Thesis (Ph. D.)--Uniformed Services University of the Health Sciences, 2005. / Typescript (photocopy).

The adulteration of phytotherapic formulations has been increasing considerably in the recent years in several countries, by the fact that there is not an established efficient monitoring for the control of the manipulation and commercialization of the so called natural medicines . As the possibility of adulteration is relatively wide in terms of compound classes, the need of analytical methods with good sensitivity and selectivity, which are able to identify and quantify simultaneously more than one pharmaceutical in the same phytotherapic formulation, is very important. Considering the well known effects of these adulterants and its use and abuse in the formulations for weigh loss, two separations methods were developed in this study to enable the study of benzodiazepines alprazolam, clonazepam, chlordiazepoxide, diazepam, flurazepam, lorazepam, medazepam and midazolam as possible adulterants in phytotherapic formulations. For the electrophoretic method the optimized conditions were: buffer phosphate 100 mM, 15% acetonitrile (pH 2,0) as an electrolyte; fused silica capillary coated with a 60 cm layer of polymida (9,5 cm to the detector window) with 75 Um of internal diameter, operating at 25 °C; 15 kV of applied voltage, UV detection at 200 nm and anodic hydrodynamic injection for 2 seconds with a pressure of 30 mbar. The chromatographic method was optimized as the following conditions: eluent acetonitrile: water 40:60 (v / v) (pH 4,0) at flow 0,5 mL/min, UV detection at 230 nm and injection of 20 μL. The adulteration in these phytotherapic formulations occurs usually with the use of only one pharmaceutical class: a benzodiazepine, a anorexic and a antidepressant. It is not expected to find in the same sample more than one benzodiazepine. Therefore, the eletroforetic and chromatography proposed methods do not have the objective to detect all of benzodiazepines together in a same sample, but rather to promote the individual identification of all in a sample. The RP-HPLC method was validated for the determination of these benzodiazepines and applied for the determination of the adulterants in phytotherapic formulations used in the treatment of obesity, which have been commercialized as natural medicines by Brazilian pharmacies. The recovery experiments promoted recoveries values higher than 84,25 % for all the analyzed adulterants. The developed methods introduced high sensitivity, analytical precision, low cost and rapid analysis, confirming the applicability of the methods as an alternative for the control and monitoring of abuse use of these pharmaceuticals in phytotherapic formulations passible of adulteration. / A adulteração de formulações fitoterápicas tem aumentado consideravelmente nos últimos anos em alguns países, pelo fato de que ainda não há uma fiscalização eficiente estabelecida para o controle da manipulação e comercialização dos chamados medicamentos naturais . Como a possibilidade de adulteração é relativamente ampla em termos de classes de compostos, surge assim, a necessidade de métodos analíticos de boa seletividade e sensibilidade, capazes de identificar e quantificar simultaneamente mais de um fármaco na mesma formulação fitoterápica. Sabendo-se dos efeitos indesejados que esses adulterantes podem causar, além da necessidade de alertar a sociedade sobre os perigos do uso e abuso desses adulterantes nas formulações para emagrecimento, desenvolveu-se neste trabalho dois métodos de separação, para possibilitar o estudo da presença dos benzodiazepínicos alprazolam, clonazepam, clordiazepóxido, diazepam, flurazepam, lorazepam, medazepam e midazolam como possíveis adulterantes em produtos fitoterápicos: eletroforese capilar de zona (CZE) e cromatografia líquida de alta eficiência por fase reversa (RP-HPLC). Para o método eletroforético as condições otimizadas foram: eletrólito de trabalho tampão fosfato 100 mM, 15% acetonitrila (pH 2,0); capilar de sílica fundida revestido de poliimida de 60 cm de comprimento (com 9,5 cm da janela do detector) com diâmetro interno de 75 Um, operando a 25°C; voltagem aplicada de 15 kV; detecção UV em 200 nm e injeção hidrodinâmica anódica durante 2 segundos com pressão de 30 mBar. O método cromatográfico foi otimizado na seguinte condição: eluente acetonitrila:água 40:60 (v/v) (pH 4,0) em fluxo 0,5 mL/min; detecção UV em 230 nm e injeção de 20 μL. As adulterações nestas formulações fitoterápicas ocorrem, geralmente, com o uso de somente uma classe de fármacos: um benzodiazepínico, um anorexígeno e um antidepressivo. Não se espera encontrar em uma mesma amostra mais de um benzodiazepínico, portanto, os métodos eletroforéticos e cromatográficos propostos não têm como objetivo detectar todos os benzodiazepínicos juntos em uma mesma amostra e sim, promover a identificação individual de todos em uma amostra. O método de RP-HPLC foi validado para a determinação desses benzodiazepínicos e empregado na análise de formulações fitoterápicas utilizadas no tratamento da obesidade, as quais são comercializadas como medicamentos naturais por farmácias de manipulação brasileiras. Os ensaios de recuperação realizados promoveram recuperações acima de 84,25 % para todas as espécies de adulterantes analisadas. Os métodos desenvolvidos apresentaram alta sensibilidade, precisão analítica, baixo custo e análises rápidas, comprovando a aplicabilidade dos mesmos como uma alternativa para o controle e fiscalização do uso abusivo destes fármacos presentes em formulações fitoterápicas passíveis de adulteração.

