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Diss. (sammanfattning) Stockholm : Karolinska institutet, 2010. / Härtill 4 uppsatser.

Percutaneous delivery of drugs promises many advantages over oral or intravenous administration, such as a better control of blood levels, a reduced incidence of systemic toxicity, an absence of hepatic first-pass metabolism, better patient compliance, etc. However, the dermal drug transport is limited by the unsuitable physicochemical properties of most drugs and the efficient barrier function of the skin. Thus, numerous attempts have been reported to improve topical absorption of drugs, concentrating mainly on the barrier function of the stratum corneum by use of penetration enhancers and/or skin warming. An alternative and interesting possibility for improved dermal permeability is the synthesis of derivatives or analogues with the aim of changing the physicochemical properties in favour of skin permeation, efficacy and therapeutic value. Cyclizine (I) is an anti-emetic drug primarily indicated for the prophylaxis and treatment of nausea and vomiting associated with motion sickness, post operation and Meniere's disease. It acts both on the emetic trigger zone and by damping the labyrinthine sensitivity. Pharmacologically it has anti-histaminic, antiserotonergic, local anaesthetic and vagolytic actions. It is widely used and also suitable for children from six year of age. Percutaneous absorption of (I) can, among others, avoid the "first-pass" effect and the discomfort of injection. The main objective of this study was to explore the feasibility of percutaneous absorption of (I) and its alkyl analogues via physicochemical characterization and assessment of their permeation parameters. The intent was also to establish a correlation between the physicochemical properties of these compounds and their percutaneous rate of absorption. To achieve these objectives, the study was undertaken by synthesizing the alkyl analogues and determining the physicochemical parameters relevant to skin transport. Identification and level of purity for the prepared analogues were confirmed by mass spectrometry (MS), nuclear magnetic resonance (NMR) spectrometry and infrared (IR) spectrometry. Experimental aqueous solubility (25 °c & 32 °C) and partition coefficient for each compound were determined. In vitro permeation studies were performed at pH 7.4, using Franz diffusion cells with human epidermal membranes. Diffusion experiments were conducted over a period of 24 hours maintaining a constant temperature (37 DC) by means of water bath. All samples were analysed by high pressure liquid chromatography (HPLC). Cyclizine (I) has a methyl group at N-4. Increasing the alkyl chain length on N-4 of the piperazine ring resulted' in compounds with lower melting points and higher water solubility than (I). (II) exhibited 3-fold increase in water solubility, followed by (IV) with about 2.5 fold increase. The water solubility of (III) was almost the same as that of (I). Log partition coefficients increased linearly with increasing alkyl chain length. The analogues therefore, possessed more favourable physicochemical properties to be delivered percutaneously. Indeed, the in vitro skin permeation data proved that these analogues could be delivered more easily than (I) itself. The flux of (I) was 0.132 ug/cm2/h in a saturated aqueous solution. Compound (II) resulted in a 53-fold (6.952 ug/cm2/h) increase in permeation compared to (I). (III) and (IV) resulted in a 2- and 5fold enhancement of permeation respectively. Based on the results of the study, it seems that increased aqueous solubility and low level of crystallinity play a vital role in optimizing percutaneous absorption of (I) and its alkyl analogues. But the importance of the effect of increased lipophilicity cannot be ignored. The low percutaneous• absorption of (I) might be attributed to its low aqueous solubility and increased crystallinity, as is evident from the higher melting point than the analogues. From all the permeability data using aqueous solutions, it is clear that compound (II) is the best permeant of this series and in addition it is known that this compound antagonizes the effects of histamine. / Thesis (M.Sc. (Pharm.))--North-West University, Potchefstroom Campus, 2004.

