Abstract Molar incisor hypomineralization (MIH) is often accompanied by dental hypersensitivity and difficulty in achieving effective analgesia. Objective: This study evaluated the effectiveness of preemptive analgesia in children with severe MIH, post-eruptive enamel breakdown, and hypersensitivity. Methodology: Ibuprofen (10 mg/kg child weight) or placebo was administered, followed by infiltrative anesthesia and restoration with resin composite. Hypersensitivity was evaluated in five moments. The data were analyzed using the chi-square test, Fisher’s exact test, and t-test. Results: Preemptive analgesia provided benefits for the treatment of severe cases of MIH, with an increase in the effectiveness of infiltrative anesthesia and improved patient comfort during the restorative procedure. Conclusion: Preemptive analgesia has shown efficacy in reducing hypersensitivity during restorative dental procedures, evidencing the significance of this study for patients with MIH and hypersensitivity.

Abstract This study showcases the clinical efficacy of mucoadhesive patches designed for the buccal delivery of lidocaine and prilocaine hydrochlorides (1:1, 30 mg/patch). Such patches were developed for needle-free pre-operative local anesthesia in dentistry, aiming at mitigating the use of infiltrative anesthesia for medium-complexity clinical procedures. The patches were manufactured encompassing drug-release, mucoadhesive and backing layers, all prepared through film casting using biocompatible materials. Fifty-eight (n = 58) adult patients (65% women and 35% men) were randomly selected and included in a one-arm open clinical prospective cohort study. The average age of the subjects was of 50 years. The majority (59%) of the subjects, mostly women (82%), reported needle-phobia or anxiety due to dental procedures, which was assessed through a questionnaire approved by the ethical council for human use in research. The patches were positioned in the gingival region of the teeth involved in the procedure (86% on the maxillary and 14% on the mandibular bone). Two anesthetic patches were applied on each patient: one in the vestibular region and another in the palate/lingual portion, and these patches remained attached to the placement sites throughout the procedures. Concerning the dental procedures performed, 40% were cavity preparations and dental restorations of medium cavities; 29% staple facilities; 10% gingival retractions; 9% subgingival scrapings; 3% gingivalplasties; 3% supragingival preparations; 3% occlusal adjustments; and 2% subgingival preparations. In 90% of the cases, it was not necessary to complement with conventional infiltrative local anesthesia during the procedures. Patients did not report any discomfort or side effect during or after the administration of the patches. Among the cases in which there was the need for complementation, 50% were cavity preparations and dental restorations; 33% supragingival preparations; and 17% gingivoplasties. The complementary anesthesia volume was of 0.63 ± 0.23 mL and women corresponded to 83% of the participants who needed such intervention. Furthermore, in most cases, the patch was capable of initiating the anesthesia within a short time frame (5 minutes) and reaching the maximum anesthetic effect within 15 and 25 min, lasting at least 50 min. Undesirable side effects were not reported either 2 h after the administration or within the 6-month follow-up. Therefore, the anesthetic patches developed provide needle-free, painless, safe, and patient/dentist-friendly advances in performing routine medium-complexity dental procedures.

ABSTRACT A validation study of a reverse-phase high-performance liquid chromatographic assay for the quantification of two furanocoumarins (psoralen and bergapten) in soft extract obtained from Brosimum gaudichaudii Trécul, Moraceae, roots was conducted. The developed method was sensitive, rapid, reproducible, easy and precise, and showed linearity (r > 0.99) in the range of 10–64 µg/ml for psoralen, and 9–56 µg/ml for bergapten. It also showed a good efficiency for the photodegradation analysis of psoralen and bergapten in the soft extract. The photostability results showed that the Higuchi model presented the best fitting to the obtained data. Both chemical markers showed stability over 2.6 days, suggesting potential applications of the extract in obtaining intermediate products from this plant material. Furanocoumarins take around 30 min to be activated by UV light, reaching the maximum biological potential. Thus, the results obtained to the Higuchi model, corresponding to 2.6 days of stability, shows feasibility with future applications of these chemical markers.

