José Cabrita

Antimicrobial activity of Guinea-Bissau traditional remedies

The ethanolic extracts of twelve plants selected through ethnomedical survey in Guinea-Bissau were investigated for their in vitro antimicrobial properties over ten bacteria and Candida albicans, using agar diffusion and dilution methods. All the tested extracts showed some activity against at least one of the bacteria. Most of the extracts (79%) showed activity against Staphylococcus aureus and only one (Cryptolepis sanguinolenta) against Escherichia coli. Cryptolepis sanguinolenta and Terminalia macroptera root extracts showed some activity against Candida albicans as well as showing an interesting profile of activity against most of the enteropathogen microorganisms. Inhibition zones against Staphylococcus aureus were localised on extract chromatograms by bioautographic techniques.

Evaluation of a pharmaceutical care program for hypertensive patients in rural Portugal.

OBJECTIVES To evaluate the community pharmacists capacity to positively influence the results of antihypertensive drug therapy through a pharmaceutical care program and to determine what factors limit the program. DESIGN Randomized, controlled study. SETTING Private pharmacy caring for a semiliterate, rural Portuguese population. PATIENTS Random sample of 100 patients with a diagnosis of essential hypertension who had been on drug treatment for less than 6 months. Patients were randomly assigned to an intervention (n = 50) or a control (n = 50) group. INTERVENTION Individualized health promotion by a research pharmacist involving monthly appointments for 6 months to monitor blood pressure; assess adherence to treatment; prevent, detect, and resolve drug-related problems (DRPs); and encourage nonpharmacologic measures for blood pressure control. Control patients received traditional care. MAIN OUTCOME MEASURES Control of blood pressure; decreases in systolic/diastolic blood pressure; number of detected, resolved, and prevented DRPs. RESULTS From the initial sample of 100 patients, 41 patients in the intervention group and 41 patients in the control group completed the longitudinal study. After 6 months, prevalence of uncontrolled blood pressure decreased by 77.4% in the intervention group (P < .0001) and by 10.3% in the control group (P = .48). Systolic blood pressure fell from a mean +/- standard deviation of 152 mm Hg +/- 23 mm Hg to 129 +/- 15 mm Hg in intervention patients and 148 +/- 16 mm Hg to 143 +/- 20 mm Hg in control patients (P < .001). Twenty-four of 29 (83%) detected actual DRPs were resolved. About 40% of potential DRPs were prevented. CONCLUSION In this rural community, a pharmaceutical care program was associated with significant improvements in blood pressure control in hypertensive patients.

Antimicrobial activity of Terminalia macroptera root

Terminalia macroptera Guill et Perr. (Combretaceae) is a medicinal plant used in Guinea-Bissau and other West African countries to treat infectious diseases. The ethanol extract from T. macroptera decorticated root and their liquid-liquid partition fractions, were screened for antimicrobial activity, by the twofold serial microdilution assay against seven reference bacterial strains and against Candida albicans. The extract and fractions showed some activity against at least one of the test microorganisms. The best results were obtained against Shigella dysenteriae and Vibrio cholerae. The minimum inhibitory concentrations (MIC) of T. macroptera ethanol extract were also determined for about 100 clinical strains of Campylobacter sp., Escherichia coli, Salmonella sp., Shigella sp. and Vibrio cholerae. The ethanol extract activity against Campylobacter strains is similar to co-trimoxazole, higher than sulfamethoxazole but lower than tetracycline, erythromycin, ampicillin and streptomycin. Ellagitannins are the major compounds in the extract and active fractions. The obtained results suggest a potential importance of this medicinal plant in the treatment of enteric diseases, particularly in Campylobacter infections.

