged infusions have been shown to be safer and potentially more effective than bolus regimens of 5- fluorouracil as treatment for advanced colorectal cancer. However, infusional 5- fluorouracil requires central venous access and costly infusion pumps. Development of oral fluoropyrimidines has allowed longer exposures to 5-fluorouracil with increased convenience. UFT and leucovorin given thrice daily showed improved safety and no significant difference in survival or response rate compared with bolus 5- fluorouracil and leucovorin. This study with 98 patients was conducted to evaluate whether UFT and leucovorin given twice daily provided comparable time to progression (TTP) to the same combination administered three times a day. Secondary objectives included evaluation of toxicity, overall tumor response rate, and survival. Median time to progression was 3.8 months, compared with 3.5 months observed with the thrice-daily regimen. The twice-daily regimen had a response rate of 11% and median survival of 12.8 months, comparable to the 12% and 12.4 months seen with the thrice-daily regimen. The incidence of grade 3-4 drug-related diarrhea was 30% on the twice-daily and 21% on the thrice-daily schedule. Results suggest that the twice-daily schedule has similar safety and efficacy to the thrice-daily schedule.

Swallowing solid oral medications whole is a daily struggle for people who have swallowing difficulties. In aged care facilities, healthcare workers frequently modify medications for residents, e.g. crush tablets or open capsules, to make the medicines easier to administer, and swallow. These practices are not always safe and can put residents at risk of adverse effects. Through the use of interviews, surveys, and observations, this project investigated barriers and facilitators to giving medicines to aged care residents with swallowing difficulties, and then proposed the design of an intervention program to improve safe medication practices for these residents.

This thesis presents two new concepts in oral drug administration and the results of evaluation of some relevant formulation factors.

Investigation into improving the homogeneity of mixtures for tableting indicated that it may be possible to obtain interactive dry mixtures of micronised drugs containing drug proportions as low as 0.015% w/w. By studying the relationship between disintegration time and tensile strength, it was found that the microstructure surrounding the disintegrant particles may influence the disintegration process. Therefore, avoidance of excipients which are highly deformable or very soluble in water will result in more rapid disintegration. Further, it is possible to increase the bioadhesive properties of a non-bioadhesive carrier material by forming interactive mixtures containing a fine particulate bioadhesive material.

The new sublingual tablet concept presented is based on interactive mixtures consisting of a water-soluble carrier covered with fine drug particles and a bioadhesive component. With this approach, it is possible to obtain rapid dissolution in combination with bioadhesive retention of the drug in the oral cavity. Clinical data indicate that this allows rapid sublingual absorption while simultaneously avoiding intestinal absorption.

An individualised dose administration system is also presented. This system is based on the use of standardised units (microtablets), each containing a sub-therapeutic amount of the active ingredient. The required dose is fine-tuned by electronically counting out a specific number of these units using an automatic dose dispenser. A patient handling study supported the suggestion that the dosage of some medications can be more easily and safely individualised for each patient with this method than by using traditional methods of mixing different standard tablet strengths or dividing tablets.

Níveis sangüíneos de ciclosporina A (CSA) que minimizam a rejeição celular aguda (RCA) no transplante renal com o menor efeito tóxico vêm sendo o alvo de recentes pesquisas. A escolha de terapia imunossupressora com várias drogas permite o uso de doses mais baixas e com menores efeitos colaterais. Níveis de CSA necessários para evitar RCA podem variar com diferentes esquemas terapêuticos. Este estudo prospectivo realizado em um único centro avaliou a eficácia e segurança de dois diferentes níveis sangüíneos de CSA através da área sob a curva de doze horas (AUC 0-12). Cinqüenta e oito receptores de transplante renal foram randomizados para dois grupos, 25 para o grupo AUC0-12 alta (9000-11000 ng.h/mL) e 33 para o grupo AUC0-12 baixa (5000-7000 ng.h/mL). Após a introdução da CSA, a AUC foi avaliada nos dias 4, 7, 14, 21, 28, 42, 56, 70, 84 e 90. Os grupos foram comparáveis em idade, sexo, cor, tipo de doador, uso de indução e outras drogas imunossupressoras. Não houve diferença estatística na incidência de RCA. Foi realizada análise dos pacientes que apresentaram RCA em comparação com os pacientes livres de RCA. A análise de regressão logística mostrou que é necessária uma AUC 0-12 >- 9500 ng.h/mL com especificidade de 84% e sensibilidade de 76%, AUC 0-4 4000 ng.h/mL com especificidade de 91% e sensibilidade de 84% e C2 (concentração sangüínea na segunda hora pós- 6 dose) com especificidade de 92% e sensibilidade de 84% >- 1450 ng/ml, para predizer ausência de RCA. Quando utilizada terapia de indução, níveis mais baixos de AUC0-12, AUC0-4 e C2 (8160 3636 ng.h/ml, 3146 +- 262 ng.h/ml, 1043 +- 151 ng/mL, respectivamente) foram necessários para evitar RCA, em relação aos pacientes que não rejeitaram e não receberam indução (11072 +- 3809 ng.h/ml, 5403 +- 1782 ng.h/ml e 1816 +- 151ng/mL, respectivamente). Esses dados confirmam a necessidade de altos níves de CSA, na ausencia de indução para prevenção de RCA nos três primeiros meses pós-transplante renal e, o emprego de indução permite que níveis sangüíneos mais baixos de CSA sejam empregados com o intuito de prevenir RCA nos primeiros 90 dias após transplante renal
Multiple-drug therapy allows the use of lower doses with fewer side effects. Cyclosporin A (CSA) levels necessary to avoid rejection may vary with different drug combinations. To address this issue, fifty-eight kidney transplant recipients were randomized into two groups: 25 patients to the twelve-hour area under the curve (AUC0-12) high arm (9000-11000 ng.h/mL) and 33 to the AUC0-12 low arm (5000-7000 ng.h/mL). After CSA introduction, AUC0-12 was measured at days 4, 7, 14, 21, 28, 42, 56, 70, 84, and 90. The two groups were comparable regarding age, gender, race, donor type, induction therapy and other immunosuppressive drugs. There was no significant difference in the rate of acute cellular rejection episodes between the two groups. A retrospective analysis was carried out comparing rejectors to non-rejectors, related to induction therapy status. Logistic regression analysis revealed that an AUC0-12 >- 9000 ng.h/mL or AUC0-4 >-4000ng.h/mL or two-hour post-dose cyclosporin level (C2) of >- 1450 ng/mL predicted a rejection-free course. Lower levels of C2 and AUC 0-4 (1043 +-151 ng/mL and 3146 +- 262ng/mL, respectively) were required in non-rejecting patients when induction therapy was used

