Plantas medicinales en farmacia comunitaria: de la validación farmacológica al DNA-Barcoding

A lo largo de los años, numerosos hechos han puesto en manifiesto el papel esencial de las plantas medicinales para la salud humana como fuente molecular con potencial terapéutico y base para la obtención de nuevos medicamentos. La Organización Mundial de la Salud (OMS) establece que la terapéutica basada en plantas medicinales es una parte importante y con frecuencia subestimada de la atención al paciente. Las plantas medicinales fueron declaradas como “fuente inagotable de nuevos fármacos” en el año 1978 por la OMS. En la actualidad, millones de personas en el mundo consumen plantas medicinales con fines terapéuticos; debido a ello, la OMS ha diseñado la denominada Estrategia 2014/2023 cuyo fin es reforzar el papel dela medicina tradicional, resaltando la importancia de promover e incluir el uso de plantas medicinales en los sistemas de salud de los países miembros..

EVALUACIÓN DE LA EFICACIA DE LA ATENCIÓN FARMACÉUTICA EN PACIENTES CON DERMATITIS ATÓPICA

RESUMEN Introducción: La dermatitis atópica es una enfermedad inflamatoria y crónica de la piel que afecta en gran medida a la calidad de vida de los pacientes de la padecen. Objetivo: Evaluar la eficacia de la atención farmacéutica en pacientes con dermatitis atópica diagnosticada, valorando su impacto sobre la sintomatología y la adherencia al tratamiento. Métodos: Se realizó un estudio experimental longitudinal prospectivo en 50 pacientes con dermatitis atópica no controlada, llevando a cabo una actuación farmacéutica individualizada basada en tres estrategias: educación sanitaria, seguimiento farmacoterapéutico, e intervención sobre el cuidado dermocosmético. Se evaluó la sintomatología y la adherencia al tratamiento farmacológico de cada paciente, y su evolución tras la intervención. Resultados: Los datos obtenidos se analizaron mediante el test estadístico de McNemar, confirmando que el 79,17% de los pacientes graves y el 92,30% de los casos moderados mejoraron significativamente tras la intervención. El valor obtenido del estadístico (Z=3,49) indicó que las variables intervención farmacéutica y mejora del paciente no eran independientes, siendo la primera la causa de la segunda. Al inicio del estudio, el 42% de los pacientes eran incumplidores, mientras que al final del mismo sólo el 23,81% lo eran. Conclusión: Este estudio demuestra que la atención farmacéutica, y más concretamente el seguimiento farmacoterapéutico, son herramientas útiles y necesarias para reducir la sintomatología y mejorar la calidad de vida de los pacientes con dermatitis atópica. PALABRAS CLAVE: dermatitis atópica; atención farmacéutica; intervención farmacéutica; eficacia.   ABSTRACT Introduction: Atopic dermatitis is an inflammatory and chronic skin disease that greatly affects the quality of life of patients suffering from it. Objective: To evaluate the efficacy of pharmaceutical care in patients with diagnosed atopic dermatitis, assessing its impact on symptomatology and adherence to treatment. Methods: A prospective longitudinal experimental study was conducted in 50 patients with uncontrolled atopic dermatitis, and an individualized pharmaceutical action was carried out based on three strategies: health education, pharmacotherapeutic follow-up, and intervention on the dermocosmetic routine. The symptomatology and adherence to the pharmacological treatment of each patient, and their evolution after the intervention were evaluated. Results: The data obtained were analyzed by means of the McNemar statistical test, confirming that 79.17% of the serious patients and 92.30% of the moderate cases improved significantly after the intervention. The value obtained from the statistic (Z = 3.49) indicated that the variables pharmaceutical intervention and patient improvement were not independent, the former being the cause of the latter. At the beginning of the study, 42% of the patients were noncompliant, while at the end of the study only 23.81% were noncompliant. Conclusion: This study demonstrates that pharmaceutical care, and more specifically pharmacotherapy follow-up, are useful and necessary tools to reduce symptomatology and improve the quality of life of patients with atopic dermatitis. KEY WORDS: atopic dermatitis; pharmaceutical care; pharmaceutical intervention; effectiveness