Cryptolepis sanguinolenta activity against diarrhoeal bacteria

Cryptolepine is the main alkaloid of Cryptolepis sanguinolenta (Lindl.) Schlechter, a plant used in traditional medicine in West Africa. The minimal inhibitory concentrations (MICs) of cryptolepine, ethanol and aqueous extracts of Cryptolepis sanguinolenta root were determined for 65 strains of Campylobacter jejuni, 41 strains of Campylobacter coli isolated from sporadic cases of gastroenteritis in Portugal and 86 strains of Vibrio cholerae isolated from patients with enteric infections in Angola, Brazil and Portugal. The ethanol extract activity against Campylobacter strains (MIC90% = 25 micrograms/ml) is higher than that of co-trimoxazole and sulfamethoxazole and Campylobacter strains susceptibility for cryptolepine (MIC90% = 12.5 micrograms/ml) is equal for ampicillin. The ethanol extract and cryptolepine show some activity against the Vibrio cholerae strains, although their activities are lower than that of tetracycline. The results suggest that these roots could be a therapeutic alternative for bacterial etiologic diarrhoea in West Africa.

Anti-Helicobacter pylori activity of Terminalia macroptera root.

The root of Terminalia macroptera Guill. & Perr. (Combretaceae) is widely used in African traditional medicine to treat various infectious diseases, including stomach-associated diseases. This study investigates the in vitro activity of T. macroptera root extract against reference strains and clinical isolates of H. pylori and attempts to localize the extract bioactivity. T. macroptera hydroethanol (80% V/V) root extract (Tmr) activity was tested against three standard strains and sixty two clinical strains of H. pylori. Tmr liquid-liquid partition fractions were screened against twenty H. pylori strains. Qualitative analysis of Tmr and its fractions was performed by HPLC-UV/DAD. The antibiotic characterization of the H. pylori strains revealed that 20% of the tested clinical isolates were resistant to at least two of the three antibiotics belonging to the main groups of antibiotics used in multi-therapy to eradicate H. pylori infections. In contrast, Tmr showed anti-H. pylori activity against the majority (92%) of the tested strains (MIC(50) and MIC(90)=200 μg/ml). The Tmr water liquid-liquid fraction (Tmr-3) and the precipitate obtained from this fraction (Tmr-5) were the most active tested samples, showing a MIC(50) of 100 μg/ml. The present work proves the in vitro activity of T. macroptera against H. pylori, thus confirming the utility of this traditional medicinal plant to treat stomach complaints due to H. pylori infection. The main compounds of Tmr and of Tmr-3 were the ellagitannins terchebulin and punicalagin. These compounds can be considered as markers of T. macroptera root active extracts against H. pylori.

Self-report of symptom frequency and symptom distress in kidney transplant recipients

The aim of this study was to assess symptom frequency and symptom distress associated with adverse effects of immunosuppressive therapy in kidney transplant recipients and to correlate it with compliance and socio‐demographic characteristics.

Acyloxymethyl as a Drug Protecting Group. Part 3. Tertiary O-Amidomethyl Esters of Penicillin G: Chemical Hydrolysis and Anti-Bacterial Activity

AbstractPurpose. O-(N-alkylamido)methyl esters of penicillin G were studied as a new class of prodrugs. Methods. Their hydrolysis in aqueous buffers containing 20 % (v/v) of acetonitrile was investigated by HPLC. Results. A U-shaped pH-rate profile was seen with a pH-independent process extending from pH ca. 2 to pH ca. 10. This pathway is characterised by kinetic data that are consistent with a uni-molecular mechanism involving rate-limiting iminium ion formation and penicillinoate expulsion. Penicillin G and the corresponding amide are the ultimate products detected and isolated, indicating that β-lactam ring opening is much slower than ester hydrolysis. The O-(N-alkylamido)methyl esters of penicillin G displayed similar in vitro antibacterial activity to penicillin G itself. Conclusions. Compared to the penicillin G derivatives, the much higher stability of the O-(N-methylbenzamido)methyl benzoate, acetate and valproate esters (which gave rise to a Bronsted βlg value of ca. -1) suggests that tertiary N-acyloxymethylamides may be useful prodrugs for carboxylic acid drugs with pKa >4.