Percutaneous delivery of drugs promises many advantages over oral or intravenous administration, such as a better control of blood levels, a reduced incidence of systemic toxicity, an absence of hepatic first-pass metabolism, better patient compliance, etc. However, the dermal drug transport is limited by the unsuitable physicochemical properties of most drugs and the efficient barrier function of the skin. Thus, numerous attempts have been reported to improve topical absorption of drugs, concentrating mainly on the barrier function of the stratum corneum by use of penetration enhancers and/or skin warming. An alternative and interesting possibility for improved dermal permeability is the synthesis of derivatives or analogues with the aim of changing the physicochemical properties in favour of skin permeation, efficacy and therapeutic value. Cyclizine (I) is an anti-emetic drug primarily indicated for the prophylaxis and treatment of nausea and vomiting associated with motion sickness, post operation and Meniere's disease. It acts both on the emetic trigger zone and by damping the labyrinthine sensitivity. Pharmacologically it has anti-histaminic, antiserotonergic, local anaesthetic and vagolytic actions. It is widely used and also suitable for children from six year of age. Percutaneous absorption of (I) can, among others, avoid the "first-pass" effect and the discomfort of injection. The main objective of this study was to explore the feasibility of percutaneous absorption of (I) and its alkyl analogues via physicochemical characterization and assessment of their permeation parameters. The intent was also to establish a correlation between the physicochemical properties of these compounds and their percutaneous rate of absorption. To achieve these objectives, the study was undertaken by synthesizing the alkyl analogues and determining the physicochemical parameters relevant to skin transport. Identification and level of purity for the prepared analogues were confirmed by mass spectrometry (MS), nuclear magnetic resonance (NMR) spectrometry and infrared (IR) spectrometry. Experimental aqueous solubility (25 °c & 32 °C) and partition coefficient for each compound were determined. In vitro permeation studies were performed at pH 7.4, using Franz diffusion cells with human epidermal membranes. Diffusion experiments were conducted over a period of 24 hours maintaining a constant temperature (37 DC) by means of water bath. All samples were analysed by high pressure liquid chromatography (HPLC). Cyclizine (I) has a methyl group at N-4. Increasing the alkyl chain length on N-4 of the piperazine ring resulted' in compounds with lower melting points and higher water solubility than (I). (II) exhibited 3-fold increase in water solubility, followed by (IV) with about 2.5 fold increase. The water solubility of (III) was almost the same as that of (I). Log partition coefficients increased linearly with increasing alkyl chain length. The analogues therefore, possessed more favourable physicochemical properties to be delivered percutaneously. Indeed, the in vitro skin permeation data proved that these analogues could be delivered more easily than (I) itself. The flux of (I) was 0.132 ug/cm2/h in a saturated aqueous solution. Compound (II) resulted in a 53-fold (6.952 ug/cm2/h) increase in permeation compared to (I). (III) and (IV) resulted in a 2- and 5fold enhancement of permeation respectively. Based on the results of the study, it seems that increased aqueous solubility and low level of crystallinity play a vital role in optimizing percutaneous absorption of (I) and its alkyl analogues. But the importance of the effect of increased lipophilicity cannot be ignored. The low percutaneous• absorption of (I) might be attributed to its low aqueous solubility and increased crystallinity, as is evident from the higher melting point than the analogues. From all the permeability data using aqueous solutions, it is clear that compound (II) is the best permeant of this series and in addition it is known that this compound antagonizes the effects of histamine. / Thesis (M.Sc. (Pharm.))--North-West University, Potchefstroom Campus, 2004.

