3D printing of medicines: current challenges

Trabalho Final de Mestrado Integrado, Ciências Farmacêuticas, 2021, Universidade de Lisboa, Faculdade de Farmácia.A impressão tridimensional tem vindo a ganhar relevância no desenvolvimento científico e, inevitavelmente, na área farmacêutica. Esta tecnologia permite o desenvolvimento de formulações individualizadas, ajustadas às necessidades do doente e, por isso, pode vir a tornar-se uma ajuda valiosa na área dos medicamentos órfãos. Para além disto, também permite o desenvolvimento de formas farmacêuticas com várias substâncias ativas e/ou diferentes perfis de libertação de fármaco, que poderá vir a permitir um aumento da adesão à terapêutica por parte dos doentes polimedicados. Apesar de atualmente já haver um fármaco impresso aprovado pela FDA desde 2015, o Spritam®, ainda há várias limitações associadas a esta tecnologia, nomeadamente a regulamentação, matérias-primas, controlo do processo e validação do mesmo, controlo de qualidade, estabilidade e a localização na cadeia de fabrico. Quanto à regulamentação, não havendo diretivas regulamentares específicas para esta tecnologia na área farmacêutica, acaba por se adaptar a regulamentação existente. A escolha das matérias-primas é limitada pela capacidade de impressão e a estabilidade físico-química, reduzindo a panóplia de materiais adequados para esta técnica. Para o controlo do processo seria benéfico adaptar um controlo em tempo real optando, preferencialmente, por métodos não destrutivos, pois não sendo esta tecnologia a ideal para produção em larga escala, a perda de qualquer unidade teria um peso negativo significativo no balanço geral do processo. A validação do processo deve ser elaborada de forma a garantir a qualidade, segurança e eficácia do medicamento. Para isso, é necessário validar não só o software, como todo o processo. No controlo de qualidade, mais uma vez, deve-se optar por métodos não destrutivos e selecionar, pelo menos, um para avaliar o sucesso da impressão, sendo que pode ser utilizada o Quality by Design como uma ferramenta para otimizar o processo. A estabilidade, tal como nos outros processos, também deve ser testada e a localização da impressão tridimensional no ciclo do medicamento é outra questão levantada, uma vez que tanto poderá ter um papel na farmácia hospitalar ou comunitária, como na indústria farmacêutica ou, já numa hipótese remota, na casa do doente.Three-dimensional printing is a technique that has been drawing attention recently in the scientific community and, inevitably, in the pharmaceutical field. As allows the development of personalized medicine, adapted to the patient’s needs, it can be a valuable tool for orphan drugs. On the other hand, it also allows the development of dosage forms with various active pharmaceutical ingredients and/or with different drug release profiles, which can improve patient compliance. Although there is a printed medicine approved by FDA since 2015, Spritam®, there are still a few limitations in this methodology, as regulation, raw materials, process controls and validation, quality control, stability, and even location. In terms of regulation, there are no specific regulatory guidelines regarding this technology in the pharmaceutical area, however, a 3D printed drug product should be produced following the existing guidelines that can be adapted. In terms of raw materials, the range available is limited by printability and physicochemical stability, reducing the suitable materials. For process control, it would be advantageous to adopt a real-time control and, favour non-destructive techniques, as the loss of any unit would harm the overall balance of the process. Process validation should be designed to ensure the quality, safety, and efficacy of the drug product. Taking this into account is necessary to validate the software to the process itself. In terms of quality control, should go for non-destructive methods, once again, and is going to be needed to assess the success of the print. Quality by design can be used as a tool to optimize the process. As in other methodologies, stability test must be conducted and the location of the three-dimensional impression on the drug cycle is another issue that arises, as it may play a role in the hospital or community pharmacies, as in the pharmaceutical industry or, in a more remote hypothesis, at the patient’s home

ATLANTIC BIRD TRAITS: a data set of bird morphological traits from the Atlantic forests of South America