Factores associados à hipertensão arterial nos utentes de farmácias em Portugal

OBJETIVO: Estimar a prevalencia, tratamento e controlo da hipertensao e identificar factores associados em utentes de farmacias comunitarias. METODOS: Estudo transversal com 1.042 utentes de 40 a 65 anos em 60 farmacias comunitarias de Portugal Continental entre outubro de 2005 e janeiro de 2006. Os dados foram obtidos pela aplicacao de questionario e medicao de parâmetros biologicos. Foram realizadas tres regressoes logisticas sequenciais para verificar associacao entre as variaveis. RESULTADOS: A idade media foi de 53,7 anos e a razao homem/mulher foi 0,68. A prevalencia da hipertensao arterial foi de 54,8%. Cerca de 70% dos hipertensos encontravam-se sob tratamento anti-hipertensivo e, destes, 47,7% estavam controlados. A hipertensao esteve positivamente associada a idade mais elevada, sexo masculino, ser casado, apresentar indice de massa corporal e nivel de colesterol total mais alto, ser diabetico, ter doenca cardiovascular pessoal ou familiar precoce e reportar mais consultas medicas por ano. A hipertensao tratada mostrou-se positivamente associada a ser mulher, nao casado, ser diabetico, viver numa area urbana e reportar mais de tres consultas medicas por ano. Nos hipertensos tratados, estar controlado foi positivamente associado a ter comportamento aderente a terapeutica anti-hipertensiva (auto-reporte), percepcionar o efeito desta medicacao e ser de baixo risco cardiovascular. Os modelos preditivos apresentaram areas sob as respectivas curvas ROC entre 0,72 e 0,78, com capacidade discriminatoria aceitavel. CONCLUSOES: A prevalencia da hipertensao foi elevada, mas similar a encontrada em outros estudos realizados em Portugal. A proporcao de doentes tratados foi satisfatoria, em contraste com o nivel insuficiente de controlo.OBJECTIVE To estimate the prevalence, treatment and control of hypertension, and to identify factors associated in community pharmacy users. METHODS A cross-sectional study was conducted with 1,042 pharmacy users, aged between 40 and 65 years, in 60 community pharmacies of continental Portugal, between October 2005 and January 2006. Data were obtained with the application of a questionnaire and measurement of biological parameters. A total of three sequential logistic regressions were performed to verify an association among variables. RESULTS Mean age was 53.7 years and the male/female ratio was 0.68. Prevalence of arterial hypertension was 54.8%. Approximately 70% of hypertensive individuals were undergoing antihypertensive treatment and, of these, 47.7% were controlled. Hypertension was positively associated with older age, male sex, being married, higher body mass index and higher total cholesterol level, being a diabetic, having a family or personal history of premature cardiovascular disease, and reporting more medical visits per year. When treated, hypertension was found to be positively associated with the female sex, not being married, being a diabetic, living in an urban area, and reporting more than three medical visits per year. In hypertensive users who were treated, being controlled was positively associated with self-reporting adherent behavior towards antihypertensive treatment, perceiving the effect of these drugs and having a low cardiovascular risk. The predictive models showed areas under the respective ROC curves between 0.72 and 0.78, with an acceptable discriminatory power. CONCLUSIONS The prevalence of hypertension was high, although similar to that found in other studies conducted in Portugal. The proportion of hypertensive individuals under treatment was satisfactory, in contrast to an insufficient level of control.

