Diclofenac-β-cyclodextrin for colonic drug targeting: in vivo performance in rats

The aim of this in vivo study was to assess the ability of the prodrug conjugate diclofenac-β-cyclodextrin to release diclofenac in the colon following oral administration, using sulfapyridine (a metabolite of sulfasalazine) as a marker of colonic absorption. Two groups of rats were used; the test rats received a suspension containing the two prodrugs, diclofenac-β-cyclodextrin and sulfasalazine, while the control rats received a suspension containing the corresponding free drugs, sodium diclofenac and sulfapyridine. The rats were fasted overnight with free access to water before and throughout the first 12 hours of the study. Blood was collected from the tail vein at pre-determined time points and the plasma analyzed for the concentrations of diclofenac and sulfapyridine. Following the oral administration of the two prodrugs, a more extended absorption profile was observed and Cmax was achieved 10 hours post-dose, in contrast to rapid absorption of the free drugs (tmax of diclofenac being 1.3 h, and that of sulfapyridine being 2.1 h) . In addition to a later tmax, conjugation of diclofenac to β-cyclodextrin also resulted in a reduced Cmax and a reduced AUC. The same tmax for diclofenac-β-cyclodextrin as for sulfasalazine confirms the colonic metabolism of diclofenac-β-cyclodextrin. This study shows the potential of this new cyclodextrin-based prodrug to target and release diclofenac specifically in the colon following oral administration

Isolated Taylor Bubbles in Co-Current with Shear Thinning CMC Solutions in Microchannels—A Numerical Study

Slug flow is a multiphase flow pattern characterized by the occurrence of long gas bubbles (Taylor bubbles) separated by liquid slugs. This multiphase flow regime is present in many and diversified natural and industrial processes, at macro and microscales, such as in eruption of volcanic magmas, oil recovery from pre-salt regions, micro heat exchangers, and small-sized refrigerating systems. Previous studies in the literature have been mostly focused on tubular gas bubbles flowing in Newtonian liquids. In this work, results from several numerical simulations of tubular gas bubbles flowing in a shear thinning liquid in microchannels are reported. To simulate the shear thinning behavior, carboxymethylcellulose (CMC) solutions with different concentrations were considered. The results are compared with data from bubbles flowing in Newtonian liquids in identical geometric and dynamic conditions. The numerical work was carried out in computational fluid dynamics (CFD) package Ansys Fluent (release 16.2.0) employing the volume of fluid (VOF) methodology to track the volume fraction of each phase and the continuum surface force (CSF) model to insert the surface tension effects. The flow patterns, the viscosity distribution in the liquid, the liquid film thickness between the bubble and the wall, and the bubbles shape are analyzed for a wide range of shear rates. In general, the flow patterns are similar to those in Newtonian liquids, but in the film, where a high viscosity region is observed, the thickness is smaller. Bubble velocities are smaller for the non-Newtonian cases.</jats:p

Recomendação de Curvas de Crescimento para Crianças Nascidas Pré-Termo

Em 2013, a Secção de Neonatologia da Sociedade Portuguesa de Pediatria, face à existência de várias curvas de avaliação de crescimento para crianças nascidas pré-termo e à falta de homogeneidade de critérios na sua escolha, nomeou um grupo de peritos que procedeu à revisão crítica das curvas disponíveis e recomenda as que considera mais adequadas para utilização na prática clínica em fases específicas da vida: ao nascimento (Fenton 2013), durante o internamento na unidade de Neonatologia (Fenton 2013 e Ehrenkranz 1999) e a longo prazo (OMS 2006). As decisões foram tomadas com base na classificação sistemática do nível de evidência e do grau de recomendação. A presente recomendação: é válida enquanto não forem publicados os resultados do estudo do consórcio multicêntrico INTERGROWTH-21st, recentemente incumbido da construção de valores de referência, mais próximos do padrão, de crianças nascidas pré-termo; tem o propósito de auxiliar os clínicos na decisão clínica, mas não ser o único instrumento de avaliação do crescimento das crianças nascidas pré-termo; pode não proporcionar elementos suficientes para orientação do crescimento de todas estas crianças

Comparing the cost-effectiveness of two screening strategies for latent tuberculosis infection in Portugal

