Formação em práticas integrativas e complementares em saúde: desafios para as universidades públicas / Professional education in complementary and alternative medicine: challenges for the public universities / Formación en medicina complementaria y alternativa: desafíos para las universidades públicas

Resumo Legitimadas pela Organização Mundial da Saúde, as Práticas Integrativas e Complementares apresentam demanda crescente e têm a formação profissional como um dos maiores desafios para o seu avanço no Sistema Único de Saúde. O estudo quantitativo descrito apresenta a oferta de disciplinas e cursos em Práticas Integrativas e Complementares em seis instituições de ensino superior públicas no Estado do Rio de Janeiro, em 2014, identificada em seus respectivos sites e secretarias segundo as variáveis: instituições de ensino superior, subárea de saúde, nível do ensino (graduação e pós-graduação), subtemas das Práticas Integrativas e Complementares (Homeopatia, Acupuntura, Meditação etc.), formato (obrigatório, eletivo ou optativo) e conteúdo (informativo ou formativo). Os resultados mostram uma oferta de 56 unidades de ensino, distribuída em quase todas as subáreas de saúde, com maior concentração em cursos de Medicina, Farmácia e Enfermagem. De perfil predominantemente opcional e informativo, apresenta a Homeopatia, Meditação e Práticas Corporais como temas mais frequentes. A análise desta oferta, apoiada na perspectiva do cuidado integral e referenciada em literatura nacional e internacional, aponta desafios para a ampliação e qualificação do ensino de Práticas Integrativas e Complementares, dentre eles a inserção integrada em cursos de saúde visando a interação e complementaridade entre saberes distintos.

Abstract Legitimated by the World Health Organization, Complementary and Alternative Medicine have shown an increasing demand in the Western world. Professional training is considered one of it's biggest challenges to its advance in the Brazilian National Health System. The descriptive quantitative study presents the availability of modules of Complementary and Alternative Medicine in six public institutions of higher education at the state of Rio de Janeiro, 2014, identified on these respective websites and secretariat, and classified according to the variables: institutions of higher education, health subarea, level of education (undergraduate and graduate), subtopics of Complementary and Alternative Medicine (Homeopathy, Acupuncture, Meditation etc.); Format (mandatory, elective or optional) and content (informative or formative). The results shows an offer of 56 modules distributed in almost all sub-areas of health care, mainly in Medicine, Pharmacy and Nursing, with a predominantly optional and informative approach. The main themes are Homeopathy, Meditation and Body Practices. The analysis of this offer, based on the perspective of integral care and referenced in national and international literature, points out challenges for the expansion and qualification of the teaching of Integrative and Complementary Practices, among them the integrated insertion in health courses aiming at the interaction and complementarity between knowledge.

Resumen Recomendada por la Organización Mundial de la Salud, la Medicina Complementaria y Alternativa tiene creciente demanda, siendo la formación profesional un gran reto para su avance en el sistema de salud brasileño. El estudio cuantitativo descriptivo presenta la oferta de enseñanza de medicinas complementares identificada en los sitios y secretarías de seis instituciones de educación superior públicas en el Estado del Río de Janeiro, Brasil, 2014, de acuerdo con las variables: subárea de salud, nivel de la enseñanza (graduación y posgrado), subtemas de las medicinas complementares, formato (obligatorio, electivo o optativo) y contenido (informativo o formativo). Los resultados muestram 56 módulos en medicina complementaria y alternativa, repartidos en casi todas saboreas de salud, concentrados en cursos de Medicina, Farmacia y Enfermería, principalmente a través de materias opcionales, con el perfil informativo. Los temas principales son Homeopatía, Meditación y Prácticas Corporales. La análisis, desde el punto de vista de la atención integral y con referencia a la literatura nacional e internacional, señala retos para su expansión y calificación: ampliar la oferta, con un enfoque transversal y integrado a lo largo de los cursos, enfatizando las posibilidades de interacción y complementariedad entre diferentes conocimientos y prácticas de salud.

Physicochemical and in vitro biological evaluations of furazolidone-based ß-cyclodextrin complexes in Leishmania amazonensis.

Recently, there have been numerous cases of leishmaniasis reported in different Brazilian states. The use of furazolidone (FZD) to treat leishmaniasis has been previously described; however, the drug is associated with adverse effects such as anorexia, weight loss, incoordination, and fatigue in dogs. Thus, in the present study, we prepared and evaluated inclusion complexes between FZD and ß-cyclodextrin (ß-CD) to guarantee increased drug solubility and reduce the toxicity associated with high doses. The FZD:ß-CD complexes were prepared by two different techniques (kneading and lyophilization) prior to incorporation in an oral pharmaceutical dosage form. Formation of the complexes was confirmed using appropriate physicochemical methods. Antileishmanial activity against L. amazonensis was tested in vitro via a microplate assay using resazurin dye and cytotoxicity was determined using the fibroblast L929 lineage. Solubility studies showed the formation of complexes with complexation efficiencies lower than 100%. Physicochemical analysis revealed that FZD was inserted into the ß-CD cavity after complexation by both methods. Biological in vitro evaluations demonstrated that free FZD and the FZD:ß-CD complexes presented significant leishmanicidal activity against L. amazonensis with IC50 values of 6.16 µg/mL and 1.83 µg/mL for the complexes prepared by kneading and lyophilization, respectively. The data showed that these complexes reduced the survival of promastigotes and presented no toxicity for tested cells. Our results indicate that the new compounds could be a cost-effective alternative for use in the pharmacotherapy of leishmaniasis in dogs infected with L. amazonensis.