Copaiba oil, an oleoresin extracted from Copaifera genus, has been widely used in popular medicine for the treatment of several diseases. The aim of this study was to investigate the antifungal activity of the copaiba oil and its isolated compounds caryophyllene oxide, copalic acid and acetoxycopalic acid against Trichophyton rubrum, Trichophyton mentagrophytes and Microsporum gypseum strains, using microdilution method and microscopy techniques. It was found that the copaiba oil and the copalic acid were active against dermatophytes by minimal inhibitory concentration (MIC) and minimal fungicidal concentration (MFC) tests. The MIC and MFC of copaiba oil against T. rubrum, T. mentagrophytes and M. gypseum were 125 µg mL-1 (250 µg mL-1), 500 µg mL-1 (500 µg mL-1) and 250 µg mL-1 (250 µg mL-1), respectively. For copalic acid, the MIC and MFC were 50 µg mL-1 (100 µg mL-1), 100 µg mL-1 (100 µg mL-1) and 50 µg mL-1 (100 µg mL-1), respectively. Fluorescence microscopy and scanning electronic microscopy were used to investigate inhibition on hyphal growth by compounds, copaiba oil and copalic acid, showing a strong inhibition and an irregular growth pattern. Cell wall, cytoplasmic membrane and intracellular contents were also damaged. In conclusion, copaiba oil and copalic acid showed great activity against dermatophytes, being potential compounds for the development of antifungal drugs.

Bioresorbable polymeric films were prepared by solvent casting using a tyrosine-derived polycarbonate and metronidazole (MDZ) as the model drug at 2.5%, 5% and 10% (w/w). Drug loading did not affect the water uptake, drug release, polymer degradation or erosion profiles. All devices released approximately 85% (w/w) of the drug within a 1.5 h period. This may be attributed to the rapid water uptake of the polymer. An increase in the water uptake correlated with a linear rate increase of the polymer degradation (0.968 ≤ R2 ≤ 0.999). Moreover, MDZ presented a remarkable plasticizing effect for the polymer and drug loading exerted a significant impact on the mechanical properties of the obtained films. The results obtained can be used to further the development of novel biocompatible and biodegradable polymeric platforms for the delivery of metronidazole and other drugs in a broad range of pharmaceutical applications.

Analisar o perfil de consultas médicas e de medicamentos para o tratamento de comorbidades em pacientes com diabetes atendidos no Sistema Único de Saúde. Estudo farmacoepidemiológico e transversal realizado de mar/2006 a fev/2007. Foram incluídos no estudo portadores de diabetes atendidos no Distrito Sanitário Oeste de Ribeirão Preto (SP), sendo analisadas as consultas médicas realizadas na atenção primária, secundária e emergência, além dos medicamentos prescritos para tratamento de comorbidades associadas ao diabetes. Foram identificados 3.198 pacientes, com idade média de 60,4 anos e aproximadamente 55,0% idosos. Os medicamentos do sistema cardiovascular foram os mais prescritos, sendo que 60,0% dos pacientes utilizavam captopril ou enalapril. Além disso, 40,6% dos pacientes faziam uso de ácido acetilsalicílico em dose antiagregante plaquetário. Em relação às consultas médicas, os pacientes apresentaram média de 5,1 visitas ao ano, na atenção primária, na atenção secundária e no atendimento de emergência. A utilização de ácido acetilsalicílico e estatina foram menores do que a relatada na literatura e os dados indicam uma alta prevalência de admissão no atendimento de emergência.

The scope of this paper was to analyze the profile of medical consultations and drugs used for the treatment of comorbidities in patients with diabetes attended in the Brazilian Unified Health System. This was a pharmaco-epidemiological cross-sectional study conducted between March 2006 and February 2007 All patients with diabetes attended in the western sanitary district of Ribeirao Preto in the state of São Paulo were included in the study. The types of medical attendance (primary, secondary and emergency care) and the drugs prescribed for the treatment of comorbidities were analyzed. The drugs were classified according to the Anatomical Therapeutic Chemical Classification System and 3,198 patients were identified. The mean age was 60.4 years and more than 55% of the patients were 60 years or older. The cardiovascular drugs most used were captopril or enalapril (60%). About 40.6% of the patients used acetylsalicylic acid in platelet antiaggregant doses. The patients had an average of 5.1 medical consultations per year (primary care, secondary care and emergency care). The utilization of statins and acetylsalicylic acid was less than that reported in the literature and the data indicate a high prevalence of admission to emergency care.

