Factores relacionados con la no adherencia al tratamiento farmacológico en hipertensos del Policlínico XX Aniversario. Diseño de un programa educativo

Introducción: La hipertensión arterial es la enfermedad crónica más frecuente en el mundo, generalmente necesita tratamiento farmacológico y el promedio de adherencia terapéutica a largo plazo alcanza solamente el 50%.Objetivo: Evaluar los factores que influyen en la no adherencia al tratamiento farmacológico en los pacientes hipertensos del área de salud del policlínico XX Aniversario de Santa Clara, y diseñar un programa educativo sobre el tema.Método: Se realizó un estudio de corte transversal en un universo de 510 pacientes hipertensos, de los que se seleccionó una muestra aleatoria de 102 hipertensos con tratamiento farmacológico. Se efectuó una entrevista individual para evaluar la adherencia al tratamiento (test Morisky-Green-Levine) y se indagó sobre otros datos de interés. Fueron escogidos 10 médicos vinculados a la atención primaria a quienes se les aplicó un cuestionario para evaluar su conocimiento sobre la hipertensión arterial y su tratamiento.Resultados: La cifra de hipertensos sin adherencia al tratamiento farmacológico representó el 58,8%. El seguimiento incorrecto, la prescripción inadecuada y los profesionales con insuficientes conocimientos sobre hipertensión arterial y su terapéutica contribuyeron a la falta de adherencia al tratamiento hipotensor. Finalmente se diseñó un programa educativo a partir de las deficiencias encontradas, el cual quedó conformado por dos plegables y una charla educativa para los pacientes y un curso de postgrado para los médicos.Conclusiones: La no adherencia al tratamiento farmacológico se relacionó con un deficiente control de la enfermedad. El porcentaje de prescripciones inadecuadas en los pacientes incluidos en el estudio fue elevado, cuando fueron adecuadas se relacionaron con una mejor adherencia. Las necesidades de información de los médicos de la atención primaria fueron: la selección de los antihipertensivos de acuerdo con la presencia de otras enfermedades y las pautas terapéuticas.Introduction: Hypertension is the most common chronic disease in the world, it usually requires pharmacological treatment and the average long-term medication adherence reaches only 50%.Objective: To evaluate factors related with non-adherence to pharmacological treatment in hypertensive patients at the Policlínico XX Aniversario’s health area in Santa Clara, and to design an educational program on the subject.Method: A cross-sectional study was carried out in a population of 510 hypertensive patients, from which a random sample of 102 hypertensive patients with pharmacological treatment was selected. An individual interview was conducted to evaluate adherence to treatment (Morisky-Green-Levine test) and other interest data was examined. Ten primary care-related physicians were selected and given a questionnaire to evaluate their knowledge about high blood pressure and its treatment.Results: The number of hypertensive patients without adherence to pharmacological treatment represented a 58.8%. Incorrect follow-up, inadequate prescribing, and professionals with deficient knowledge about high blood pressure and its treatment contributed to lack of adherence to hypotensive treatment. Finally, a deficiency-based educational program was designed, which consisted of two foldings and educational lectures for patients, and a postgraduate course for physicians.Conclusions: Non-adherence to pharmacological treatment was associated to poor disease control. Percentage of inadequate prescriptions in the study patients was high and when adequate they were related to better adherence. Primary care physicians’ information needs were: Selection of antihypertensive drugs according to the presence of other diseases and therapeutic guidelines

PLoS ONE

Over the past decade, zebrafish (Danio rerio) have emerged as an attractive model for in vivo drug discovery. In this study, we explore the suitability of zebrafish larvae to rapidly evaluate the anti-inflammatory activity of natural products (NPs) and medicinal plants used in traditional medicine for the treatment of inflammatory disorders. First, we optimized a zebrafish assay for leukocyte migration. Inflammation was induced in four days post-fertilization (dpf) zebrafish larvae by tail transection and co-incubation with bacterial lipopolysaccharides (LPS), resulting in a robust recruitment of leukocytes to the zone of injury. Migrating zebrafish leukocytes were detected in situ by myeloperoxidase (MPO) staining, and antiinflammatory activity was semi-quantitatively scored using a standardized scale of relative leukocyte migration (RLM). Pharmacological validation of this optimized assay was performed with a panel of anti-inflammatory drugs, demonstrating a concentration-responsive inhibition of leukocyte migration for both steroidal and non-steroidal anti-inflammatory drugs (SAIDs and NSAIDs). Subsequently, we evaluated the bioactivity of structurally diverse NPs with well-documented antiinflammatory properties. Finally, we further used this zebrafish-based assay to quantify the anti-inflammatory activity in the aqueous and methanolic extracts of several medicinal plants. Our results indicate the suitability of this LPS-enhanced leukocyte migration assay in zebrafish larvae as a front-line screening platform in NP discovery, including for the bioassayguided isolation of anti-inflammatory secondary metabolites from complex NP extracts.Cuencavolumen 8; número 1