Coronary artery disease (CAD) is the leading cause of death worldwide. Treatment with coronary interventions, long-term treatment and life style changes can reduce symptoms and improve prognosis. The aim of this thesis was to investigate aspects of invasive treatment for multivessel coronary artery disease, and to investigate adherence to prevention guidelines one year after myocardial infarction.  We used the national quality registry SWEDEHEART to collect data on long term treatment one year after myocardial infarction for 51 620 patients < 75 years of age. For 17 236 of the patients, we collected LDL-cholesterol measurements from SWEDEHEART and defined use of lipid lowering drugs from the Prescribed Drug Register. We developed a questionnaire for post-PCI-patients to investigate patients’ understanding of cause and treatment of coronary artery disease. For 23 342 PCI-patients with multivessel coronary artery disease, SWEDEHEART-data was linked to Swedish health data registries to determine one year outcome for patients undergoing incomplete vs. complete revascularization.   Lipid control (LDL-cholesterol < 1.8 mmol/L) was attained by one in four patients one year after myocardial infarction, whereas blood pressure control (< 140 mmHg) was attained by two thirds of patients. Lipid and blood pressure control was lower for women but there was no gender difference in smoking cessation rate: 56 %. Over 90 % of patients were treated with a statin after myocardial infarction but treatment was intensified for only one in five patients with LDL-cholesterol above target. The questionnaire study revealed that non-modifiable factors such as age and heredity were more often seen as cause of coronary artery disease than modifiable life style factors. Only one in five patients perceived CAD as a chronic illness, requiring life style changes. Two thirds of PCI-patients with multivessel disease underwent incomplete revascularisation, and this was associated with a twofold risk for the combination of death, myocardial infarction and repeat revascularization up to one year, compared to patients who underwent complete revascularization. We conclude that  long term treatment after myocardial infarction is suboptimal in relation to guideline recommendations. Assessment of patients’ views on CAD and better health education post PCI may facilitate life style changes. Further studies need to investigate whether complete revascularization will improve outcome for PCI-patients with multivessel disease.

Coronary artery disease is a leading cause of morbidity and mortality in developed countries. Percutaneous transluminal coronary angioplasty (PTCA) is an important treatment option when intervention is required; namely for patients with relatively severe occlusions. However, adverse events including recurrence of angina pectoris and restenosis of the treated artery limit patient prognosis, with subsequent re-vascularisation often necessary. Platelet activation accompanies PTCA, with platelet adhesion and aggregation involved in thrombus formation during restenosis. During platelet activation, highly coagulant platelet-derived microparticles (PMPs) are formed, and it is likely that these PMPs will also be produced during PTCA. While platelet aggregation inhibitors used during PTCA limit platelet aggregation and decrease the incidence of restenosis, they do not prevent PMPs being formed. PMPs are capable of adhesion and aggregation, and adhere to PTCA treated arteries in an animal model. Therefore, in order to understand the phenomenon of restenosis and its improved limitation, it is necessary to investigate PMP formation during PTCA. The field of PMP study is in its infancy, with conflicting results from the substantial inequities in methods of PMP measurement, which may be exacerbated by PMP heterogeneity. The current literature on this topic is reviewed in Chapter 2, where the PMP surface and possible functions are considered, and the PMP size and morphology examined. To conclude, the relationship between PMPs and PTCA is explored, with a focus on the potential role of PMPs in restenosis. The knowledge deficiencies in this field are highlighted at the conclusion of this chapter. Very little is known regarding the production of PMPs with PTCA. The level of PMPs during PTCA was monitored in paired arterial blood samples obtained from seventy-five patients undergoing the procedure (Chapter 3). A significant increase in PMPs from baseline to completion of PTCA was clearly demonstrated for the first time. This indicated that procoagulant PMPs are produced during PTCA and may contribute to subsequent restenosis. Furthermore, administration of the platelet aggregation inhibitor abciximab to a group of thirty-eight high risk patients limited PMP formation; given that abciximab patients required more rigorous PTCA, the protective benefit of this medication for PMP production is underlined. Although few patients in this study experienced restenosis, it is interesting to note that of those treated with abciximab, all patients suffering subsequent restenosis were revascularised using PTCA. This demonstrates that their occlusions were comparatively mild as the need for coronary artery bypass grafting was avoided, and suggests that minimisation of PMP levels may assist in limiting the progression of severe restenosis. The increased peripheral level of PMPs predicated investigation of the coronary circulation to determine local events. Although the level of PMPs increased significantly within the coronary arteries of PTCA patients, there was no corresponding increase in the coronary sinus (Chapter 4). This important finding indicated that significant levels of PMPs remained within the coronary circulation, where their ability to adhere, aggregate and accelerate haemostasis may allow them to contribute directly to restenosis. During the time when