Andréia Cristina Conegero Sanches

Antioxidant and antifungal activities of extracts and condensed tannins from Stryphnodendron obovatum Benth.

The antioxidant activity of stem-bark extracts from Stryphnodendron obovatum Benth., including fractions and isolated compounds, was evaluated by DPPH in thin-layer chromatography. All the fractions and isolated compounds showed antioxidant activity. Antifungal activity was determined by the minimum inhibitory concentration (MIC) and minimum fungicidal concentration (MFC) against the yeasts Candida albicans, Candida parapsilosis, Candida krusei and Candida tropicalis. All extracts (CE, EtOAc and FW), subfractions (F1-F12) and the compounds I, II and III were inactive against the yeasts. Against C. parapsilosis and C. albicans, fractions F13-15 and F20 showed moderate antifungal activity, and fractions F16-19 and F21-22 showed good activity. Chemical isolation of the ethyl-acetate fraction resulted in the identification of three compounds: epigallocatechin, gallocatechin and epigallocatechin-(4b®8)-gallocatechin.

Wound Healing Agents: The Role of Natural and Non-Natural Products in Drug Development

Impaired wound healing leads to infection and tissue necrosis. This has spurred the search for wound healing agents derived from natural and non-natural sources. Although natural products are widely used as lead compounds for the design of therapeutic drugs, few studies have looked for potential wound healing compounds in nature. In this review, we briefly discuss each phase of the wound healing process. Examples of natural and non-natural products with wound healing activities are listed, and the structure-activity relationship of fifty one compounds are described. An understanding of how these compounds exert their activities in biological systems is essential for their future development and application as wound healing agents.

Determinação quantitativa de taninos em três espécies de Stryphnodendron por cromatografia líquida de alta eficiência

A method of separation and quantification by reverse-phase high-performance liquid chromatography (HPLC) was developed, using water (0.05% TFA):acetonitrile (0.05% TFA) as the mobile phase in a gradient system. Flavan-3-ols present in a semipurified extract from the stem bark of Stryphnodendron adstringens, Stryphnodendron polyphyllum and Stryphnodendron obovatum were analyzed. The HPLC was performed with the ethyl-acetate fraction (EAF) using a solid-phase extraction on cartridges C18-E with methanol:water (2:8), filtered through a membrane of 0.5 μm pore size; the column was Phenomenex® Gemini C-18 (5 μm) at 30 oC, with a flow rate of 0.8 mL/min. The analysis was done at 210 nm. Gallic acid and gallocatechin solutions were used as calibration standards. The proposed method was validated by resolution RE No. 899/2003 of the National Health Surveillance Agency. Quantitative analysis of the EAF showed high contents of flavan-3-ols in the stem bark of all three species. This study demonstrated that it is possible to determine the concentration of individual substances in tannin-rich plants. The system developed can be used as a chromatographic profile for the semipurified fraction of S. adstringens, S. polyphyllum, and S. obovatum.

Efficacy of topical antifungal drugs in different dermatomycoses: a systematic review with meta-analysis

OBJECTIVE To evaluate and compare the efficacy of topical antifungal drugs applied to the treatment of each dermatomycosis. METHODS A systematic review of randomized clinical trials, published in Portuguese, Spanish and English until July 2010, which compared the use of azole and allylamine antifungal drugs among themselves and with placebo in the treatment of cutaneous candidiasis and T. versicolor, T. pedis, T. cruris and T. corporis was performed. The efficacy outcomes evaluated were mycological cure at the end of treatment and sustained cure. RESULTS Of the 4,424 studies initially identified, 49 met the selection criteria and were included in the meta-analyses. The grouped efficacy data evidenced the superiority of antifungal drugs compared to placebo, regardless of the dermatomycosis under evaluation, with odds ratio values ranging from 2.05 (95% CI 1.18-3.54) to 67.53 (95% CI 11.43-398.86). Allylamines were better than azoles only for the outcome sustained cure (OR 0.52 [95% CI 0.31-0.89]). CONCLUSION There is consistent evidence of the superiority of antifungal drugs over the use of placebo, and placebo-controlled studies are no longer justifiable. Allylamines maintain the mycological cure for longer periods compared to azole drugs. Given the significant cost difference among the classes, pharmacoeconomic analyses should be performed.

Frequency of potential interactions between drugs in medical prescriptions in a city in southern Brazil

CONTEXT AND OBJECTIVE Drug interactions form part of current clinical practice and they affect between 3 and 5% of polypharmacy patients. The aim of this study was to identify the frequency of potential drug-drug interactions in prescriptions for adult and elderly patients. TYPE OF STUDY AND SETTING: Cross-sectional pharmacoepidemiological survey in the Parque Verde housing project, municipality of Cascavel, Paraná, Brazil, between December 2006 and February 2007. METHODS Stratified cluster sampling, proportional to the total number of homes in the housing project, was used. The sample consisted of 95 homes and 96 male or female patients aged 19 or over, with medical prescriptions for at least two pharmaceutical drugs. Interactions were identified using DrugDigest, Medscape and Micromedex softwares. RESULTS Most of the patients were female (69.8%), married (59.4%) and in the age group of 60 years or over (56.3%), with an income less than or equal to three minimum monthly salaries (81.3%) and less than eight years of schooling (69.8%); 90.6% of the patients were living with another person. The total number of pharmaceutical drugs was 406 (average of 4.2 medications per patient). The drugs most prescribed were antihypertensives (47.5%). The frequency of drug interactions was 66.6%. Among the 154 potential drug interactions, 4.6% were classified as major, 65.6% as moderate and 20.1% as minor. CONCLUSION The high frequency of drug prescriptions with a potential for differentiated interactions indicates a situation that has so far been little explored, albeit a reality in household surveys.