INTRODUÇÃO: Existem poucos estudos na literatura sobre o efeito de drogas no posicionamento vertical das pálpebras. Esse assunto é importante na análise da dinâmica palpebral, principalmente em afecções como a blefaroptose. O objetivo deste estudo é determinar a ação de uma gota do colírio de fenilefrina a 10% sobre as pálpebras superior e inferior de indivíduos normais e portadores de blefaroptose adquirida involucional e verificar a ocorrência de alterações no posicionamento das pálpebras superior e inferior do olho contralateral. MÉTODOS: Realizou-se um estudo clínico, prospectivo e aberto com indivíduos normais e pacientes com blefaroptose adquirida involucional, que foram submetidos à instilação de uma gota do colírio de fenilefrina a 10% em um dos olhos. Todos os indivíduos foram filmados antes e após a instilação da medicação (3, 10, 15, 30, 45 e 60 minutos). As imagens foram submetidas ao processamento digital e editadas para análise das medidas palpebrais. Foi traçada uma linha horizontal a partir do canto medial em direção ao canto externo. Considerouse como altura da pálpebra superior a distância entre o ponto mais alto da margem palpebral superior e a linha horizontal traçada. A altura palpebral inferior foi avaliada como a distância entre o ponto mais baixo da margem palpebral inferior e a referida linha. RESULTADOS: Foram incluídos na pesquisa 70 indivíduos normais e 40 portadores de blefaroptose adquirida involucional. Em relação à blefaroptose, a maioria apresentava quadro bilateral (92,5%) e grau mínimo (45%). Em relação à resposta ao colírio de fenilefrina a 10%, a medida antes da instilação da medicação diferiu significativamente dos demais momentos (p< 0,001), com elevação média da pálpebra superior de 0,92 mm e retração de 0,40 mm na altura palpebral inferior em todos os grupos estudados. Em relação ao olho contralateral, observou-se queda da pálpebra superior em praticamente todos os momentos estudados, com o menor nível aos 3 minutos (queda média de 0,66 mm). A pálpebra inferior contralateral mostrou uma elevação média de 0,35 mm. CONCLUSÕES: A instilação de uma gota do colírio de fenilefrina a 10% em olhos de indivíduos normais e pacientes portadores de blefaroptose adquirida involucional altera a posição das pálpebras superior e inferior do olho testado, como também das pálpebras do olho contralateral
INTRODUCTION: There are few studies in the literature on the effect of drugs on the vertical positioning of the eyelids. This issue is important in the analysis of the eyelid dynamics mainly in disorders such as blepharoptosis. The aim of this study is to determine the action of a single drop of 10% phenylephrine on the upper and lower eyelids of healthy subjects and patients with acquired involutional blepharoptosis and observe the occurrence of changes in the positioning of the upper and lower eyelids of the contralateral eye. METHOD: A prospective clinical trial was done with healthy subjects and patients with acquired involutional blepharoptosis. The patients were submitted to the instillation of a single drop of 10% phenylephrine in one eye. All subjects were filmed before and after instillation of medication (3, 10, 15, 30, 45 and 60 minutes). The images were submitted to digital processing and edited to analyze lid measurements. A horizontal line was drawn from the medial canthus toward the outer. The upper eyelid height was measured as the distance between the highest point of the upper eyelid margin and the horizontal line drawn. The lower eyelid height was the distance between the lowest point of the margin lower eyelid and the drawn line. RESULTS: Seventy healthy subjects and 40 patients with acquired involutional blepharoptosis were included. Most patients had bilateral (92,5%) and mild blepharoptosis (45%). After 10% phenylephrine instillation, upper lid height showed a mean elevation of 0,92 mm, which was significantly different at all time measurements (p< 0,001). The lower eyelid height changed with a mean retraction of 0,40 mm. In the contralateral eye was observed a fall of upper eyelid in all most all times studied, with the lowest level observed at 3 minutes (with average fall of 0,66 mm). The contralateral lower eyelid showed an average elevation of 0,35 mm. CONCLUSION: Instillation of a single drop of 10% phenylephrine altered the position of upper and lower eyelids on the tested eye, as well as of the contralateral eye on both groups, healthy subjects and patients with acquired involutional blepharoptosis

Infusions, decoctions, alcoholic preparations and other dosage forms of Artemisia afra are frequently used in South African traditional medicine. Generally when these preparations are made without applying good manufacturing practices they do not meet microbial quality control standards, safety and toxicity criteria and encourage poor patients compliance. To overcome the aforementioned disadvantages of traditional dosage forms a sold dosage form, i.e. a table might be recommended. The first objective of this study was to formulate and manufacture a rapid release tablet dosage of Artemisia afra that would contain an amount of plant material equivalent to that found in its traditional liquid dosage forms and that would meet conventional pharmaceutical standards. The second objective was to conduct a pilot study to obtain a preliminary profile of the bioavailability of select flavonoids presents in both the tablet and traditional liquid preparation of Artemisia afra in humans.