Introduction and objectives: Screening for latent tuberculosis infection (LTBI) in close contacts of infectious TB cases might include Tuberculin Skin Test (TST) and Interferon-Gamma Release Assays (IGRA), in combination or as single-tests. In Portugal, the screening strategy changed from TST followed by IGRA to IGRA-only testing in 2016. Our objective was to compare the cost-effectiveness of two-step TST/IGRA with the current IGRA-only screening strategy in immunocompetent individuals exposed to individuals with respiratory TB. Materials and methods: We reviewed clinical records of individuals exposed to infectious TB cases diagnosed in 2015 and 2016, in two TB outpatient centers in the district of Porto. We estimated medical, non-medical and indirect costs for each screening strategy, taking into account costs of tests and health care personnel, travel distance from place of residence to screening site and employment status. We calculated the incremental cost-effectiveness ratio (ICER) as the cost difference between the two screening strategies with the difference number of LTBI diagnosis as a measure of cost-effectiveness, assuming that treating LTBI is a cost-effective intervention. We also calculated adjusted odds-ratios to test the association between diagnosis of LTBI and screening strategy and estimated the total cost for averting a potential TB case. Results: We compared 499 contacts TST/IGRA screened with 547 IGRA-only. IGRA-only strategy yielded a higher screening effectiveness for diagnosing latent tuberculosis infection (aOR 2.12, 95%CI: 1.53 - 2.94). ICER was €106 per LTBI diagnosis, representing increased effectiveness with a slightly increased cost of IGRA-only screening strategy. Conclusions: Our data suggests that in Portugal LTBI screening with IGRA-only is more cost-effective than the two-step TST/IGRA testing strategy, preventing a higher number of cases of TB cases

The Portuguese Severe Asthma Registry: Development, Features, and Data Sharing Policies

The Portuguese Severe Asthma Registry (Registo de Asma Grave Portugal, RAG) was developed by an open collaborative network of asthma specialists. RAG collects data from adults and pediatric severe asthma patients that despite treatment optimization and adequate management of comorbidities require step 4/5 treatment according to GINA recommendations. In this paper, we describe the development and implementation of RAG, its features, and data sharing policies. The contents and structure of RAG were defined in a multistep consensus process. A pilot version was pretested and iteratively improved. The selection of data elements for RAG considered other severe asthma registries, aiming at characterizing the patient's clinical status whilst avoiding overloading the standard workflow of the clinical appointment. Features of RAG include automatic assessment of eligibility, easy data input, and exportable data in natural language that can be pasted directly in patients' electronic health record and security features to enable data sharing (among researchers and with other international databases) without compromising patients' confidentiality. RAG is a national web-based disease registry of severe asthma patients, available at asmagrave.pt. It allows prospective clinical data collection, promotes standardized care and collaborative clinical research, and may contribute to inform evidence-based healthcare policies for severe asthma.info:eu-repo/semantics/publishedVersio

Deletion of BmoR affects the expression of genes related to thiol/disulfide balance in Bacteroides fragilis

Bacteroides fragilis, an opportunistic pathogen and commensal bacterium in the gut, is one the most aerotolerant species among strict anaerobes. However, the mechanisms that control gene regulation in response to oxidative stress are not completely understood. In this study, we show that the MarR type regulator, BmoR, regulates the expression of genes involved in the homeostasis of intracellular redox state. Transcriptome analysis showed that absence of BmoR leads to altered expression in total of 167 genes. Sixteen of these genes had a 2-fold or greater change in their expression. Most of these genes are related to LPS biosynthesis and carbohydrates metabolism, but there was a signifcant increase in the expression of genes related to the redox balance inside the cell. A pyridine nucleotide-disulfde oxidoreductase located directly upstream of bmoR was shown to be repressed by direct binding of BmoR to the promoter region. The expression of two other genes, coding for a thiosulphate:quinoneoxidoreductase and a thioredoxin, are indirectly afected by bmoR mutation during oxygen exposure. Phenotypic assays showed that BmoR is important to maintain the thiol/disulfde balance in the cell, confrming its relevance to B. fragilis response to oxidative stress

DNA methylation-based profiling of bone and soft tissue tumours: a validation study of the 'DKFZ Sarcoma Classifier'

Diagnosing bone and soft tissue neoplasms remains challenging because of the large number of subtypes, many of which lack diagnostic biomarkers. DNA methylation profiles have proven to be a reliable basis for the classification of brain tumours and, following this success, a DNA methylation-based sarcoma classification tool from the Deutsches Krebsforschungszentrum (DKFZ) in Heidelberg has been developed. In this study, we assessed the performance of their classifier on DNA methylation profiles of an independent data set of 986 bone and soft tissue tumours and controls. We found that the 'DKFZ Sarcoma Classifier' was able to produce a diagnostic prediction for 55% of the 986 samples, with 83% of these predictions concordant with the histological diagnosis. On limiting the validation to the 820 cases with histological diagnoses for which the DKFZ Classifier was trained, 61% of cases received a prediction, and the histological diagnosis was concordant with the predicted methylation class in 88% of these cases, findings comparable to those reported in the DKFZ Classifier paper. The classifier performed best when diagnosing mesenchymal chondrosarcomas (CHSs, 88% sensitivity), chordomas (85% sensitivity), and fibrous dysplasia (83% sensitivity). Amongst the subtypes least often classified correctly were clear cell CHSs (14% sensitivity), malignant peripheral nerve sheath tumours (27% sensitivity), and pleomorphic liposarcomas (29% sensitivity). The classifier predictions resulted in revision of the histological diagnosis in six of our cases. We observed that, although a higher tumour purity resulted in a greater likelihood of a prediction being made, it did not correlate with classifier accuracy. Our results show that the DKFZ Classifier represents a powerful research tool for exploring the pathogenesis of sarcoma; with refinement, it has the potential to be a valuable diagnostic tool