Submitted by Liliane Ferreira (ljuvencia30@gmail.com) on 2018-11-27T10:54:13Z No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Tese - Thays Colletes de Carvalho - 2018.pdf: 10167238 bytes, checksum: e63cc8b9621f34c961582121789dd84c (MD5) / Approved for entry into archive by Luciana Ferreira (lucgeral@gmail.com) on 2018-11-27T11:56:05Z (GMT) No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Tese - Thays Colletes de Carvalho - 2018.pdf: 10167238 bytes, checksum: e63cc8b9621f34c961582121789dd84c (MD5) / Made available in DSpace on 2018-11-27T11:56:05Z (GMT). No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Tese - Thays Colletes de Carvalho - 2018.pdf: 10167238 bytes, checksum: e63cc8b9621f34c961582121789dd84c (MD5) Previous issue date: 2018-10-05 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES / Ionization is a crucial step in mass spectrometry (MS) and governs the versatility of this important analytical technique. Ionization is responsible for transferring atoms and molecules, in their respective ionized forms, into the high vacuum environment of mass spectrometers, where they are discriminated as a function of their m/z ratio. Among the several techniques of ionization of MS, the technique of ionization by Paper spray (PS) is one of the simplest, versatile and can be implemented easily in MS system. In this work, several PS-MS applications in the forensic area were developed, demonstrating their ability to screen new synthetic drugs as a complementary tool to the thin layer chromatography (TLC) method and as a tool to monitor Date-rape Drugs in blood. In the first application, PS-MS was shown to be an effective and rapid method for the identification of synthetic drugs lysergic acid diethylamide (LSD), 2,5-dimethoxy-4-chloroamphetamine (DOC), 2,5-dimethoxy-4-bromoamphetamine (DOB), 25C-NBOMe, 25B-NBOMe and 25I-NBOMe) in bottles, both by the isotopic profile of the substances and by the fragmentation presented in tandem mass spectrometry. In the second application, the TLC was coupled to the PS-MS in order to achieve greater reliability in the CCD results. In this way, a CCD method for the analysis of cocaine and adulterants (caffeine, benzocaine, lidocaine and phenacetin) was optimized by evaluating its sensitivity and selectivity. In order to improve the Detection and Quantification Limits for cocaine and adulterants, the spots were analyzed by PS-MS, obtaining improvements in the. Finally, in order to solve the low PS-MS selectivity, a new substrate was developed, especially when the analytical target is in complex mixtures, such as blood. It is a membrane coated with a molecularly printed polymer (MIP) with dual function: simultaneous extraction and ionization of targets in the same device. The developed membrane was applied in the determination of benzodiazepines in blood samples from alleged date rape- drugs victims. Blood is a complex sample containing several compounds that can suppress the analyte signal. With this modification, any suppression is avoided, obtaining excellent results, both qualitative and quantitative. In conclusion, PS-MS is a fast and low-cost technique that can replace or complement conventional analyzes in a laboratory of expertise, increasing the productivity of Brazilian justice. / A ionização é uma etapa crucial em espectrometria de massas (MS) e rege a versatilidade desta importante técnica analítica. A ionização é a responsável por transferir átomos e moléculas, em suas respectivas formas ionizadas, para o ambiente de alto vácuo dos espectrômetros de massas, onde são discriminados em função de sua razão massa sobre carga (m/z). Dentre as diversas técnicas de ionização de MS, a técnica de ionização por Paper spray (PS) é uma das mais simples, versátil e pode ser implementada facilmente em sistema de MS. Nesse trabalho diversas aplicações do PS-MS na área forense foram desenvolvidas, demonstrando sua capacidade para screening de novas drogas sintéticas, como ferramenta complementar ao método de cromatografia de camada delgada (TLC) e como ferramenta para monitorar “boa noite cinderela” em sangue. Na primeira aplicação, o PS-MS mostrou ser um método eficaz e rápido para identificação de drogas sintéticas dietilamida do ácido lisérgico (LSD), 2,5-dimetoxi-4-cloroanfetamina (DOC), 2,5-dimetoxi-4- bromoanfetamina (DOB), 25C-NBOMe, 25B- NBOMe e 25I-NBOMe) em selos, tanto pelo perfil isotópico das substâncias, quanto pela fragmentação apresentada na espectrometria de massas tandem. Já na segunda aplicação, acoplou-se TLC ao PS-MS visando alcançar maior confiabilidade nos resultados de TLC. Desta maneira, otimizou-se um método de TLC para análise de cocaína e adulterantes (cafeína, benzocaína, lidocaína e fenacetina) avaliando sua sensibilidade e seletividade. Com intuito de melhorar os Limites de Detecção e Quantificação para a cocaína e adulterantes, os spots foram analisados por PS-MS, obtendo melhorias nos resultados. Por fim, com o intuito de resolver a baixa seletividade do PS-MS, um novo substrato foi desenvolvido, principalmente quando o alvo analítico está em misturas complexas, como sangue. Trata-se de uma membrana recoberta com um polímero molecularmente impresso (MIP) com dupla função: extração e ionização simultânea de alvos em um mesmo dispositivo. A membrana desenvolvida foi aplicada na determinação de benzodiazepínicos em amostras de sangue de supostas vítimas de benzodiazepínicos. O sangue é uma amostra complexa que contém vários compostos que podem suprimir o sinal do analito. Com essa modificação qualquer supressão é evitada, conseguindo-se ótimos resultados, tanto qualitativos quanto quantitativos. Sendo assim, o PS-MS é uma técnica rápida e de baixo custo, que pode substituir ou complementar as análises convencionais em um laboratório de perícia, aumentando a produtividade da justiça brasileira.