A restrição crônica de sal na dieta tem sido recomendada como medida não medicamentosa do tratamento da hipertensão arterial sistêmica. Entre os efeitos observados desta medida terapêutica tem sido descrita uma redução dos valores da pressão arterial (PA), tanto em indivíduos normotensos e pacientes hipertensos, assim como em animais de laboratório. Outros efeitos observados são alterações do metabolismo de carboidratos e de lípides. Tanto em indivíduos normotensos e pacientes hipertensos, assim como em animais de laboratório foram observadas maiores concentrações de peptídeo C e de insulina, sem alteração da glicemia e com redução da captação periférica de glicose pelos tecidos, caracterizando um estado de resistência à insulina. No metabolismo de lípides, uma outra conseqüência da restrição crônica de sal é a maior concentração plasmática de colesterol total e triacilgliceróis. Apesar da demonstração dos efeitos do sal sobre o metabolismo de carboidratos e lípides em humanos e animais existem dados conflitantes na literatura, com resultados opostos a estes descritos. Para melhor compreensão deste fenômeno, foi desenvolvido um estudo em nosso laboratório, o qual demonstrou que ratos Wistar machos que receberam restrição crônica de sal na dieta apresentaram maiores insulinemias medidas durante um teste de tolerância à glicose e sem a constatação de resistência à insulina em adipócitos isolados avaliada pela EC50 Entretanto, o que não ficou esclarecido neste estudo é se este quadro era restrito ao tecido estudado ou se ocorria no animal como um todo, ou seja, se era um fenômeno generalizado. Tendo em vista estes resultados, um outro estudo foi desenvolvido em nosso laboratório. Analisando o animal intacto, foi verificado que a restrição crônica de sal em ratos Wistar estava associada a uma menor sensibilidade à insulina medida por meio de um clamp euglicêmico hiperinsulinêmico (CLAMP) em animais anestesiados. Também foi observado maior peso corpóreo (PC) e maior massa dos tecidos adiposos. No intuito de se compreender quais eram os mecanismos envolvidos na menor sensibilidade à insulina durante a restrição de sal na dieta, também foi feito o pareamento de peso entre os animais que receberam dietas hipo (HO), normo (NR) ou hipersódica (HR) e mesmo sem diferença entre os PC, os animais sob restrição salina mantiveram-se insulino resistentes. Em uma nova etapa foi feito o bloqueio do sistema renina angiotensina com o uso de captopril (inibidor da enzima conversora de angiotensina) ou losartan (antagonista do receptor ATI de angiotensina II) tendo sido verificado que o captopril melhorou a sensibilidade à insulina, o que não ocorreu com o uso de losartan. Outra conseqüência da restrição crônica de sal na dieta é a maior atividade do sistema nervoso simpático (SNS) e uma menor atividade da via L-arginina (LA) / óxido nítrico (NO). Assim, o objetivo deste estudo foi verificar se o SNS e a via LA/NO são mecanismos envolvidos na menor sensibilidade à insulina durante a restrição crônica de sal. Para o desenvolvimento deste estudo, ratos Wistar machos receberam dieta HO, NR ou HR desde o desmame aos 21 dias de vida até completarem 12 semanas. Ao tornarem-se adultos, os ratos foram submetidos ao implante cirúrgico de cateteres e três a cinco dias após era realizado um CLAMP em ratos acordados. No dia do experimento, após um jejum de seis horas se realizava a coleta de sangue e medidas metabólicas e hemodinâmicas. Neste momento, um grupo de ratos recebeu prazosin e propranolol para o bloqueio do SNS e outro grupo recebeu veículo. Um terceiro grupo de animais recebeu LA e outro grupo recebeu D-arginina (DA). Um quinto grupo de animais que consumiu apenas a dieta HR recebeu diltiazem (bloqueador de canal de cálcio). Quarenta e cinco minutos após a infusão das drogas o CLAMP foi iniciado. Foram medidos PC, glicemias, insulinemias, lípides, nitrato/nitrito (NOx), PA sistólica (PAS), diastólica (PAD) e freqüência cardíaca (FC). O PC foi maior na dieta HO do que na NR e HR. Também foi observado maior PC na dieta NR do que HR. Em situação basal observaram-se maiores valores de glicemia e insulinemia durante a restrição salina em comparação aos ratos em dieta NR e HR. A PAS e PAD foram maiores na dieta HR em comparação aos ratos em dieta NR e HO, enquanto a FC foi maior nos ratos em dieta HO em comparação àqueles sob dietas NR e HR. Também foram observadas maiores concentrações plasmáticas de colesterol total (COL) e triacilgliceróis (TAG) durante a restrição salina. Os animais controle apresentaram menor sensibilidade à insulina em comparação àqueles em dieta NR ou HR. O bloqueio do SNS corrigiu o efeito do sal sobre a captação de glicose, não sendo mais observada diferença entre as dietas. O bloqueio do SNS não influenciou a glicemia mas reduziu a maior insulinemia nos ratos em dieta HO, não sendo mais observada diferença entre as dietas quanto às insulinemias ao início do CLAMP. A infusão de LA melhorou a menor captação periférica de glicose nos ratos em dieta HO, sem influência sobre os animais tratados com dieta NR ou HR. Diltiazen não modificou a sensibilidade à insulina apesar de ter reduzido a PA em intensidade semelhante ao bloqueio do SNS. O bloqueio do SNS reduziu os valores de PAS e PAD nas três dietas, com queda mais intensa dos seus valores nos animais sob sobrecarga salina, logo ao início do CLAMP. Diltiazen reduziu a PAS e PAD. DA não influenciou (p>0,05) os valores de PAS e PAD. Já a infusão de LA promoveu redução dos valores de PAS e PAD somente em ratos em sobrecarga salina e reduziu os maiores valores de FC observados nos ratos durante a restrição de sal na dieta. O bloqueio do SNS e a infusão de LA reduziram os maiores valores de TAG ao término do CLAMP, o que não foi observado nos grupos veículo e DA. Não foi observada modificação da concentração plasmática de COL entre os grupos independentemente dos fármacos ministrados. Durante a restrição salina foi observado menor concentração plasmática de NOx em comparação à sobrecarga salina. A infusão de LA promoveu um incremento na concentração plasmática de NOx ao término do CLAMP nas três dietas, o que não foi observado nos ratos tratados com DA. Ao término do CLAMP não foram observadas diferenças na concentração de NOx plasmático entre as dietas nos animais que receberam LA. A concentração plasmática de NOx nas três dietas foi menor nos ratos que receberam DA. Assim, o bloqueio do SNS e a ativação da via LA/NO melhoraram os efeitos metabólicos decorrentes da restrição crônica de sal.
Chronic dietary salt restriction is recommended as non-pharmacological measure of hypertension treatment. One of the observed effects of this therapeutic measure is the blood pressure (BP) decrease in normotensive subjects and in hypertensive patients, and also in laboratory animals. Another side effects observed are disorders of carbohydrate and lipid metabolism. Salt restriction induced higher C-peptide and insulin levels, without changes on plasma glucose, and lower glucose uptake by the tissues in normotensive subjects and in hypertensive patients, and also in laboratory animals, suggesting an insulin resistant state. Other consequences of salt restriction are higher plasma levels of cholesterol and triacylglycerols. Some studies have disclosed opposite results. With the objective to better understand these phenomena, a study was developed in our laboratory, that showed that male Wistar rats on chronic salt restriction presented higher insulin plasma levels measured during a glucose tolerance test, without insulin resistance in isolated adipocytes measured by the EC50 of the insulin - glucose uptake curve. It was not clear in this study if this phenomenon was restricted to the evaluated tissue or if it was a phenomenon in the whole animal. With these results, another study was developed in our laboratory. Analyzing the whole animal, chronic salt restriction in male Wistar rats was associated with lower insulin sensitivity measured by a euglycemic hyperinsulinemic clamp (CLAMP) in anesthetized rats. Higher body weight (BW) and adipose tissue mass was also observed. With the objective to understand the involved mechanisms in the lower insulin sensitivity due to dietary salt restriction, weight was paired among animals on low (LSD), normal (NSD) or high (HSD) salt diet, and even without BW difference, salt restricted animals were still insulin resistants. In another step, renin angiotensin system blockade with captopril (angiotensin enzyme conversion inhibitor) or losartan (angiotensin II type I receptor antagonist) was performed. It was observed that captopril, but not losartan, improved insulin sensitivity. Another consequence of salt restriction is a higher sympathetic nervous system (SNS) and a lower L-arginine (LA) / nitric oxide (NO) pathway activity. The objective of this study was to verify if SNS and LA / NO are mechanisms involved in the lower insulin sensitivity due to chronic salt restriction. Male Wistar rats received LSD, NSD, or HSD since weaning until adulthood. In the 12th week of age, catheters were inserted and three to five days latter, a CLAMP was performed in awaked rats. On the day of the experiment, after six hours fasting, blood samples were collected and metabolic and hemodynamic measures were done. At this moment, a group of rats received prazosin and propranolol for SNS blockade and another group received vehicle. A third group of animals received LA and a fourth group received D-arginine (DA). Another group of rats only on HSD received diltiazen (calcium channel blocker). Fourty five minutes after drug infusion the CLAMP was started. BW, plasma glucose, insulin, lipids, and nitrate/nitrite (NOx), systolic BP (SBP), diastolic (DBP), and heart rate (HR) were measured. BW was higher on LSD than on NSD and HSD. BW was also higher on NSD than HSD. Basal plasma glucose and insulin were higher during salt restriction than on NSD and HSD. SBP and DBP were higher on HSD than on NSD and LSD, and HR was higher on LSD than on NSD and HSD. Cholesterol (CHOL) and triacylglycerol (TAG) plasma levels were higher on salt restriction. LSD rats presented lower insulin sensitivity compared to animals on NSD or HSD. SNS blockade corrected effect of salt on glucose uptake. SNS blockade had no influence on glucose levels but reduced the higher plasma insulin in LSD rats, without differences in insulin levels between diets at the start of the CLAMP. LA improved the lower glucose uptake observed in LSD rats, with no influence on the rats on NSD or HSD. Diltiazen had no effect on insulin sensitivity. SNS blockade reduced SBP and DBP in rats on the three diets, with an intense BP fall on HSD rats at the start of the CLAMP. Diltiazen reduced SBP and DBP. DA had no influence in SBP and DBP. On the other hand, LA decreased SBP and DBP only in salt overloaded rats and reduced the higher HR observed on salt restricted rats. SNS blockade and LA infusion reduced the higher TAG concentration at the end of the CLAMP, which was not observed in vehicle and DA groups. COL level was not influenced by drug infusion. During salt restriction, lower plasma NOx was observed compared to salt overload. LA infusion promoted plasma NOx increment at the end of the CLAMP. At the end of the CLAMP, no difference was observed in plasma NOx among the rats on the three salt diets and infused with LA. Plasma NOx was lower in rats in the DA group. In conclusion, SNS blockade and LA/NO pathway activation improved the metabolic effects due to chronic dietary salt restriction.