Scientists have long been trying to understand why the Neotropical region holds the highest diversity of birds on Earth. Recently, there has been increased interest in morphological variation between and within species, and in how climate, topography, and anthropogenic pressures may explain and affect phenotypic variation. Because morphological data are not always available for many species at the local or regional scale, we are limited in our understanding of intra- and interspecies spatial morphological variation. Here, we present the ATLANTIC BIRD TRAITS, a data set that includes measurements of up to 44 morphological traits in 67,197 bird records from 2,790 populations distributed throughout the Atlantic forests of South America. This data set comprises information, compiled over two centuries (1820–2018), for 711 bird species, which represent 80% of all known bird diversity in the Atlantic Forest. Among the most commonly reported traits are sex (n = 65,717), age (n = 63,852), body mass (n = 58,768), flight molt presence (n = 44,941), molt presence (n = 44,847), body molt presence (n = 44,606), tail length (n = 43,005), reproductive stage (n = 42,588), bill length (n = 37,409), body length (n = 28,394), right wing length (n = 21,950), tarsus length (n = 20,342), and wing length (n = 18,071). The most frequently recorded species are Chiroxiphia caudata (n = 1,837), Turdus albicollis (n = 1,658), Trichothraupis melanops (n = 1,468), Turdus leucomelas (n = 1,436), and Basileuterus culicivorus (n = 1,384). The species recorded in the greatest number of sampling localities are Basileuterus culicivorus (n = 243), Trichothraupis melanops (n = 242), Chiroxiphia caudata (n = 210), Platyrinchus mystaceus (n = 208), and Turdus rufiventris (n = 191). ATLANTIC BIRD TRAITS (ABT) is the most comprehensive data set on measurements of bird morphological traits found in a biodiversity hotspot; it provides data for basic and applied research at multiple scales, from individual to community, and from the local to the macroecological perspectives. No copyright or proprietary restrictions are associated with the use of this data set. Please cite this data paper when the data are used in publications or teaching and educational activities. © 2019 The Authors. Ecology © 2019 The Ecological Society of Americ

ATLANTIC BIRD TRAITS

Scientists have long been trying to understand why the Neotropical region holds the highest diversity of birds on Earth. Recently, there has been increased interest in morphological variation between and within species, and in how climate, topography, and anthropogenic pressures may explain and affect phenotypic variation. Because morphological data are not always available for many species at the local or regional scale, we are limited in our understanding of intra- and interspecies spatial morphological variation. Here, we present the ATLANTIC BIRD TRAITS, a data set that includes measurements of up to 44 morphological traits in 67,197 bird records from 2,790 populations distributed throughout the Atlantic forests of South America. This data set comprises information, compiled over two centuries (1820–2018), for 711 bird species, which represent 80% of all known bird diversity in the Atlantic Forest. Among the most commonly reported traits are sex (n = 65,717), age (n = 63,852), body mass (n = 58,768), flight molt presence (n = 44,941), molt presence (n = 44,847), body molt presence (n = 44,606), tail length (n = 43,005), reproductive stage (n = 42,588), bill length (n = 37,409), body length (n = 28,394), right wing length (n = 21,950), tarsus length (n = 20,342), and wing length (n = 18,071). The most frequently recorded species are Chiroxiphia caudata (n = 1,837), Turdus albicollis (n = 1,658), Trichothraupis melanops (n = 1,468), Turdus leucomelas (n = 1,436), and Basileuterus culicivorus (n = 1,384). The species recorded in the greatest number of sampling localities are Basileuterus culicivorus (n = 243), Trichothraupis melanops (n = 242), Chiroxiphia caudata (n = 210), Platyrinchus mystaceus (n = 208), and Turdus rufiventris (n = 191). ATLANTIC BIRD TRAITS (ABT) is the most comprehensive data set on measurements of bird morphological traits found in a biodiversity hotspot; it provides data for basic and applied research at multiple scales, from individual to community, and from the local to the macroecological perspectives. No copyright or proprietary restrictions are associated with the use of this data set. Please cite this data paper when the data are used in publications or teaching and educational activities. © 2019 The Authors. Ecology © 2019 The Ecological Society of Americ