Analisar o perfil de consultas médicas e de medicamentos para o tratamento de comorbidades em pacientes com diabetes atendidos no Sistema Único de Saúde. Estudo farmacoepidemiológico e transversal realizado de mar/2006 a fev/2007. Foram incluídos no estudo portadores de diabetes atendidos no Distrito Sanitário Oeste de Ribeirão Preto (SP), sendo analisadas as consultas médicas realizadas na atenção primária, secundária e emergência, além dos medicamentos prescritos para tratamento de comorbidades associadas ao diabetes. Foram identificados 3.198 pacientes, com idade média de 60,4 anos e aproximadamente 55,0% idosos. Os medicamentos do sistema cardiovascular foram os mais prescritos, sendo que 60,0% dos pacientes utilizavam captopril ou enalapril. Além disso, 40,6% dos pacientes faziam uso de ácido acetilsalicílico em dose antiagregante plaquetário. Em relação às consultas médicas, os pacientes apresentaram média de 5,1 visitas ao ano, na atenção primária, na atenção secundária e no atendimento de emergência. A utilização de ácido acetilsalicílico e estatina foram menores do que a relatada na literatura e os dados indicam uma alta prevalência de admissão no atendimento de emergência.

The scope of this paper was to analyze the profile of medical consultations and drugs used for the treatment of comorbidities in patients with diabetes attended in the Brazilian Unified Health System. This was a pharmaco-epidemiological cross-sectional study conducted between March 2006 and February 2007 All patients with diabetes attended in the western sanitary district of Ribeirao Preto in the state of São Paulo were included in the study. The types of medical attendance (primary, secondary and emergency care) and the drugs prescribed for the treatment of comorbidities were analyzed. The drugs were classified according to the Anatomical Therapeutic Chemical Classification System and 3,198 patients were identified. The mean age was 60.4 years and more than 55% of the patients were 60 years or older. The cardiovascular drugs most used were captopril or enalapril (60%). About 40.6% of the patients used acetylsalicylic acid in platelet antiaggregant doses. The patients had an average of 5.1 medical consultations per year (primary care, secondary care and emergency care). The utilization of statins and acetylsalicylic acid was less than that reported in the literature and the data indicate a high prevalence of admission to emergency care.

OBJETIVO: Analisar as prescrições medicamentosas dos antidiabéticos orais e insulina em pacientes portadores de diabetes melito tipo 1 e tipo 2 atendidos pelo Sistema Único de Saúde (SUS) em Ribeirão Preto, SP, Brasil. SUJEITOS E MÉTODOS: Todos os pacientes com diabetes atendidos no distrito sanitário oeste de Ribeirão Preto, SP, do SUS, entre março/2006 e fevereiro/2007, foram incluídos no estudo. RESULTADOS: Foram identificados 3.982 pacientes com diabetes. Idade média dos pacientes foi de 60,6 anos e 61,0% do gênero feminino. Sessenta por cento foram tratados com monoterapia. A dose dos antidiabéticos foi menor em monoterapia quando comparada à politerapia. Dez pacientes receberam doses de glibenclamida e metformina acima da dose máxima recomendada. Além disso, em pacientes idosos, não houve redução da dose. CONCLUSÃO: A monoterapia com antidiabéticos orais foi prevalente e não houve individualização da dose de acordo com a faixa etária.

OBJECTIVE: To analyze drug prescriptions for insulin and oral antidiabetic drugs in type 1 and type 2 diabetes mellitus patients seen in the Brazilian Public Healthcare System (Unified Health System - SUS) in Ribeirao Preto, SP, Brazil. SUBJECTS AND METHODS: All the patients with diabetes seen in the SUS in the western district of Ribeirao Preto, SP, Brazil between March/2006 and February/2007 were included in the study. RESULTS: A total of 3,982 patients were identified. Mean age of the patients was 60.6 years, and 61.0% were females. Sixty percent of the patients were treated with monotherapy. Doses of oral antidiabetic drugs were lower in monotherapy than in polytherapy. Ten patients received doses of glibenclamide or metformin above the recommended maximum doses, and in elderly patients there was no reduction in drug doses. CONCLUSION: Monotherapy with oral antidiabetic drugs was the predominant procedure, and the doses were not individualized according to age.