Com o objetivo de se avaliar a importância do \"clearance\" do dietilenotriamino-pentacetato marcado com Tecnécio 99m (DTPA-Tecnécio-99m) em portadores de pneumopatia por amiodarona foram estudados 40 indivíduos, em quatro grupos. Grupo I: 10 voluntários normais, assintomáticos e não fumantes (8 homens e 2 mulheres), com média de idade de 56,80 anos. Grupo II: 10 voluntários normais, assintomáticos e fumantes (6 homens e 4 mulheres ), com média de idade de 27,50 anos. Grupo III: 10 pacientes não fumantes ( 4 homens e 5 mulheres ), com média de idade de 52,90 anos. Todos faziam uso crônico de amiodarona por via oral. Grupo IV: 10 pacientes portadores de pneumopatia por amiodarona, quatro ex-fumantes, dois fumantes e quatro não fumantes ( 8 homens e 2 mulheres) com média de idade de 52,90 anos. Todos faziam uso de amiodarona por via oral e nenhum fumou nas 4 semanas que precederam o estudo. Após espirometria que constou do registro da curva volume-tempo, todos inalaram 4 ml de solução salina contendo 740 MBq de DTPA Tecnécio-99m, durante cinco minutos. Através de uma c~mara de cintilação computadorizada foram obtidas imagens pulmonares, definindo-se 9 áreas de interesse. Para cada região escolhida foi determinada uma curva de \"clearance\" extraindo-se o valor de meia-vida biológica em minu- tos ( T 1/2 ) e a taxa percentual de \" clearance\" alvéolo capilar do radioaerossol por minuto (K%/min). Observamos que, das variáveis espirométricas consideradas, a capacidade vital forçada (CVF) e o volume expiratório forçado no 1 segundo (VEF1) mostraram diferenças significantes entre os grupos I e IV. A contagem total de radioatividade de ambos os pulmões não mostrou relação com a CVF e o VEF1. O \" clearance \" pulmonar do DTPA Tecnécio-99m foi maior nos grupos 11 e IV, porém não permitindo sua diferenciação. Estes resultados permitem concluir: Os pacientes portadores de pneumonite por amiodaro- na apresentam\" clearance \" alvéolo-capilar de DTPA Tecnécio-99m significativamente maior que os indivíduos do grupo de normais não fumantes. Este fato também se verificou em relação aos pacientes em uso crônico de amiodarona mas sem evidências de pneumopatia. Não é possível diferenciar os fumantes dos portadores de pneumonite por amiodarona através da análise da integridade da barreira alvéolo-epitelial com DTPA Tecnécio-99m. Comparativamente, o estudo da integridade alvéolo-epitelial pelo \"clearance\" pulmonar de DTPA Tecnécio-99m é mais sensível que a espirometria na avaliação da pneumonite por amiodarona, permitindo diferenciar estes pacientes dos que fazem uso crônico da droga
In order to evaluate the role of the clearance of 99m Technetium chelated to diethylenetriamine-penta-acetate ( 99mTc-DTPA) in amiodarone induced pulmonary disease, 40 individuaIs were studied in four groups. Group I: 10 normal non smoking volunteers (8 men and 2 women ), whose mean age was 56.80 years. Group lI: 10 normal smoking volunteers ( 6 men and 4 women ), aging 27.50 years in average. Group III: 10 non smoking patients ( 4 men and women ), aging 52.90 years in average, who were chronically taking oral amiodarone. Group IV: 10 patients with amiodarone induced pul- monary disease (8 men and 2 women), four non-smokers, two smokers and four previous smokers. Their mean age was 62.90 years. AIl of them were taking oral amiodarone and none has smoked in the 4 weeks previous to the study. After spirometry, where a volume-time curve was registered, alI individuaIs inhaled 740 MBq of 99mTc-DTPA diluted in 4 ml of saline, for five minutes. Pulmonary images were obtained in a computadorized scintillation camera and 9 regions of interest were selected. A clearance curve of each region was determined, from which the effective half-life in minutes (T 1/2 ) and the alveolar-capilar clearance rate per minute ( k%/min ) of the radiolabeled aerosol were mea- sured. The spirometric analys disclosed a statistically lower value of the forced vital capacity ( FVC ) and forced expiratory volume in the first second ( FEV1 ) in the patients of group IV when compared to group I. The total radioactivity count for both lungs were not influenced by FVC and FEV1. The 99mTc-DTPA clearance rate was higher in groups 11 and IV, but these two groups could not be statistically differentiated. Based on these results it 1s concluded: patients with amiodarone induced pulmonary pneumonitis have higher clearance rates of 99m Tc-DTPA than normal non smoking controls and than patients taking amiodarone but with no lung toxicity. It is not possible to separate patients with amiodarone induced disease from normal smokers by determining 99m Tc-DTPA clearance rates. The determination of the alveolar-epithelial barrier integrity by 99m Tc-DTPA clearance rate is a more sensitive test than spirometry in the evaluation of amiodarone induced pneumonitis making it possible to differentiate these patients from those who take the drug and have no lung toxicity