EVALUACIÓN DE LA EFICACIA DE LA ATENCIÓN FARMACÉUTICA EN PACIENTES CON DERMATITIS ATÓPICA

RESUMEN Introducción: La dermatitis atópica es una enfermedad inflamatoria y crónica de la piel que afecta en gran medida a la calidad de vida de los pacientes de la padecen. Objetivo: Evaluar la eficacia de la atención farmacéutica en pacientes con dermatitis atópica diagnosticada, valorando su impacto sobre la sintomatología y la adherencia al tratamiento. Métodos: Se realizó un estudio experimental longitudinal prospectivo en 50 pacientes con dermatitis atópica no controlada, llevando a cabo una actuación farmacéutica individualizada basada en tres estrategias: educación sanitaria, seguimiento farmacoterapéutico, e intervención sobre el cuidado dermocosmético. Se evaluó la sintomatología y la adherencia al tratamiento farmacológico de cada paciente, y su evolución tras la intervención. Resultados: Los datos obtenidos se analizaron mediante el test estadístico de McNemar, confirmando que el 79,17% de los pacientes graves y el 92,30% de los casos moderados mejoraron significativamente tras la intervención. El valor obtenido del estadístico (Z=3,49) indicó que las variables intervención farmacéutica y mejora del paciente no eran independientes, siendo la primera la causa de la segunda. Al inicio del estudio, el 42% de los pacientes eran incumplidores, mientras que al final del mismo sólo el 23,81% lo eran. Conclusión: Este estudio demuestra que la atención farmacéutica, y más concretamente el seguimiento farmacoterapéutico, son herramientas útiles y necesarias para reducir la sintomatología y mejorar la calidad de vida de los pacientes con dermatitis atópica. PALABRAS CLAVE: dermatitis atópica; atención farmacéutica; intervención farmacéutica; eficacia.   ABSTRACT Introduction: Atopic dermatitis is an inflammatory and chronic skin disease that greatly affects the quality of life of patients suffering from it. Objective: To evaluate the efficacy of pharmaceutical care in patients with diagnosed atopic dermatitis, assessing its impact on symptomatology and adherence to treatment. Methods: A prospective longitudinal experimental study was conducted in 50 patients with uncontrolled atopic dermatitis, and an individualized pharmaceutical action was carried out based on three strategies: health education, pharmacotherapeutic follow-up, and intervention on the dermocosmetic routine. The symptomatology and adherence to the pharmacological treatment of each patient, and their evolution after the intervention were evaluated. Results: The data obtained were analyzed by means of the McNemar statistical test, confirming that 79.17% of the serious patients and 92.30% of the moderate cases improved significantly after the intervention. The value obtained from the statistic (Z = 3.49) indicated that the variables pharmaceutical intervention and patient improvement were not independent, the former being the cause of the latter. At the beginning of the study, 42% of the patients were noncompliant, while at the end of the study only 23.81% were noncompliant. Conclusion: This study demonstrates that pharmaceutical care, and more specifically pharmacotherapy follow-up, are useful and necessary tools to reduce symptomatology and improve the quality of life of patients with atopic dermatitis. KEY WORDS: atopic dermatitis; pharmaceutical care; pharmaceutical intervention; effectiveness

Nutritional Value of Moringa oleifera Lam. Leaf Powder Extracts and Their Neuroprotective Effects via Antioxidative and Mitochondrial Regulation

Age-related neurodegenerative disorders are an increasing public health problem. Oxidative stress is one of the major causes. Medicinal plant-based functional foods can be effective for these diseases. The aim of this work is to investigate the neuroprotective role of methanol extracts of Moringa oleifera leaf powder on antioxidant/oxidant imbalance and mitochondrial regulation in a H2O2-induced oxidative stress model in human neuroblastoma cells. On nutritional analysis, results showed that moringa contained 28.50% carbohydrates, 25.02% proteins, 10.42% fat, 11.83% dietary fiber, 1.108 mg β-carotene, 326.4 µg/100 g vitamin B1 and 15.2 mg/100 g vitamin C. In-vitro assays revealed that moringa methanol extracts had more phenolic content and higher antioxidant activity than acetone extracts. Moreover, pretreatments with methanol extracts showed a protective effect against H2O2-induced oxidative damage through increasing cell viability and reducing free radicals. Furthermore, the extract decreased lipid peroxidation and enhanced glutathione levels and antioxidant enzyme activity. Finally, moringa also prevented mitochondrial dysfunction by regulating calcium levels and increasing mitochondrial membrane potential. The most active concentration was 25 µg/mL. In summary, the nutritional and functional properties of Moringa oleifera as a neuroprotective agent could be beneficial to protect against oxidative stress and provide necessary nutrients for a healthy diet

Reacciones adversas a medicamentos. Tipos y sistema de notificación.