Copaiba oil-resin, extracted from the trunk of Copaifera, and traditionally used in folk medicine in the treatment of various disorders, has been shown to be an effective antiinflamatory, antitumor, antitetanus, antiseptic and antiblenorrhagea agent. As, there are few studies evaluating its genotoxicity, this aspect of the commercial oil-resin, and its volatile and resinous fractions, were evaluated in mice by comet assay and micronucleus (MN) test. A single dose of oil resin, volatile or resin fractions (500; 1,000 or 2,000 mg/kg b.w.) was administered by gavage. The chemical compositions of Copaiba oil resin and its fractions was analyzed by gas chromatography. According to comet assaying, treatment with either one did not increase DNA damage, and as to MN testing, there was no alteration in the incidence of micronucleated polychromatic erythrocytes. Chromatographic analysis of the oil-resin itself revealed sesquiterpenes, diterpenic carboxylic acid methyl esters and high levels of β-caryophyllene. Thus, it can be assumed that the oil resin and volatile and resinous fractions from the commercial product are not genotoxic or mutagenic.

OBJETIVO: Analisar os custos relacionados a medicamentos e consultas em pacientes portadores de diabetes melito tipo 2 acompanhados por um programa de atenção farmacêutica. SUJEITOS E MÉTODOS: Estudo prospectivo e experimental foi realizado em 71 pacientes, os quais foram divididos em dois grupos: atenção farmacêutica e controle. Os pacientes do grupo atenção farmacêutica foram acompanhados mensalmente por um farmacêutico clínico. RESULTADOS: O grupo atenção farmacêutica apresentou redução estatisticamente significativa no custo da metformina e nas visitas de pronto atendimento e aumento no custo das consultas de atenção primária. Por outro lado, o grupo controle apresentou elevação estatisticamente significativa nos custos gerais de tratamento farmacológico e nas consultas em geral na ordem de 21,3%. CONCLUSÃO: O grupo atenção farmacêutica apresentou manutenção dos custos relacionados a consultas e medicamentos, enquanto o grupo controle apresentou aumento destes.

OBJECTIVE: To analyze the costs related to visits and drug prescription in outpatients with type 2 diabetes mellitus assisted by a pharmaceutical care service. SUBJECTS AND METHODS: A prospective and experimental study was carried out. Seventy one patients were divided into two groups: control and pharmaceutical care. Patients in the pharmaceutical care group were followed up monthly by a single clinical pharmacist. RESULTS: The pharmaceutical care group had a statistically significant reduction in costs of metformin and emergency department visits, and increased costs with their family physicians. On the other hand, the control group had a statistically significant increase of 21.3% in the general costs of treatment and visits. CONCLUSION: The pharmaceutical care group maintained the same costs related to drugs and visits, while the control group showed a significant increase in general costs.

Em razão do aumento considerável no gasto público com saúde, principalmente no que tange a medicamentos, vários países, como Austrália e Inglaterra, já implementaram ou estão em fase de discussão da adoção de medidas visando garantir a qualidade do atendimento prestado à população. Uma das estratégias menos danosas, mas ainda incipiente no Brasil, é a adoção de técnicas de análises econômicas, mais especificamente, a avaliação farmacoeconômica. Neste contexto, este trabalho visa contribuir com a disseminação dos conceitos e técnicas de análises econômicas com a perspectiva de que possam ser incorporadas nas decisões políticas de racionalização dos gastos e na busca da eficiência clínica. Para tanto, este artigo apresenta uma revisão bibliográfica contemplando os tipos de custos e benefícios em saúde, as metodologias de análise farmacoeconômicas, quais sejam: análise de minimização de custo, de custo-benefício, de custo-efetividade e de custo-utilidade, assim como suas principais características, vantagens, desvantagens e aplicabilidades.

Due to the considerable increase in public expenditure with health issues, mainly regarding drugs, several countries, including Australia and England, have already implemented, or are in the process of discussing the adoption of measures to ensure the quality of health care provided to the population. One of the less harmful strategies, rarely used in Brazil, is the adoption of economic techniques applied to health, more specifically, pharmacoeconomic analysis. This paper aims to contribute to the dissemination of concepts and techniques of economic analysis with a view to incorporate these into policy decisions of expenditure rationalization and the search for clinical efficiency. It includes a literature review covering the types of costs and benefits in health issues, the methodologies of pharmacoeconomic analysis, cost-minimization, cost-benefits, cost-effectiveness and cost-utility analysis, as well as its main characteristics, advantages, disadvantages and applicability.