Foram estudados prospectivamente 33 pacientes cujos cistos tinham volume médio de 298,4 + 346,9 (30 - 1700) ml. A punção foi realizada sob anestesia local com agulha 18 gauge, de 20 cm. Após seu esvaziamento, injetou-se etanol absoluto no volume equivalente a um terço do volume aspirado, até o máximo de 100 ml. Os volume médios observados após um, três e seis meses foram 47,9 + 59,4 (0 - 286) ml, 25,2 + 42,8 (0 - 208) ml e 12,7 + 30 (0 - 120) ml, respectivamente. Após esse período, 30 (91%) apresentaram remissão total dos sintomas, 2 (6%) mantiveram os sintomas, sendo um com cisto residual e outro sem cisto e um (3%) apresentou melhora parcial dos sintomas
A prospective series of 33 patients with symptomatic simple renal cysts varying from 30 to 1700 ml, were considered eligible for the study. The cysts were punctured under local anesthesia with an 18 gauge, 20 centimeters needle. A volume of ethanol equivalent to one third of the aspirated volume, up to a maximum of 100 ml, was injected into the cyst and left there. After one, three and six months, the average volume of the cyst was 47.9 + 59.4 (0 - 286)ml, 25.2 + 42.8 (0 - 208)ml and 12.7 + 30 (0 - 120)ml, respectively. After this period, 30 patients (91%) showed total remission of the symptoms, two patients (6%) maintained them and one patient (3%) had partial remission of the symptoms

The purpose of this study was to determine if there is a relationship between having military discipline, the military rank, the branch of service, the number of years served, reserve status and if these factors would affect a veterans' compliancy in taking daily medication.

INTRODUÇÃO: Os aminoglicosídeos são freqüentemente usados no berçário e podem ser tóxicos para as células ciliadas cócleo-vestibulares, especialmente para as células ciliadas externas da base da cóclea. As emissões ototacústicas produto de distorção permitem avaliar porções específicas da cóclea, antes mesmo que a sensação auditiva seja alterada, sendo ideais para análise precoce da integridade dessa estrutura auditiva, além de ser indicada para recém-nascidos por serem objetivas. O objetivo deste estudo prospectivo longitudinal é pesquisar a amplitude das emissões otoacústicas produto de distorção, causadas pelo uso de drogas ototóxicas, entre o término da administração e de 15 a 40 dias após seu uso. MÉTODOS: A população foi de recém-nascidos a termo e pré-termo provenientes de berçário e maternidade de um hospital público em Santo André, no período de julho de 2003 a setembro de 2004. A primeira avaliação ocorreu no dia da alta hospitalar. Foram avaliados três grupos: grupo controle com 33 recém-nascidos saudáveis e de termo; grupo de estudo a termo exposto a amicacina e /ou vancomicina com 19 recém-nascidos com mais de 37 semanas e grupo de estudo pré-termo exposto aos mesmos ototóxicos, com 15 recém-nascidos de 32 a 37 semanas. Os recém-nascidos não apresentavam indicadores de risco para deficiência auditiva preconizados pelo JCIH,2000 concomitante à infecção neonatal. Todos os recém-nascidos foram avaliados com idade gestacional corrigida maior que 37 semanas. As amplitudes das emissões otoacústicas dos recém-nascidos em fase de alta hospitalar foram comparadas às obtidas de 15 a 40 dias após a alta. RESULTADOS: As amplitudes das emissões otoacústicas dos recém-nascidos do grupo de estudo pré-termo foram menores que as amplitudes do grupo controle e do grupo de estudo a termo nos dois momentos de teste. As amplitudes das emissões dos recém-nascidos dos três grupos aumentaram no segundo momento de teste. As amplitudes das emissões dos recém-nascidos foram maiores na freqüência de 6.000 Hz e na orelha direita para a freqüência f2 3.000 Hz. As amplitude das emissões do grupo controle no segundo momento de teste foram semelhantes as do grupo de estudo à termo no primeiro momento da pesquisa. CONCLUSÔES: Houve aumento da amplitude das emissões otoacústicas produto de distorção desde a fase de alta até 15 a 40 dias após. A exposição a amicacina e vancomicina nas doses preconizadas pelo Neofax®, 2003/2004 não alterou as amplitudes das emissões nos recém-nascidos sem indicadores de risco concomitante à infecção neonatal.
The amynoglicosides are frequently used in nurseries and may be toxic for the cochleo-vestibular hair cells, specially for the outer cells of the cochlear base. The distortion product otoacoustic emissions allow to evaluate specific portions of the cochlea even before the hearing sensation is altered, and are ideal for the early analysis of this auditory structure integrity, besides being indicated for newborns once they are objective. The aim of this prospective longitudinal study is to research the amplitude of distortion product otoacoustic emissions caused by the ototoxic drugs use, between the end of the administration and from 15 to 40 days after its use. The population studied was composed by term and preterm newborns from a nursery and maternity of a Santo André city hospital, in the period from July 2003 to September 2004. The first evaluation occurred on the hospital discharge day. Three groups were evaluated: control group with 33 term and healthy newborns; term study group with 19 term newborns with more than 37 weeks exposed to amicacin and/or vancomycin; and preterm study group with 15 preterm newborns from 32 to 37 weeks exposed to the same ototoxic. The newborns did not present risk factors for hearing loss according to the JCIH, 2000 concomitant to the neonatal infection. All newborns were evaluated at a corrected gestational age greater than 37 weeks. The otoacoustic emissions amplitudes obtained at the hospital discharge were compared to the ones obtained from 15 to 40 days after the discharge. The results showed that the otoacoustic emissions amplitudes of the preterm study group were smaller than the amplitudes of the control group and the term study group in both moments of the test. The amplitude of the newborns’ otoacoustic emissions increased in the second moment of the test. The amplitudes were higher in the frequency of 6.000Hz and, in the right ear in the frequency f2 3.000 Hz. The otoacoustic emissions amplitudes of the control group in the second moment of the test were similar to the term study group in the first moment of the research. It was concluded that there is an increase of the distortion product otoacoustic emissions amplitude from the discharge moment until 15 to 40 days after, suggesting a maturation of the cochlear structures in the post-natal period, and that the exposure to amicacin and vancomycin on the recommended dose by Neofax®, 2003/2004 did not alter the amplitude of the emissions in the newborns without risk indicators concomitant with neonatal infection.