increased levels of PMPs were being formed, there was no evidence of platelet lysis, which refuted the hypothesis that PMPs are merely membrane fragments of lysed platelets. A wide variation in reported PMP sizes has contributed to the hypothesis that PMPs are heterogeneous. As morphological information can assist in understanding physiology, the final study was designed to investigate platelet morphology from PTCA patients (Chapter 5). Most platelets were activated prior to and following PTCA, with a slight decrease in body size occurring due to PTCA, presumably due to loss of cytoplasm in PMPs being shed as reported in the previous chapter. Importantly, platelet distal pseudopod buds were observed, and these did not alter significantly with PTCA. These buds were probably unformed PMPs, although the exact mechanism of PMP formation remains undetermined. The platelet pseudopods were longer and significantly thinner distally with PTCA, which may be due to movement of cytoplasm into these terminal swellings. In addition, buds or swellings directly on the platelet body were smaller following PTCA, and it is likely these may also be PMPs prior to detachment from the parent platelet. This work has contributed substantially to knowledge of PMPs produced during PTCA. The level of PMPs increased significantly in peripheral arterial samples, with the platelet aggregation inhibitor abciximab preventing this occurrence. This may indicate that functional aggregation receptors are an essential requirement for PMP formation under these conditions. However, it is possible for PMPs to be formed when aggregation is inhibited, and therefore the molecular mechanisms of PMP formation remain unconfirmed. The examination of PMPs from the coronary circulation provided valuable data indicating that PMPs are produced during PTCA but remain within the coronary circulation. As PMPs are capable of adhesion and aggregation, this strongly suggests that PMPs within the coronary circulation would contribute directly to pathogenesis of restenosis, although further investigation on PMPs with PTCA is necessary to confirm this association. The examination of platelet morphology during PTCA indicated that platelets possessed terminal pseudopod swellings, and cell surface swellings. Importantly, the terminal swellings, which are likely to be unformed PMPs, were observed for the first time during PTCA.

Diss. (sammanfattning) Stockholm : Karol. inst., 2004. / Härtill 4 uppsatser.

A reposição estrogênica na pós-menopausa revela-se através de benefícios na melhora da qualidade de vida, prevenção e cura da osteoporose, bem como na diminuição da incidência de doenças cardiovasculares. A via percutânea apresenta grande interesse devido a fatores como, manutenção de níveis plasmáticos e eliminação da primeira passagem hepática, responsável pelo surgimento de efeitos colaterais adversos, aliados a relativa simplicidade de desenvolvimento e produção, facilidade na aplicação e versatilidade. Neste trabalho foram viabilizadas formulações de géis hidroalcoólicos contendo estradiol com diferentes bases, adaptando e desenvolvendo metodologias para determinação de características físicas, químicas e tecnológicas, como espalhabilidade, consistência, liodisponibilidade, teor da substância ativa e conservantes, bem como ensaios preliminares de penetração na pele, e em membranas artificiais e de estabilidade física e química de estradiol e dos conservantes. Verificou-se que dois dos gíss desenvolvidos, com bases de carbômero (Carbopol 940®) e hidroxietilcelulose (Cellosize QP 100®), apresentaram características apropriadas no que diz respeito a consistência, espalhabilidade e promoção da penetração de estradiol através da pele. Esta foi avaliada através do desenvolvimento ponderal uterino de ratas castradas e determinação dos níveis séricos de estradiol por fluorimunoensaio, não havendo diferença significativa entre os produtos neste ensaio. Ambas as formulações mostraram-se estáveis fisicamente, porém, o produto desenvolvido com base de hidroxietilcelulose apresentou degradação significativa de estradiol. Os ensaios de absorção de estradiol em membranas artificiais não diferenciou significativamente as formulações quanto ao tipo de base e tempo de exposição, observou-se entretanto, que existe uma relação entre a quantidade aplicada de gel e de estradiol absorvido. / The hormonal replacement therapy for menopausal symptoms intents the healing and prevention of osteoporosis, the decrease of the incidence of cardiovascular diseases as well the improvement of life quality, affording relief from any of a long list of subjective complaints. The election of a transdermal estradiol formulation is due to its abilities to bypass the liver resulting adequate hormonal plasmatic levels. In addition, it is considerably simple to manufacture and to adapt to individual dosages. This research aims the formulation of estradiol as an hydroalcoholic gel using different gelformers. The development and adaptation of methodologies to perform the physical, chemical and biological characterization of the formulated products were also realized. Two of the formulated gels showed appropriate characteristics of consistence, spreading and skin permeation. They were prepared with carbomer (Carbopol 940) and hydroxiethylcellulose (Cellosize QP 100). Biological evaluation was performed by the essay of the uterusweight of castrated rats and by immunofluorescence assay. The statistical analysis showed no differences between the methods and gels. The stability test for the two formulations yielded good physical stability results but the hydroxyethylcellulose gel showed significant estradiol degradation. Although the gels artificial membrane absorptions didn't differ when submeted to difference contact times, it was detected a kind of relationship between the applied gel amount and the absorbed estradiol.