A solubilidade de fármacos ainda é um dos principais desafios no desenvolvimento de formulações farmacêuticas. As dispersões sólidas (DS) apresentam grande potencial para melhorar a solubilidade de fármacos. O praziquantel é o fármaco de primeira escolha no tratamento da esquistossomose, contudo a baixa solubilidade em água restringe seu uso à administração pela via oral. Apesar da baixa solubilidade, o PZQ é bem absorvido através do trato gastrintestinal, mas doses orais elevadas são requeridas para garantir concentrações suficientes de fármaco para o tecido alvo. O objetivo deste estudo foi melhorar a solubilidade, a dissolução e avaliar a absorção do PZQ. As DS foram formuladas com óleo de castor hidrogenado - PEG 60 (CR-60), pelo uso dos métodos de fusão e evaporação do solvente. PZQ puro, mistura física (MF) e DS de CR-60-PZQ (1:2; 1:1; 2:1) foram comparados quanto à solubilidade, dissolução e absorção intestinal. Os resultados experimentais mostraram aumento na solubilidade, na taxa de dissolução e na absorção intestinal do PZQ nas DS. A solubilidade do PZQ foi maior em meio ácido, mostrando uma dependência do pH. O aumento na solubilidade do PZQ nas DS com CR-60 foi atribuída a fatores como aumento da molhabilidade, solubilização local, redução granulométrica e redução da cristalinidade ou, ainda, a ocorrência de uma solução sólida intersticial.

The solubility behavior of drugs remains one of the most challenging aspects in formulation development. Solid Dispersion (SD) has tremendous potential for improving drug solubility. Although praziquantel (PZQ) is the first drug of choice in the treatment of schistosomiasis, its poor solubility has restricted its delivery oral route. In spite of its poor solubility, PZQ is well absorbed in the gastrointestinal tract, but large doses are required to achieve adequate concentration at the target sites. The aim of this study was to improve the solubility and dissolution rate of PZQ and to evaluate its intestinal absorption. SDs were formulated with PEG-60 castor oil hydrogenated (CR-60) using a fusion and evaporation method. Pure PZQ and physical mixtures (PM) and PZQ-CR-60 (2:1; 1:1; 1:2 ratios) were compared as regards their solubility, dissolution and intestinal absorption. The experimental results demonstrated the improvement in the solubility, dissolution rate and intestinal absorption. In addition, the solubility behavior showed pH dependency and that the solubility of PZQ was slower in acidic medium than in neutral and basic mediums. The increase in PZQ solubility of the SD with the CR-60 could be attributed to several factors such as improved wettability, local solubilization, drug particle size reduction and crystalline or, interstitial solid solution reduction.

O sistema de saúde nacional, impulsionado por contextos econômicos restritivos, passou por uma reestruturação organizacional na década de 1990, voltada à atenção primária. Apesar das reformas, a incidência de diabetes mellitus ainda atinge elevadas proporções. Devido à alta morbi-mortalidade, a prevenção dessa morbidade tem-se tornado foco atual, fazendo-se necessário o desenvolvimento de programas eficazes e viáveis ao Sistema Único de Saúde, tais como ênfase na prevenção primária, controle da incidência e complicações da doença. Para que isso ocorra, o modelo da atenção atual prestada ao paciente deve ser modificado, priorizando a atenção primária, com a substituição do modelo médico-hegemônico por uma equipe interdisciplinar, onde o farmacêutico, como membro da equipe, possa prover seus serviços, minimizando assim impactos sociais, humanísticos e econômicos que a doença acarreta para a sociedade. O objetivo da presente revisão foi abordar a temática do diabetes mellitus e as dificuldades do controle associado à ineficácia da logística adotada, principalmente no Sistema Único de Saúde.

The Brazilian Health Care System stimulated for restrictive economic contexts had passed for reorganization in the decade of 1990, directed mainly to the primary attention. Although the reforms, the incidence of diabetes mellitus still reaches epidemic levels. The diabetes prevention has become actual preoccupation due the high morbimortality that accompanies this disease, becoming necessary the development of efficient and viable programs for Brazilian Public Health system such as emphasis in the primary prevention, control of the diseases incidence and complications. To obtain this goal, the current model of attention given to the patient must be modified, prioritizing the primary attention and a replacement of the hegemonic medical model for another one, formed by an interdisciplinary team, where the pharmacist as a member could offer his/her services should occur, thus minimizing social, humanistic and economic impacts that the diabetes causes for the society. The aim of this present revision is to approach the diabetes mellitus, the difficulties for its control associated with the adopted ineffective system, mainly in the Brazilian Public Health System.