Beta blockers are commonly prescribed for the chronic treatment of hypertension, one of the most prolific disease states worldwide. The beta blockers selected for this study include acebutolol hydrochloride, labetalol hydrochloride, metoprolol tartrate oxprenolol hydrochloride and propranolol hydrochloride. All of these compounds have a short elimination half-life, necessitating multiple dose per day regimens and therefore the development of sustained release dosage forms incorporating these agents was considered beneficial in terms of extending the dosing interval, with the aim of improving patient compliance and subsequent therapeutic outcomes. Preformulation studies that were conducted included moisture content analysis by Karl Fischer titration, and DSC, a method used to predict potential interactions between the drugs and tablet excipients. Tablets were manufactured by both wet granulation and direct compression techniques, and the resultant drug release characteristics were evaluated using the USP Apparatus 3(BIO.DIS). A validated isocratic HPLC method, capable of separating the five drug candidates simultaneously, was developed and used for the analysis of drug samples. Tablet quality was assessed using analyses that included the physical assessment of weight, diameter, thickness, hardness and friability, as well as content uniformity of tablets, before and after dissolution testing. Direct compression tablet formulations containing each of the five beta blockers were successfully adapted from a prototype wet granulation matrix tablet containing metoprolol tartrate, and various formulation variables were investigated to establish,their effect on the rate and extent of drug release from these tablets. The grade and quantity of ethylcellulose used in the wet granulation and direct compression formulae influenced the release rate of some drug candidates. In addition, an alternative formulation method, involving freeze-drying of the drug with an ethylcellulose dispersion, was shown to have potential for altering release rates further. Anti-frictional agents, talc and colloidal silicon dioxide, did not affect drug release from these matrices,however, they affected the physical character:istics such as tablet weight and thickness, of the resultant tablets. All of the matrix tablets formulated were shown to release drug according to square root of time kinetics, in a sustained manner over a 22 hour period.

Adult rats produce two main types of ultrasonic vocalizations (USVs), occurring at 22 and 50 kHz USVs. These calls are associated with aversive and rewarding stimuli, respectively. The neural mechanism of amphetamine-induced calling was examined in lesion and antagonist studies. We also tested whether amphetamine-induced 50 kHz USVs could predict individual differences in intravenous self-administration or conditioned place preference behavior. Further experiments examined whether 50 kHz USVs could be evoked by amphetamine-conditioned sensory stimuli and by rewarding electrical brain stimulation. Overall, our experimental findings: (1) identify certain experimental conditions that increase amphetamine-induced 50 kHz calling, (2) provide evidence that these calls may be dependent on mesolimbic dopaminergic transmission, (3) relate individual differences in 50 kHz vocalizing to other behavioural measures of drug reward, and (4) show that in some situations, 50 kHz calls reflect anticipation of expected rewards.

Conventional solid dosage forms often lead to fluctuations which exceed the maximum safe therapeutic level and/or decline below the minimum effective level. It is recognised that many drugs for chronic administration should be administered on a schedule that maintains plasma drug concentration within the therapeutic window. Research in controlled release dosage forms aims at designing a system with a zero-order input (eg, ideally to deliver 8.33% of the dose per hour over a 12 hour duration), producing steady state plasma drug levels. Oral dministration of drugs prepared as a controlled release formulation is extremely popular, and has attracted the attention of pharmaceutical scientists during the last decade. This has been due to the simultaneous convergence of various factors (eg, discovery of novel polymers and devices, better understanding of formulation and physiological constraints, expiration of existing patents, prohibitive cost of developing new drug entities), involved in the development of these delivery systems. Controlled release oral products can be formulated as single or multiple unit dosage forms and the relative merits of multiple unit forms with their own rate controlling systems are well established. This work describes the development of a relatively inexpensive multiple-unit capsule dosage form of theophylline containing coated mini-tablets for drug delivery throughout the gastrointestinal tract. Preformulation studies on theophylline anhydrous included solubility and dissolution rate determinations. Techniques including X-ray powder diffraction, differential scanning colorimetry and infrared spectroscopy provided no evidence of true polymorphism after recrystallisation from various solvents. However, scanning electron micrographs showed the effects of solvent polarity and cooling rate on the size and shape of recrystallised particles. Theophylline granules were manufactured by using various binders and were film coated by fluidised bed technology with various proportions of ethylcellulose, containing varying amounts of PEG 1540. In vitro release rates were dependent upon coating thickness and the proportion of PEG, which, being water soluble, created pores in the coating during dissolution studies as observed by a scanning electron microscope. However, substantial proportions of the drug remained unreleased from the granules. In order to overcome the problems of drug retention, plain granules were used and theophylline mini-tablets (3 mm diameter, weighing 15 - 20 mg) were manufactured and film coated with various Eudragits ® and other polymeric mixtures (soluble and insoluble). In vitro dissolution profiles from samples enclosed in hard gelatin capsules were determined using the USPXXI paddle apparatus in test media at pH 1.2 (HCI), pH 5.4 and 7.4 (phosphate buffers) at 37'C. Monitoring of in vitro theophylline release over 12 h, under identical hydrodynamic conditions, showed that the dissolution rate at pH 1.2 is substantially greater (95% of total drug content released in < 10 h) than that in phosphate buffers. The maximum release after 12 h was approximately 20 and 30% of total drug content of the tablet at pH 5.4 and 7.4, respectively. However, in vivo bioavailability after oral administration of tablets to rabbits corresponded to over 95% of total drug, compared with the same dose administered intravenously. The retarded drug release during in vitro dissolution in phosphate buffer was attributed to a possible interaction of phosphate ions with theophylline molecules at the tablet core-coat interface. These findings indicate that both rate and extent of theophylline release from the slow release coated mini-tablets are highly sensitive to phosphate buffers. The data also emphasise the usefulness of an animal model for assessment of in vivo drug release and subsequent absorption during the development of modified release dosage forms. Mini-tablets were subjected to isothermal and cyclic stresses to reach conditions for up to 6 months at different temperatures and relative humidity. The film integrity was maintained but ageing of the coating occurred which impeded dissolution. Reduced drug release was temperature related while the effect of relative humidi% was insignific~t. Encapsulated mini-tablets (uncoated and coated with Eudragit RL and RS 2% w/w) equivalent to a 300 mg dose, were evaluated both in vitro and in vivo using beagle dogs. The pharmacokinetic parameters from single and multiple dose studies showed several advantages over Theo-Dur® 300 mg tablets. Precise dosage titration is possible by careful adjustment of the number of encapsulated mini-tablets. This multiple unit mini-tablet delivery system will allow for greater flexibility in dosage adjustment compared to the currently available preparations, allowing individualised fine dose titration in those patients requiring therapeutic drug monitoring. The developmentof the multiple unit mini-tablet formulation appears to provide an optimal dosage form with maximum flexibility in respect of dose, duration range and ease of production.

This research project investigates the long-term consequences of perinatal exposure to high-fat (HF) on the mesocorticolimbic dopamine (DA) system. Adult offspring of mothers fed a HF diet (30% fat, compared to 5% in control mothers (C)) during the last week of gestation and throughout lactation displayed decreased locomotion in response to an acute amphetamine challenge and decreased behavioral sensitization to repeated amphetamine compared to C animals. These behavioral effects were accompanied by small increases in tyrosine hydroxylase expression in the ventral tegmental area and significant increases in DA and DOPAC content in the NAc, suggesting an elevated DA tone in this target field. In the NAc, there were no significant changes in D1, D2 receptors or DA transporter (DAT) levels between diet groups. The behavioural and biochemical data were collected in adulthood, long after the termination of the diet suggesting that a HF perinatal diet is inducing permanent changes within the DA system and might contribute to the development of metabolic disturbances.