In vivo wound healing and antiulcer properties of white sweet potato (Ipomoea batatas)

The potential of tuber flour of Ipomoea batatas (L.) Lam. cv. Brazlândia Branca (white sweet potato) as wound healing and antiulcerogenic agent was investigated in vivo in animal model. Excision on the back of Wistar rats was performed to induce wounds that were topically treated with Beeler’s base containing tuber flour of white sweet potato at 2.5%. Number of cells undergoing metaphase and the degree of tissue re-epithelialization were investigated 4, 7 and 10 days post-treatment. The protective effect of aqueous suspension of tuber flour (75 and 100 mg/kg animal weight) on gastric mucosa of Wistar rats was also studied by using the ethanol-induced ulceration model. Ointment based on white sweet potato at 2.5% effectively triggered the healing of cutaneous wound as attested by the increased number of cells undergoing metaphase and tissue re-epithelialization regardless the time of wound treatment. Tuber flour potentially prevented ethanol-induced gastric ulceration by suppressing edema formation and partly protecting gastric mucosa wrinkles. Crude extracts also exhibited potential as free radical scavengers. The results from animal model experiments indicate the potential of tuber flour of white sweet potato to heal wounds.

Eficácia de antifúngicos tópicos em diferentes dermatomicoses: uma revisão sistemática com metanálise

OBJECTIVE: To evaluate and compare the efficacy of topical antifungal drugs applied to the treatment of each dermatomycosis. METHODS: A systematic review of randomized clinical trials, published in Portuguese, Spanish and English until July 2010, which compared the use of azole and allylamine antifungal drugs among themselves and with placebo in the treatment of cutaneous candidiasis and T. versicolor, T. pedis, T. cruris and T. corporis was performed. The efficacy outcomes evaluated were mycological cure at the end of treatment and sustained cure. RESULTS: Of the 4,424 studies initially identified, 49 met the selection criteria and were included in the meta-analyses. The grouped efficacy data evidenced the superiority of antifungal drugs compared to placebo, regardless of the dermatomycosis under evaluation, with odds ratio values ranging from 2.05 (95% CI 1.18-3.54) to 67.53 (95% CI 11.43-398.86). Allylamines were better than azoles only for the outcome sustained cure (OR 0.52 [95% CI 0.31-0.89]). CONCLUSION: There is consistent evidence of the superiority of antifungal drugs over the use of placebo, and placebo-controlled studies are no longer justifiable. Allylamines maintain the mycological cure for longer periods compared to azole drugs. Given the significant cost difference among the classes, pharmacoeconomic analyses should be performed.

Efficacy and safety of amphotericin B lipid‐based formulations—A systematic review and meta‐analysis

Invasive fungal infections, an important cause of mortality, are primarily treated using amphotericin B, which is available in different formulations, both conventional and lipid‐based (liposomal, lipid complex, colloidal dispersion and Intralipid® infusion). The aim of our study was to determine the efficacy and safety of conventional amphotericin B vs its lipid‐based formulations. A systematic review followed by pairwise meta‐analysis was performed, including randomised controlled trials (RCTs) that evaluated the use of lipid‐based amphotericin B in patients with any degree of immunosuppression and susceptibility to invasive fungal infection. An electronic search was conducted using PubMed, Scopus, Web of Science and Scielo databases. Extracted outcomes were related to efficacy (cure) and safety (incidence of adverse events). Results were evaluated and meta‐analyses were performed. Twenty‐three RCTs were identified (n=2677 participants) for meta‐analysis. No significant differences between conventional amphotericin B and any of the five formulations evaluated were observed, with regard to the efficacy analysis. With respect to the adverse events of nephrotoxicity, fever, chills and vomiting, all lipid formulations presented better profiles than the conventional formulation. The present systematic review and meta‐analysis showed that conventional amphotericin B presents the same efficacy profile as lipid‐based formulations, although the latter were associated with a safer profile.

Inquérito farmacoepidemiológico de pacientes de meia idade e idosos em três comunidades de Cascavel, PR - Brasil: Verificação evolutiva do conhecimento terapêutico

Variables on therapeutic knowledge in pre- and post-intervention periods and the social and demographic characteristics of 80 middle-aged and elderly (45 years or more) patients in three parish communities in Cascavel, PR - Brazil are provided. A pharmacoepidemiological survey was developed; a prospective study between November 2003 and December 2004 was undertaken; data were collected in a semi-structured form. Females (82.5%) were predominant; average age 67.3 years old; schooling less than 8 years; most of them married (57.5%); only the couple inhabits the house (63.7%); income 1 to 3 salaries (80%); mean numbers of prescribed medicines pre- and post-intervention were 4.3 and 3.5, respectively. Medicine for the cardiovascular system (48.2%) was the most described (48.2%). Variables - reading information on drug and its frequency, knowledge on the medicine used and importance of information - were statistically non-significant, although difference in relative frequency from the pre- to the post-intervention period existed. Nevertheless, difference with regard to degree of progress in results shows clinical relevance with a favorable trend towards the benefit/risk ratio.

Efficacy and safety of amphotericin B formulations: a network meta-analysis and a multicriteria decision analysis.

Despite its broad spectrum, conventional amphotericin B (AB) is associated with serious adverse events. Lipid‐based formulations may offer safer options. We aimed to synthesize the evidence of efficacy and safety of AB formulations.