Phytochemical screening and evaluation of the central nervous system activity of the ethanolic extract of Eugenia clarensis Britton & P.Wilson

Context: Eugenia clarensis Britton & P. Wilson is an endangered plant endemic of central region of Cuba. Aims: To perform phytochemical profile of ethanolic leaf extract of E. clarensis and evaluate its central nervous system (CNS) activity. Methods: The dried powder of leaves of E. clarensis was exhaustively extracted with ethanol by maceration. This extract underwent preliminary phytochemical analysis and these results were corroborated by the thin layer chromatographic technique. CNS effects were investigated in NMRI mice at doses 200, 400 and 800 mg/kg using Irwin test, curiosity tests and traction. Results: Phytochemical screening suggested the presence of phenols, tannins, triterpenoids, sterols, flavonoids, coumarins, quinones, resins and reducing sugar. The oral administration of this extract, in Irwin test, produced slight reduction in spontaneous motor activity and muscle tone in mice at doses of 400 and 800 mg/kg, moreover, it exhibited diuretic activity. In addiction this extract at dose 800 mg/kg decreased number of times which mice introduced its head into holes in comparison with the negative control. In the traction test, the mice treated with the extract showed a non-significant failure in traction at all doses tested. Conclusions: These findings indicate that the extract in higher doses has exerts a weak sedative and non-effect about the motor coordination. The results obtained in the preliminary phytochemical testing thus suggest that the ethanolic leaf extract of E. clarensis contains some metabolites, which may be responsible of sedative action

Integration of Microfractionation, qNMR and Zebrafish Screening for the In Vivo Bioassay-Guided Isolation and Quantitative Bioactivity Analysis of Natural Products

Natural products (NPs) are an attractive source of chemical diversity for small-molecule drug discovery. Several challenges nevertheless persist with respect to NP discovery, including the time and effort required for bioassay-guided isolation of bioactive NPs, and the limited biomedical relevance to date of in vitro bioassays used in this context. With regard to bioassays, zebrafish have recently emerged as an effective model system for chemical biology, allowing in vivo high-content screens that are compatible with microgram amounts of compound. For the deconvolution of the complex extracts into their individual constituents, recent progress has been achieved on several fronts as analytical techniques now enable the rapid microfractionation of extracts, and microflow NMR methods have developed to the point of allowing the identification of microgram amounts of NPs. Here we combine advanced analytical methods with high-content screening in zebrafish to create an integrated platform for microgram-scale, in vivo NP discovery. We use this platform for the bioassay-guided fractionation of an East African medicinal plant, Rhynchosia viscosa, resulting in the identification of both known and novel isoflavone derivatives with anti-angiogenic and anti-inflammatory activity. Quantitative microflow NMR is used both to determine the structure of bioactive compounds and to quantify them for direct dose-response experiments at the microgram scale. The key advantages of this approach are (1) the microgram scale at which both biological and analytical experiments can be performed, (2) the speed and the rationality of the bioassay-guided fractionation - generic for NP extracts of diverse origin - that requires only limited sample-specific optimization and (3) the use of microflow NMR for quantification, enabling the identification and dose-response experiments with only tens of micrograms of each compound. This study demonstrates that a complete in vivo bioassay-guided fractionation can be performed with only 20 mg of NP extract within a few days.status: publishe

Anti-inflammatory activity of natural products.

a<p>Leukocyte migration is expressed as relative values (RLM).</p>***<p>p<0.001,</p>**<p>0.001*</p><p>0.01</p

Fishing Anti-Inflammatories from Known Drugs: In Silico Repurposing, Design, Synthesis and Biological Evaluation of Bisacodyl Analogues

International audienc

Inhibitory effects of some natural products in various inflammatory targets.

<p>Inhibitory effects of some natural products in various inflammatory targets.</p

Scoring of leukocyte migration in the transected tails of zebrafish larvae.

<p>All larvae (<i>nacre</i>) are four days post-fertilization (4 dpf), with anterior to the left, scale bar = 10 µm. Dark spots (marked by arrows) represent leukocytes migrating to the injured zone in the transected tails. Migrating leukocytes were counted in the region to the right of the dashed red arc. <b>A</b>, tail of an uncut larva; <b>B</b>, tail-cut with score 0; <b>C</b>, tail-cut with score 1; <b>D</b>, tail-cut with score 2; <b>E</b> tail-cut with score 3; <b>F,</b> tail-cut with score 4. <b>^a</b>Experimental values obtained for each larvae are normalized to a relative value expressed as relative leukocyte migration (RLM); +LPS: with inclusion of lipopolysaccharides. <b>^b</b>Percentage of anti-inflammatory activity is obtained as (1−RLM)x100.</p