The use of minocycline for the treatment of a broad range of systemic infections and for severe acne has been associated with vestibular side effects. The severity of side effects may lead to poor adherence to therapy by patients. The use of sustained release formulations of minocycline that display slow dissolution of minocycline following administration may be beneficial in reducing the incidence and severity of side effects. Therefore, sustained release capsule dosage forms containing 100 mg minocycline (base) were manufactured and assessed for use as sustained release oral dosage forms of minocycline. Minocycline sustained release capsules were manufactured based on matrix technologies using hydroxypropylmethyl cellulose (HPMC) and Compritol® as release retarding polymers. The rate and extent of minocycline release from the capsules was evaluated using USP Apparatus 1 and samples were analysed using a validated High Performance Liquid Chromatographic (HPLC) method with ultraviolet (UV) detection. Differences in the rate and extent of minocycline release from formulations manufactured using HPMC or Compritol® were influenced by the concentration of polymer used in the formulations. The rate and extent of minocycline release was faster and greater when low concentrations of polymer were used in formulations. The effect of different excipients on the release pattern(s) of minocycline and particularly their potential to optimise minocycline release from experimental formulations was investigated. The use of diluents such as lactose and microcrystalline cellulose (MCC) revealed that lactose facilitated minocycline release when HPMC was used as the polymer matrix. In contrast, the use of lactose as diluent resulted in slower release of minocycline from Compritol® based formulations. The addition of sodium starch glycolate to HPMC based formulations resulted in slower release of minocycline than when no sodium starch glycolate was used. Compritol® based formulations were observed to release minocycline faster following addition of sodium starch glycolate and Poloxamer 188 to experimental formulations. In vitro dissolution profiles were compared to a target or reference profile using the difference and similarity factors, ƒ1 and ƒ2 , and a one way analysis of variance (ANOVA). In addition, the mechanism of minocycline release was elucidated following fitting of dissolution data to the Korsmeyer-Peppas, Higuchi and Zero order models. Minocycline release kinetics were best described by the Korsmeyer-Peppas model and the values of the release exponent, n (italics), revealed that drug release was a result of the combined effects of minocycline diffusion through matrices and erosion of the matrices. These in vitro dissolution profiles were better fit to the Higuchi model than to the Zero order model. Two formulations that displayed a fit to the Zero order model were identified for further studies as potential dosage forms for sustained release minocycline.

Objetivos: Estimar a concordância entre as práticas e as evidências disponíveis em uma unidade de terapia intensiva pediátrica. Métodos: Estudo retrospectivo de todos os pacientes internados durante 2001. As práticas foram classificadas em adequadas ou não-adequadas de acordo com recomendações. Esperava-se para as práticas recomendadas 90% de concordância, para as contra-indicadas, discordância de até 10% e para aquelas onde havia incertezas, 50%. Resultados: Foram selecionadas 114 publicações e avaliadas 253/275 internações (92%). O uso foi considerado apropriado para albumina em 47,6% (IC 95% 39% – 55%); dopamina <3mg/kg/min 87,9% (83% – 92%); sedação e analgesia 88,6% (87% – 90%); transfusões de concentrado de hemácias 95,2% (92% – 97%); profiliaxia de úlcera de estresse 89,7% (88% – 91%).
Objectives: Estimate the concordance between the practices and the evidence available in a pediatric intensive care unit. Methods: Retrospective study of all admitted patients during 2001. The practices were classified as adequate or non-adequate according to recommendations. It was expected 90% concordance for the recommended practices, while for non-adequate practices, discordance until 10% and for those where there was doubt, 50%. Results: 114 publications were selected and 253/275 admissions (92%) were evaluated. Use was considered appropriate for albumin in 47.6% (IC 95% 39% – 55%); dopamine <3mg/kg/min 87.9% (83% – 92%); sedation and analgesia 88.6% (87% – 90%); red blood cell transfusions 95.2% (92% – 97%); stress ulcer prophylaxis 89.7% (88% – 91%).