Factors associated with arterial hypertension in pharmacy users in Portugal

OBJETIVO: Estimar a prevalencia, tratamento e controlo da hipertensao e identificar factores associados em utentes de farmacias comunitarias. METODOS: Estudo transversal com 1.042 utentes de 40 a 65 anos em 60 farmacias comunitarias de Portugal Continental entre outubro de 2005 e janeiro de 2006. Os dados foram obtidos pela aplicacao de questionario e medicao de parâmetros biologicos. Foram realizadas tres regressoes logisticas sequenciais para verificar associacao entre as variaveis. RESULTADOS: A idade media foi de 53,7 anos e a razao homem/mulher foi 0,68. A prevalencia da hipertensao arterial foi de 54,8%. Cerca de 70% dos hipertensos encontravam-se sob tratamento anti-hipertensivo e, destes, 47,7% estavam controlados. A hipertensao esteve positivamente associada a idade mais elevada, sexo masculino, ser casado, apresentar indice de massa corporal e nivel de colesterol total mais alto, ser diabetico, ter doenca cardiovascular pessoal ou familiar precoce e reportar mais consultas medicas por ano. A hipertensao tratada mostrou-se positivamente associada a ser mulher, nao casado, ser diabetico, viver numa area urbana e reportar mais de tres consultas medicas por ano. Nos hipertensos tratados, estar controlado foi positivamente associado a ter comportamento aderente a terapeutica anti-hipertensiva (auto-reporte), percepcionar o efeito desta medicacao e ser de baixo risco cardiovascular. Os modelos preditivos apresentaram areas sob as respectivas curvas ROC entre 0,72 e 0,78, com capacidade discriminatoria aceitavel. CONCLUSOES: A prevalencia da hipertensao foi elevada, mas similar a encontrada em outros estudos realizados em Portugal. A proporcao de doentes tratados foi satisfatoria, em contraste com o nivel insuficiente de controlo.OBJECTIVE To estimate the prevalence, treatment and control of hypertension, and to identify factors associated in community pharmacy users. METHODS A cross-sectional study was conducted with 1,042 pharmacy users, aged between 40 and 65 years, in 60 community pharmacies of continental Portugal, between October 2005 and January 2006. Data were obtained with the application of a questionnaire and measurement of biological parameters. A total of three sequential logistic regressions were performed to verify an association among variables. RESULTS Mean age was 53.7 years and the male/female ratio was 0.68. Prevalence of arterial hypertension was 54.8%. Approximately 70% of hypertensive individuals were undergoing antihypertensive treatment and, of these, 47.7% were controlled. Hypertension was positively associated with older age, male sex, being married, higher body mass index and higher total cholesterol level, being a diabetic, having a family or personal history of premature cardiovascular disease, and reporting more medical visits per year. When treated, hypertension was found to be positively associated with the female sex, not being married, being a diabetic, living in an urban area, and reporting more than three medical visits per year. In hypertensive users who were treated, being controlled was positively associated with self-reporting adherent behavior towards antihypertensive treatment, perceiving the effect of these drugs and having a low cardiovascular risk. The predictive models showed areas under the respective ROC curves between 0.72 and 0.78, with an acceptable discriminatory power. CONCLUSIONS The prevalence of hypertension was high, although similar to that found in other studies conducted in Portugal. The proportion of hypertensive individuals under treatment was satisfactory, in contrast to an insufficient level of control.

Effects of economic recession on elderly patients’ perceptions of access to health care and medicines in Portugal

Background In view of the current financial and demographic situation in Portugal, accessibility to health care may be affected, including the ability to adhere to medication. Objective To evaluate the perceived effects of the crisis on elderly patient’s access to medicines and medical care, and its implications on medicine-taking behaviour. Setting Community pharmacy. Method A cross-sectional study was undertaken during April 2013, where elderly patients answered a self-administered questionnaire based on their health-related experiences in the current and previous year. Binary logistic regression was used to ascertain the effects of potential predictors on the likelihood of adherence. Main outcome measures self-reported adherence. Results A total of 1231 questionnaires were collected. 27.3% of patients had stopped using treatments or health services in the previous year for financial motives; mostly private medical appointments, followed by dentist appointments. Almost 30% of patients stopped purchasing prescribed medicines. Over 20% of patients reduced their use of public services. Out-of-pocket expenses with medicines were considered higher in the current year by 40.1% of patients. The most common strategy developed to cope with increasing costs of medicines was generic substitution, but around 15% of patients also stopped taking their medication or started saving by increasing the interdose interval. Conclusion Reports of decreasing costs with medicines was associated with a decreased likelihood of adherence (OR 0.42; 95% CI 0.27–0.65). Lower perceived health status and having 3 or more co-morbidities were associated with lower odds of adhering, whilst less frequent medical appointments was associated with a higher likelihood of exhibiting adherence.