La seguridad de los medicamentos es una parte esencial de la seguridad de los pacientes. Teniendo en cuenta que la terapia con medicamentos es uno de los servicios sanitarios más utilizados, en necesario prestar una especial atención a la seguridad en el uso de los mismos. En este trabajo se ha realizado una revisión bibliográfica sobre los distintos tipos de reacciones adversas a medicamentos y su mecanismo de notificación al sistema, para el cual se utilizaron diferentes fuentes de información. Se analiza, además, el Programa de Notificación Espontánea: método de farmacovigilancia basado en la comunicación, recogida y evaluación de notificaciones de sospechas de reacciones adversas a medicamentos. La notificación de las RAM ha de hacerse por todo aquel profesional sanitario ante la sospecha de asociación entre reacción adversa y medicamento utilizado hay que notificarlo a las autoridades competentes. En algunos países también pueden llevar a cabo la notificación los propios ciudadanos. En España la notificación de las RAM a través de la oficina de farmacia se lleva a cabo mediante el sistema de la tarjeta Amarilla

Pharmacological Update Properties of Aloe Vera and its Major Active Constituents

Aloe vera has been traditionally used to treat skin injuries (burns, cuts, insect bites, and eczemas) and digestive problems because its anti-inflammatory, antimicrobial, and wound healing properties. Research on this medicinal plant has been aimed at validating traditional uses and deepening the mechanism of action, identifying the compounds responsible for these activities. The most investigated active compounds are aloe-emodin, aloin, aloesin, emodin, and acemannan. Likewise, new actions have been investigated for Aloe vera and its active compounds. This review provides an overview of current pharmacological studies (in vitro, in vivo, and clinical trials), written in English during the last six years (2014–2019). In particular, new pharmacological data research has shown that most studies refer to anti-cancer action, skin and digestive protective activity, and antimicrobial properties. Most recent works are in vitro and in vivo. Clinical trials have been conducted just with Aloe vera, but not with isolated compounds; therefore, it would be interesting to study the clinical effect of relevant metabolites in different human conditions and pathologies. The promising results of these studies in basic research encourage a greater number of clinical trials to test the clinical application of Aloe vera and its main compounds, particularly on bone protection, cancer, and diabetes

DNA-Based Authentication and Metabolomics Analysis of Medicinal Plants Samples by DNA Barcoding and Ultra-High-Performance Liquid Chromatography/Triple Quadrupole Mass Spectrometry (UHPLC-MS)

There is growing interest for medicinal plants in the world drug market. Particularly, Matricaria recutita L., Valeriana officinalis L., Tilia spp., and Camellia sinensis (L.) Kuntze are some of the most consumed medicinal plants for treatment of minor health problems. Medicinal plants are seen as natural and safe; however, they can cause interactions and produce adverse reactions. Moreover, there is lack of consensus in medicinal plants regulation worldwide. DNA barcoding and UHPLC-MS technique are increasingly used to correctly identify medicinal plants and guarantee their quality and therapeutic safety. We analyzed 33 samples of valerian, linden, tea, and chamomile acquired in pharmacies, supermarkets, and herbal shops by DNA barcoding and UHPLC-MS. DNA barcoding, using matk as a barcode marker, revealed that CH1 sold as Camellia sinensis was Blepharocalyx tweediei, and sample TS2 sold as linden belong to Malvales. On the other hand, UHPLC-MS analysis revealed the presence of bioactive compounds (apigenin-7-glucoside, acetoxy valerenic acid, valerenic acid, epigallocatechin, and tiliroside). However, none of samples met minimum content of these active principles (except for valerenic acid in VF3) according to the European Medicines Agency (EMA) and Real Spanish Pharmacopeia. In conclusion, this study revealed the need to incorporate DNA barcoding and HPLC-MS techniques in quality controls of medicinal plants.Depto. de Farmacología, Farmacognosia y BotánicaFac. de FarmaciaTRUEpu

Pharmacological Update Properties of Aloe Vera and its Major Active Constituents

Aloe vera has been traditionally used to treat skin injuries (burns, cuts, insect bites, and eczemas) and digestive problems because its anti-inflammatory, antimicrobial, and wound healing properties. Research on this medicinal plant has been aimed at validating traditional uses and deepening the mechanism of action, identifying the compounds responsible for these activities. The most investigated active compounds are aloe-emodin, aloin, aloesin, emodin, and acemannan. Likewise, new actions have been investigated for Aloe vera and its active compounds. This review provides an overview of current pharmacological studies (in vitro, in vivo, and clinical trials), written in English during the last six years (2014–2019). In particular, new pharmacological data research has shown that most studies refer to anti-cancer action, skin and digestive protective activity, and antimicrobial properties. Most recent works are in vitro and in vivo. Clinical trials have been conducted just with Aloe vera, but not with isolated compounds; therefore, it would be interesting to study the clinical effect of relevant metabolites in different human conditions and pathologies. The promising results of these studies in basic research encourage a greater number of clinical trials to test the clinical application of Aloe vera and its main compounds, particularly on bone protection, cancer, and diabetes