O avanço econômico, científico e tecnológico, vem levando a um aumento da expectativa de vida e consequente envelhecimento da população. Assim, o idoso requer atenção especial pela maior incidência de doenças crônicas e degenerativas e pelo aumento concomitante no uso de fármacos, podendo ocasionar complicações pela sua maior vulnerabilidade à eventos adversos (EAs), uso inapropriado e abusivo, exposição à interações medicamentosas sérias, e casos de iatrogenias. Acrescenta-se o fato particular de um aumento abusivo no uso de benzodiazepínicos (BDZs). O objetivo deste trabalho foi rever e sintetizar as evidências geradas por ensaios clínicos controlados e randomizados sobre a incidência de EAs relacionados ao uso de BDZs em idosos com ansiedade ou insônia em comparação àqueles que, sob as mesmas condições clínicas, não o utilizaram. Desenvolveu-se a recuperação de artigos em cinco bases de dados eletrônicas na área da saúde (PubMed, SCOPUS, Web of Science, Cochrane Central, e LILACS), para posterior análise combinada (metanálise) dos resultados evidenciados. / The economic, scientific and technological progresses have provided an increase in life expectancy and the consequent process of aging. Thus, the elderly requires special attention due to the higher incidence of chronic and degenerative diseases and the higher concomitant increase in the drugs use that may cause complications by increasing ulnerability for adverse events (AEs); nappropriate and abusive use; exposition to serious drug interactions, and iatrogenic cases. Add to these the particular abusive increase in benzodiazepine (BDZ) use. The objective of this study was to review and synthesize the evidence generated by randomized controlled trials on the incidence of AEs related to therapy with BDZs in elderly with anxiety or insomnia compared to those under the same clinical conditions, not medicated. The articles were recovered in five healthcare electronic databases (PubMed, SCOPUS, Web of Science, Cochrane Central, and LILACS), for subsequent combined analysis (meta-analysis) of the results.

These British Association for Psychopharmacology guidelines cover the range and aims of treatment for anxiety disorders. They are based explicitly on the available evidence and are presented as recommendations to aid clinical decision making in primary and secondary medical care. They may also serve as a source of information for patients and their carers. The recommendations are presented together with a more detailed review of the available evidence. A consensus meeting involving experts in anxiety disorders reviewed the main subject areas and considered the strength of evidence and its clinical implications. The guidelines were constructed after extensive feedback from participants and interested parties. The strength of supporting evidence for recommendations was rated. The guidelines cover the diagnosis of anxiety disorders and key steps in clinical management, including acute treatment, relapse prevention and approaches for patients who do not respond to first-line treatments.

These British Association for Psychopharmacology guidelines cover the range and aims of treatment for anxiety disorders. They are based explicitly on the available evidence and are presented as recommendations to aid clinical decision making in primary and secondary medical care. They may also serve as a source of information for patients and their carers. The recommendations are presented together with a more detailed review of the available evidence. A consensus meeting involving experts in anxiety disorders reviewed the main subject areas and considered the strength of evidence and its clinical implications. The guidelines were constructed after extensive feedback from participants and interested parties. The strength of supporting evidence for recommendations was rated. The guidelines cover the diagnosis of anxiety disorders and key steps in clinical management, including acute treatment, relapse prevention and approaches for patients who do not respond to first-line treatments.