NEOTROPICAL ALIEN MAMMALS: a data set of occurrence and abundance of alien mammals in the Neotropics

Biological invasion is one of the main threats to native biodiversity. For a species to become invasive, it must be voluntarily or involuntarily introduced by humans into a nonnative habitat. Mammals were among first taxa to be introduced worldwide for game, meat, and labor, yet the number of species introduced in the Neotropics remains unknown. In this data set, we make available occurrence and abundance data on mammal species that (1) transposed a geographical barrier and (2) were voluntarily or involuntarily introduced by humans into the Neotropics. Our data set is composed of 73,738 historical and current georeferenced records on alien mammal species of which around 96% correspond to occurrence data on 77 species belonging to eight orders and 26 families. Data cover 26 continental countries in the Neotropics, ranging from Mexico and its frontier regions (southern Florida and coastal-central Florida in the southeast United States) to Argentina, Paraguay, Chile, and Uruguay, and the 13 countries of Caribbean islands. Our data set also includes neotropical species (e.g., Callithrix sp., Myocastor coypus, Nasua nasua) considered alien in particular areas of Neotropics. The most numerous species in terms of records are from Bos sp. (n = 37,782), Sus scrofa (n = 6,730), and Canis familiaris (n = 10,084); 17 species were represented by only one record (e.g., Syncerus caffer, Cervus timorensis, Cervus unicolor, Canis latrans). Primates have the highest number of species in the data set (n = 20 species), partly because of uncertainties regarding taxonomic identification of the genera Callithrix, which includes the species Callithrix aurita, Callithrix flaviceps, Callithrix geoffroyi, Callithrix jacchus, Callithrix kuhlii, Callithrix penicillata, and their hybrids. This unique data set will be a valuable source of information on invasion risk assessments, biodiversity redistribution and conservation-related research. There are no copyright restrictions. Please cite this data paper when using the data in publications. We also request that researchers and teachers inform us on how they are using the data

Evaluation of a quality improvement intervention to reduce anastomotic leak following right colectomy (EAGLE): pragmatic, batched stepped-wedge, cluster-randomized trial in 64 countries

Background Anastomotic leak affects 8 per cent of patients after right colectomy with a 10-fold increased risk of postoperative death. The EAGLE study aimed to develop and test whether an international, standardized quality improvement intervention could reduce anastomotic leaks. Methods The internationally intended protocol, iteratively co-developed by a multistage Delphi process, comprised an online educational module introducing risk stratification, an intraoperative checklist, and harmonized surgical techniques. Clusters (hospital teams) were randomized to one of three arms with varied sequences of intervention/data collection by a derived stepped-wedge batch design (at least 18 hospital teams per batch). Patients were blinded to the study allocation. Low- and middle-income country enrolment was encouraged. The primary outcome (assessed by intention to treat) was anastomotic leak rate, and subgroup analyses by module completion (at least 80 per cent of surgeons, high engagement; less than 50 per cent, low engagement) were preplanned. Results A total 355 hospital teams registered, with 332 from 64 countries (39.2 per cent low and middle income) included in the final analysis. The online modules were completed by half of the surgeons (2143 of 4411). The primary analysis included 3039 of the 3268 patients recruited (206 patients had no anastomosis and 23 were lost to follow-up), with anastomotic leaks arising before and after the intervention in 10.1 and 9.6 per cent respectively (adjusted OR 0.87, 95 per cent c.i. 0.59 to 1.30; P = 0.498). The proportion of surgeons completing the educational modules was an influence: the leak rate decreased from 12.2 per cent (61 of 500) before intervention to 5.1 per cent (24 of 473) after intervention in high-engagement centres (adjusted OR 0.36, 0.20 to 0.64; P < 0.001), but this was not observed in low-engagement hospitals (8.3 per cent (59 of 714) and 13.8 per cent (61 of 443) respectively; adjusted OR 2.09, 1.31 to 3.31). Conclusion Completion of globally available digital training by engaged teams can alter anastomotic leak rates. Registration number: NCT04270721 (http://www.clinicaltrials.gov)