Effectiveness and safety of home-based versus centre-based exercise programmes for pulmonary hypertension: a systematic review with meta-analysis.

Introduction Pulmonary hypertension is a pathophysiological disorder with poor prognosis. Exercise intolerance and lower physical activity levels are common features of pulmonary hypertension and affect patients' quality of life. Exercise training effectively improves clinical outcomes in this population, but access to rehabilitation centres is often limited. A home-based exercise training component could be an accessible and cost-effective alternative, but the efficacy and safety of this approach in pulmonary hypertension remain unclear. Methods We conducted a systematic review and meta-analysis of studies retrieved from six international databases. The studies evaluated home-based exercise interventions in patients with pulmonary hypertension, including both stand-alone and hybrid setups, and assessed safety, efficacy (exercise capacity, cardiorespiratory outcomes and functional class) and adherence. Results We included 19 studies. Compared with inactive controls, home-based exercise training improved the 6-min walk distance (mean difference (MD) 54.85 m, p<0.01), peak oxygen uptake (standardised MD 0.83 mL·kg−1·min−1, p<0.01), ventilatory efficiency (MD −3.93, p<0.01) and quality of life scores. Improvements in clinical outcomes were comparable between home-based and centre-based interventions. No clinical worsening or exercise training-related severe adverse events were reported; however, most studies did not report health-related self-monitoring strategies at home. The level of adherence was generally high, and the drop-out rates were comparable between home-based and centre-based interventions. Conclusion Home-based exercise interventions appear to be viable alternatives to centre-based programmes for patients with pulmonary hypertension, showing comparable improvements in clinical outcomes. However, limited reporting on self-monitoring may affect the overall safety assessment. Further research is needed to determine the optimal implementation of these interventions

Assessment of stability of a spray dried extract from the medicinal plant Bidens pilosa L.

AbstractSpray drying has been successfully employed for the encapsulation of herbal bioactive compounds resulting in stable phytopharmaceutical preparations. Bidens pilosa L. is a South American medicinal plant with proved antimalaric, hepatoprotector and antioxidant activities, generally linked to their secondary metabolites, flavonoids and polyacetylenes. In this work the physicochemical stability of an optimized spray dried composition from a B. pilosa extract was evaluated at three different stress storage conditions in open containers and in sealed sachets. High performance liquid chromatography was employed to monitor the concentration of three marker compounds over 12months. Color variation of the stored samples was evaluated by using a color spectrophotometer. It was observed that the concentration of the monitored compounds of the plant decreases more drastically in samples stored in open containers. The two flavonoids monitored, rutin and hyperoside, showed lower degradation than the polyacetylene. The concentration of the markers did not change significantly at the lowest temperature. With regard to color, darker hues were observed at higher temperatures and storage times. This study showed that the storage conditions cause significant impact on stability of standardized spray dried B. pilosa extract

Influência do processo de secagem e condição de armazenamento de extratos secos de Bauhinia forficata e Passiflora alata sobre seu perfil de dissolução

No Brasil, os produtos fitoter&#225;picos s&#227;o considerados medicamentos, sendo necess&#225;rio o estabelecimento de estudos que assegurem a manuten&#231;&#227;o dos requisitos de qualidade durante o processamento e o armazenamento. Testes de dissolu&#231;&#227;o podem ser empregados para se estimar a biodisponibilidade de um f&#225;rmaco, sendo uma an&#225;lise rotineira no desenvolvimento e controle de qualidade de medicamentos alop&#225;ticos. A determina&#231;&#227;o do perfil de dissolu&#231;&#227;o de fitoter&#225;picos tamb&#233;m pode ser um importante crit&#233;rio para avalia&#231;&#227;o da sua qualidade lote-a-lote, bem como para os estudos de desenvolvimento e de estabilidade. O objetivo deste trabalho foi investigar a influ&#234;ncia dos m&#233;todos de secagem e da condi&#231;&#227;o de armazenagem sobre os perfis de dissolu&#231;&#227;o dos flavonoides totais de extratos secos de duas plantas medicinais bastante difundidas no Brasil, a Bauhinia forficata e a Passiflora alata. Os extratos secos foram produzidos pelo processo de secagem em leito de jorro e em spray drying, sendo submetidos a condi&#231;&#245;es de armazenagem aceleradas (temperatura de 40 &#177; 2&#186;C e umidade relativa de 75 &#177; 5%, por um per&#237;odo de 90 dias). Os perfis de dissolu&#231;&#227;o foram obtidos para amostras de extratos secos antes e ap&#243;s o per&#237;odo de armazenamento. O teor de flavonoides totais foi quantificado por espectrofotometria. Os extratos secos de B. forficata e P. alata apresentaram adequada libera&#231;&#227;o de flavonoides nos ensaios de dissolu&#231;&#227;o. Os extratos secos de Passiflora alata apresentaram completa dissolu&#231;&#227;o dos flavonoides, 92% e 98% dos teores originais ap&#243;s 60 minutos de ensaio, respectivamente para o extrato seco em leito de jorro e em spray drying