A reposição estrogênica na pós-menopausa revela-se através de benefícios na melhora da qualidade de vida, prevenção e cura da osteoporose, bem como na diminuição da incidência de doenças cardiovasculares. A via percutânea apresenta grande interesse devido a fatores como, manutenção de níveis plasmáticos e eliminação da primeira passagem hepática, responsável pelo surgimento de efeitos colaterais adversos, aliados a relativa simplicidade de desenvolvimento e produção, facilidade na aplicação e versatilidade. Neste trabalho foram viabilizadas formulações de géis hidroalcoólicos contendo estradiol com diferentes bases, adaptando e desenvolvendo metodologias para determinação de características físicas, químicas e tecnológicas, como espalhabilidade, consistência, liodisponibilidade, teor da substância ativa e conservantes, bem como ensaios preliminares de penetração na pele, e em membranas artificiais e de estabilidade física e química de estradiol e dos conservantes. Verificou-se que dois dos gíss desenvolvidos, com bases de carbômero (Carbopol 940®) e hidroxietilcelulose (Cellosize QP 100®), apresentaram características apropriadas no que diz respeito a consistência, espalhabilidade e promoção da penetração de estradiol através da pele. Esta foi avaliada através do desenvolvimento ponderal uterino de ratas castradas e determinação dos níveis séricos de estradiol por fluorimunoensaio, não havendo diferença significativa entre os produtos neste ensaio. Ambas as formulações mostraram-se estáveis fisicamente, porém, o produto desenvolvido com base de hidroxietilcelulose apresentou degradação significativa de estradiol. Os ensaios de absorção de estradiol em membranas artificiais não diferenciou significativamente as formulações quanto ao tipo de base e tempo de exposição, observou-se entretanto, que existe uma relação entre a quantidade aplicada de gel e de estradiol absorvido. / The hormonal replacement therapy for menopausal symptoms intents the healing and prevention of osteoporosis, the decrease of the incidence of cardiovascular diseases as well the improvement of life quality, affording relief from any of a long list of subjective complaints. The election of a transdermal estradiol formulation is due to its abilities to bypass the liver resulting adequate hormonal plasmatic levels. In addition, it is considerably simple to manufacture and to adapt to individual dosages. This research aims the formulation of estradiol as an hydroalcoholic gel using different gelformers. The development and adaptation of methodologies to perform the physical, chemical and biological characterization of the formulated products were also realized. Two of the formulated gels showed appropriate characteristics of consistence, spreading and skin permeation. They were prepared with carbomer (Carbopol 940) and hydroxiethylcellulose (Cellosize QP 100). Biological evaluation was performed by the essay of the uterusweight of castrated rats and by immunofluorescence assay. The statistical analysis showed no differences between the methods and gels. The stability test for the two formulations yielded good physical stability results but the hydroxyethylcellulose gel showed significant estradiol degradation. Although the gels artificial membrane absorptions didn't differ when submeted to difference contact times, it was detected a kind of relationship between the applied gel amount and the absorbed estradiol.