Modulation of the endocannabinoid system (ECS) is of great interest for its therapeutic relevance in several pathophysiological processes. The CB2 subtype is largely localized to immune effectors, including microglia within the central nervous system, where it promotes anti-inflammation. Recently, a rational drug design toward precise modulation of the CB2 active site revealed the novelty of Pyrrolo[2,1-c][1,4]benzodiazepines tricyclic chemotype with a high conformational similarity in comparison to the existing leads. These compounds are structurally unique, confirming their chemotype novelty. In our continuing search for new chemotypes as selective CB2 regulatory molecules, following SAR approaches, a total of 17 selected (S,E)-11-[2-(arylmethylene)hydrazono]-PBD analogs were synthesized and tested for their ability to bind to the CB1 and CB2 receptor orthosteric sites. A competitive [H]CP-55,940 binding screen revealed five compounds that exhibited >60% displacement at 10 μM concentration. Further concentration-response analysis revealed two compounds, and , as potent and selective CB2 ligands with sub-micromolar activities ( = 146 nM and 137 nM, respectively). In order to support the potential efficacy and safety of the analogs, the oral and intravenous pharmacokinetic properties of compound were sought. Compound was orally bioavailable, reaching maximum brain concentrations of 602 ± 162 ng/g (p.o.) with an elimination half-life of 22.9 ± 3.73 h. Whether administered via the oral or intravenous route, the elimination half-lives ranged between 9.3 and 16.7 h in the liver and kidneys. These compounds represent novel chemotypes, which can be further optimized for improved affinity and selectivity toward the CB2 receptor.

This revision of the 2005 British Association for Psychopharmacology guidelines for the evidence-based pharmacological treatment of anxiety disorders provides an update on key steps in diagnosis and clinical management, including recognition, acute treatment, longer-term treatment, combination treatment, and further approaches for patients who have not responded to first-line interventions. A consensus meeting involving international experts in anxiety disorders reviewed the main subject areas and considered the strength of supporting evidence and its clinical implications. The guidelines are based on available evidence, were constructed after extensive feedback from participants, and are presented as recommendations to aid clinical decision-making in primary, secondary and tertiary medical care. They may also serve as a source of information for patients, their carers, and medicines management and formulary committees.

The desire to enhance and make ourselves better is not a new one and it has continued to intrigue throughout the ages. Individuals have continued to seek ways to improve and enhance their well-being for example through nutrition, physical exercise, education and so on. Crucial to this improvement of their well-being is improving their ability to remember. Hence, people interested in improving their well-being, are often interested in memory as well. The rationale being that memory is crucial to our well-being. The desire to improve one’s memory then is almost certainly as old as the desire to improve one’s well-being. Traditionally, people have used different means in an attempt to enhance their memories: for example in learning through storytelling, studying, and apprenticeship. In remembering through practices like mnemonics, repetition, singing, and drumming. In retaining, storing and consolidating memories through nutrition and stimulants like coffee to help keep awake; and by external aids like notepads and computers. In forgetting through rituals and rites. Recent scientific advances in biotechnology, nanotechnology, molecular biology, neuroscience, and information technologies, present a wide variety of technologies to enhance many different aspects of human functioning. Thus, some commentators have identified human enhancement as central and one of the most fascinating subject in bioethics in the last two decades. Within, this period, most of the commentators have addressed the Ethical, Social, Legal and Policy (ESLP) issues in human enhancements as a whole as opposed to specific enhancements. However, this is problematic and recently various commentators have found this to be deficient and called for a contextualized case-by-case analysis to human enhancements for example genetic enhancement, moral enhancement, and in my case memory enhancement (ME). The rationale being that the reasons for accepting/rejecting a particular enhancement vary depending on the enhancement itself. Given this enormous variation, moral and legal generalizations about all enhancement processes and technologies are unwise and they should instead be evaluated individually. Taking this as a point of departure, this research will focus specifically on making a case for ME and in doing so assessing the ESLP implications arising from ME. My analysis will draw on the already existing literature for and against enhancement, especially in part two of this thesis; but it will be novel in providing a much more in-depth analysis of ME. From this perspective, I will contribute to the ME debate through two reviews that address the question how we enhance the memory, and through four original papers discussed in part three of this thesis, where I examine and evaluate critically specific ESLP issues that arise with the use of ME. In the conclusion, I will amalgamate all my contribution to the ME debate and suggest the future direction for the ME debate.