A utilização da cintilografia de perfusão miocárdica (CPM) estava limitada a pacientes que podiam realizar algum tipo de exercício, para ampliarmos a disponibilidade clínica da CPM, vários protocolos com estresses farmacológicos foram desenvolvidos. A adenosina fármaco amplamente utilizado, potente vasodilatador coronariano, apresenta uma importante interação com outras substâncias que anatagonizam seus efeitos, o dipiridamol, alimentos com cafeína e derivados de xantinas. O tempo de suspensão de cafeína da dieta para o uso exógeno da adenosina na realização da CPM ainda não está definido. Para testar essa hipótese avaliamos a influência da abstinência de cafeína em 24h, 12h e 1h, através de sua dosagem sérica, antes do estresse farmacológico com adenosina e sua possível repercussão nas imagens da CPM e o efeito vasodilatador no sistema cardiovascular. Definimos como objetivo primário: comparar a presença e a extensão dos defeitos reversíveis da CPM verificados em pacientes com abstinência de café por 24 horas (E1) com as imagens da randomização com 1 hora e 12 horas (E2) sem cafeína e como objetivos secundários: avaliar a presença e intensidade dos paraefeitos, comportamento da frequência cardíaca e da pressão arterial sistêmica. Foram submetidos ao estresse farmacológico com adenosina 194 pacientes para a realização da CPM, dos quais 43 pacientes preencheram os critérios para a randomização (defeitos perfusionais transitórios na CPM com adenosina). Excluímos seis pacientes (13,9%), três (6,9%) se recusaram a realizar a fase da randomização e os outros três (6,9%) nos quais não houve consenso entre os observadores em relação aos defeitos de perfusionais transitórios. A média de idade dos 37 pacientes analisados foi de 61,4 ± 8,3 anos, sendo 21 pacientes do sexo masculino (56,8%). Na avaliação das imagens da CPM, não houve diferença entre as imagens obtidas no grupo E1 comparadas as imagens de 1 (2,0 ± 1,5) hora ou 12 (12,6 ± 3,1) horas sem cafeína (E2). As médias de cafeína sérica encontradas foram de 0,14 ± 0,17 mg/l no grupo E1 do E2 de 1 hora e 0,13 ± 0,24 mg/l no grupo E1 do E2 de 12 horas, na randomização de 1 hora de 1,97± 0,83 mg/l e de 12 horas de 1,51 ± 1,46 mg/l (E1 vs. E2: p < 0,001). Em relação à presença dos paraefeitos, ocorreram em 31 pacientes (83,7%) e os mais freqüentes foram: dor precordial atípica, cansaço e dor em região cervical. Não foram observadas diferenças em relação às freqüências absolutas e relativas na ocorrência de paraefeitos entre os grupos. A intensidade dos paraefeitos foi verificada através de análise subjetiva comparando os sintomas em relação aos exames. Notou-se que em 22 pacientes (59,4%), caracterizaram o estudo randomizado como bem melhor, ou melhor, que o de 24 horas. A pressão arterial sistêmica e a freqüência cardíaca também não apresentaram diferenças entre os grupos. Conclusões: Os resultados permitem inferir que o uso da cafeína ingerida 2 horas antes da realização da CPM com adenosina foi eficaz e segura, pois apesar da modificação da resposta vasodilatadora máxima alcançada, traduzida pela melhor tolerância do exame realizado com menos tempo de ausência de cafeína na dieta, não modificou o resultado final da CPM
Myocardial perfusion imaging (MPI) in the past was only available to patients who were able to perform some type of exercise. Many protocols were developed with pharmacologic stress in order to enlarge the clinical availability of myocardial perfusion imaging (MPI). Adenosine is widely used and a potent coronary vasodilator, exhibits a significant interaction with other substances which antagonize its effects, such as dipyridamole, food products containing caffeine and xanthine derivatives. We found no clear consensus as to the time between caffeine ingestion and a cardiovascular adenosine stress test. To test this hypothesis we evaluated the influence of 24-hour, 12-hour and 1-hour caffeine abstinence, by assessing plasma caffeine levels before adenosine pharmacological stress, the possible repercussions on MPI images and vasodilatory effects on the cardiovascular system. The primary endpoint was to compare the presence and extent of reversible myocardial perfusion defects found in patients with 24-hour abstinence from coffee (E1), with images from patients randomized to 1-hour or 12-hour caffeine abstinence (E2). As secondary endpoints we evaluated the presence and intensity of paraeffects, as well as heart rate and systemic arterial blood pressure behavior. For this purpose, 194 patients underwent pharmacological stress with adenosine for MPI, 43 of whom fulfilled criteria for randomization (patients with transient perfusion defects detected on adenosine MPI). Six patients were excluded (13.9%), three patients (6.9%) who refused to undergo randomization, and other three (6.9%) in whom the observers could not reach consensus regarding transient perfusion defects. Mean age for the 37 patients analyzed was 61.4 ± 8.3 years, 21 patients male (56.8%). In the evaluation of myocardial perfusion images, no differences were detected between images obtained in the 24-hour E1 arm, and those from 1 (2.0 ± 1.5) hour or 12 (12.6 ± 3.1) hours randomization E2. Mean plasma caffeine level was 0.14 ± 0.17 mg/l in group E1 of the 1-hour arm E2, and 0.13 ± 0.24 mg/l in group (E1) of the 12-hour arm (E2), respectively, compared with 1.97± 0.83 mg/l, in the 1-hour, and 1.51 ± 1.46 mg/l, in the 12-hour (E2) randomized arms (E1 vs. E2: p < 0.001). In the 31 patients (83.7%) with presence of paraeffects, the most frequent were: atypical precordial pain, tiredness and pain on cervical area. There were no differences in the absolute and relative frequency in the occurrence of paraeffects between groups. However, with respect to the intensity of pareffects, a subjective analysis was undertaken, comparing symptoms of two exams. which resulted in 22 patients (59.4%) ranking the randomized study a lot better, or better than the 24-hour one. The systemic blood pressure and the heart rate behavior also did not reveal any significant differences between groups. Conclusions: The results may imply that the use of caffeine ingested 2 hours prior to the CPM with adenosine was effective and safe, for despite the change in maximal vasodilator response achieved, manifested by better tolerance of the examination with less time in the absence of caffeine in the diet, did not change the final result of the CPM

Foram estudadas 20 pacientes na menacme portadoras de leiomioma uterino, sintomáticas, que utilizaram anastrozol na dose 1 mg/dia por três meses consecutivos. Durante o tratamento acompanhou-se o volume do conjunto úteroleiomiomas com ultra-sonografia, no momento inicial e após um mês e três meses do início do uso da medicação. Além disso, foi observada a evolução da sintomatologia relacionada ao leiomioma (hipermenorréia, dismenorréia e metrorragia), presença de sintomas ligados ao hipoestrogenismo e dosagens séricas de FSH, estradiol, colesterol total e frações, triglicérides e glicose. Obtivemos redução média do volume do conjunto útero-leiomiomas de 9,32% até 31%. Houve diminuição significante dos sintomas relacionados ao leiomioma do útero. Não ocorreram sintomas ligados ao hipoestrogenismo. Não se comprovou modificação significante dos demais parâmetros estudados. Concluiu-se que o inibidor da aromatase, o anastrozol, na dosagem utilizada, foi efetivo na redução volumétrica do conjunto útero-leiomiomas, além de proporcionar significativa melhora dos sintomas relacionados a essa doença, sem alterar, no entanto, os valores de FSH, estradiol, colesterol total e frações, triglicérides e glicose.
We studied 20 patients in menacme with leiomyoma in the uterus, referring symptoms, using anastrozol 1 mg per day for three months. During this treatment we monitored the uterus-leiomyoma volume using ultrasound, at the beginning, one month after and three months after the beginning of the use of the medication. We also observed the leiomyoma symptoms evolution, presence of usual symptoms of hipoestrogenism and seric values of FSH, estradiol, cholesterol and its fractions triglycerides and glicemia. We obtained reduction in uterus-leiomyoma volume of 9.32% in average, in maximum 31%. There was significative reduction in symptoms related with leiomyoma. There were not symptoms of hipoestrogenism. We not observed significative modifications in the other studied parameters. This study concluded that the aromatase inhibitor, anastrozol, in this dosage, is effective in uterus-leiomyomas reduction, cause significative reduction of the symptoms related with this illness, without change the seric dosage of FSH, estradiol, total cholesterol and fractions, triglycerides and glicemia.

Drug delivery to the nasal and ocular mucosa faces several obstacles. One of these is from the effective clearance mechanisms present in the nose and eye. Polymer gels with suitable rheological properties can facilitate the absorption of poorly absorbed drugs by increasing the contact time of the drug with the mucosa. This has been attributed to the rheological and mucoadhesive properties of the gel. The main objective of this thesis was to investigate the importance of these features for the anticipated in vivo contact time, here exemplified by the ocular and nasal routes of administration.

The in situ gelling polymer gellan gum was found to have a favourable rheological and in vivo performance. When administered in the nasal cavity of rats, a gel was formed that could remain at the site of administration for up to 4 hours. In addition, the epithelial uptake and transfer of a 3 kDa fluorescein dextran was higher than for a mannitol solution. Therefore, it was concluded that a gellan gum formulation should be a promising strategy for nasal drug delivery.

The potential mucoadhesive properties of a variety of polymer gels were investigated using a rheological method and by measuring the tensile force required to detach the gel from a mucosa. With both methods the rheological properties of the gel were a determining factor for the results obtained. The rheological method was found to have several limitations. One of these was that a positive response, interpreted as mucoadhesion, was only seen with weak gels. The tensile method could, in contrast, detect strengthening of the mucus only for strong gels. However, this method reflects the in vivo performance of the gel better than the rheological method.

Finally, dielectric spectroscopy was explored as a tool for investigating the likelihood of intimate surface contact between the gel and the mucus layer. This novel approach involved determining the ease with which a charged particle can pass the gel-mucus interface layer, and may enable the study of the events at the interface closer to the molecular level, than is possible with the rheological and tensile strength methods.