Submitted by FERNANDA CRISTINA BASQUES null (ferbasques@fmb.unesp.br) on 2017-01-07T20:11:54Z No. of bitstreams: 1 MestradoFerBasques.pdf: 2100437 bytes, checksum: ea4eef96d0c26544ece6a714e13edb07 (MD5) / Approved for entry into archive by Juliano Benedito Ferreira (julianoferreira@reitoria.unesp.br) on 2017-01-11T13:22:30Z (GMT) No. of bitstreams: 1 basques_fc_me_bot.pdf: 2100437 bytes, checksum: ea4eef96d0c26544ece6a714e13edb07 (MD5) / Made available in DSpace on 2017-01-11T13:22:30Z (GMT). No. of bitstreams: 1 basques_fc_me_bot.pdf: 2100437 bytes, checksum: ea4eef96d0c26544ece6a714e13edb07 (MD5) Previous issue date: 2016-12-07 / Introdução. O cateterismo cardíaco é um teste diagnóstico invasivo utilizado para detecção de alterações cardíacas dos pacientes com queixas cardiovasculares como anginas e infartos previamente detectados. Este ocorre por meio de um cateter arterial percutâneo, podendo ser escolhida a via radial ou femoral. Objetivo Obter por meio da revisão integrativa e validação de conteúdo, os principais cuidados para a retirada do introdutor arterial pelo enfermeiro com segurança. Metodologia. Estudo de abordagem quantitativa realizado em duas etapas: primeiro a realização de uma revisão integrativa para elaboração de dois Procedimentos Operacionais Padrão (POP’s) preliminar, utilizando as Bases de Dados BVS (Biblioteca Virtual da Saúde-BVS), Scopus, Embase, Web of Science e Pubmed e numa segunda etapa a submissão para apreciação de 8 peritos para obter um parecer sobre o conteúdo apresentado, utilizando a Técnica Delphi. E a partir destes, em posse das observações feitas pelos peritos, obter os POP’s definitivos. Resultados e Discussão. Estudos mostram que o enfermeiro tem papel fundamental na equipe multidisciplinar, garantindo a segurança na técnica de retirada do introdutor arterial com segurança garantida ao paciente. Importante, porém, protocolizar e dispor a informação para a equipe de enfermagem contribuindo para autonomia do enfermeiro e segurança do paciente. Produtos elaborados. Procedimento Operacional Padrão (POP) sobre a Retirada de Introdutor Arterial mecanicamente e manualmente pelo enfermeiro e um Ebook que ficará disponível na Biblioteca Virtual do Hospital das Clinicas de Botucatu. Conclusão. Cabe ao enfermeiro à prevenção de complicações vasculares como hematomas e sangramentos locais na retirada de introdutor arterial em via femoral, mecanicamente ou manualmente. O protocolo é um recurso técnico para o enfermeiro desenvolver sua prática com maior qualidade e segurança ao paciente. / Introduction. The cardiac catheterization is an invasive diagnostic test used for the detection of changes of cardiac patients with cardiovascular complaints as angina and heart attacks previously detected. This occurs through a percutaneous arterial catheter, can be chosen via the femoral or radial. Objective. Obtain through integrative review and validation of content, the main introducer removal care nurse blood safely. Methodology. Quantitative approach study carried out in two steps: first the realization of a integrative review for development of two standard operating procedures (POP's), using the VHL (Virtual Health Library-BVS), Scopus, Embase, Web of Science and Pubmed and in a second step the submission for consideration of 8 experts for an opinion on the content presented, using the Delphi Technique. And from these, in possession of the observations made by the experts, get the POP's definitive. Results and Discussion. Studies show that the nurse has a fundamental role in the multidisciplinary team, ensuring the technical security of withdrawal of arterial introducer with guaranteed safety to the patient. Importantly, however, Docketing and disposal information for nursing staff contributing to autonomy of nurse and patient safety. Products produced. Standard operating procedure (POP) on withdrawal of Arterial Introducer mechanically and manually by the nurse and an Ebook that will be available in the Virtual Library of the Hospital das Clinicas of Botucatu. Conclusion. It is the responsibility of the nurse to prevent vascular complications such as hematoma and bleeding sites in withdrawal of blood via femoral introducer, mechanically or manually. The Protocol is a technical resource for the nurse to develop their practice with higher quality and patient safety.