Mutagenic and genotoxic potential of direct electric current in Escherichia coli and Salmonella thyphimurium strains.

Direct electric current has several therapeutic uses such as antibacterial and antiprotozoal action, tissues scarring and regeneration, as well as tumor treatment. This method has shown promising results in vivo and in vitro, with significant efficacy and almost no side effects. Considering lack of studies regarding direct electric current mutagenic and/or genotoxic effects, the present work evaluated both aspects by using five different bacterial experimental assays: survival of repair-deficient mutants, Salmonella-histidine reversion mutagenesis (Ames test), forward mutations to rifampicin resistance, phage reactivation, and lysogenic induction. In these experimental conditions, cells were submitted to an approach that allows evaluation of anodic, cathodic, and electro-ionic effects generated by 2 mA of direct electric current, with doses ranging from 0.36 to 3.60 Coulombs. Our results showed these doses did not induce mutagenic or genotoxic effects.

Homeopathic medicines for prevention of influenza and acute respiratory tract infections in children: blind, randomized, placebo-controlled clinical trial.

BACKGROUND: Influenza and its complications are common at all ages, especially in children. Vaccines and anti-influenza drugs aim to prevent it. Preventative approaches with favorable risk profiles should be considered for flu, particularly since the evidence of the efficacy of anti-viral drugs is debated. METHODS: This pragmatic clinical trial was conducted in the Brazilian Public Health System in Petrópolis (BPHSP) with children aged from 1 to 5 years old. The medications used were mainly selected based on in vitro experiments (InfluBio), and in successful qualitative clinical experiences (Homeopathic Complex). Following informed parental consent, subjects were randomly distributed, in a blind manner, to three experimental groups: Homeopathic Complex, Placebo, and InfluBio. BPHSP health agents collected flu and acute respiratory infection symptomatic episodes monthly following the established protocol. The number of these episodes was registered in one year (2009-2010). RESULTS: Out of the 600 children recruited, 445 (74.17%) completed the study (149: Homeopathic complex; 151: Placebo; 145: InfluBio). The number of flu and acute respiratory infection symptomatic episodes detected in this clinical trial was low; however, it was different between homeopathic groups and placebo (p < 0.001). In the first year post-intervention, 46/151 (30.5%) of children in the placebo group developed 3 or more flu and acute respiratory infection episodes, while there was no episode in the group of 149 children who used Homeopathic Complex, and only 1 episode in the group of 145 (1%) children who received InfluBio. CONCLUSION: These results suggested that the use of homeopathic medicines minimized the number of flu and acute respiratory infection symptomatic episodes in children, signalizing that the homeopathic prophylactic potential should be investigated in further studies.

Validation of impregnation process for homeopathic globules by spectrophotometric-UV method

We compared the impregnation techniques for globules according to the Manual of Technical Norms for Homeopathic Pharmacies (MNTFH) of the Association of Homeopathic Pharmacists (ABFH), Brazilian Homeopathic Pharmacopoeia (FHB) and variations of these techniques. The variables were evaluated in this procedure, three different sizes of globules (N o . 3, 5 and 7), the hydroalcoholic solution of 70% (v/v) Minoxidil 2% (w/v) was used to impregnate the globules in concentrations of 2, 3, 4, 5% (v/w) and the impregnation at 10 %(v/w) was used hydroalcoholic solutions at 70, 80 and 90% (v/v), and four impregnation techniques various ( A -glass, B -paper, C -cup and D -FHB). As the results of content uniformity did not demonstrate a normal distribution, the one way ANOVA and a nonparametric statistical model were used for evaluation. Considering the average, the standard deviation (SD), the individual variance of each group and the principal components analysis graphs (PCA), it was observed that the “A” impregnation of globules technique, with 5% (v/w) of the impregnation concentrations and the No.5 globule presented the best uniformity of dose. As to the drying, there was a need to use a heat source.

Compararam-se as técnicas de impregnação para glóbulos segundo o Manual de Normas Técnicas para Farmácias Homeopáticas (MNTFH) da Associação Brasileira de Farmacêuticos Homeopatas (ABFH), Farmacopeia Homeopática Brasileira (FHB) e variações destas técnicas. As variáveis avaliadas neste processo foram: três tamanhos diferentes de glóbulos (n.º 3, 5 e 7); a solução hidroalcóolica a 70% (v/v) de minoxidil a 2% (p/v) foi utilizada para impregnar os glóbulos nas concentrações de 2, 3, 4, 5% (v/p) e na impregnação a 10% (v/p) utilizaram-se as soluções hidroalcóolicas a 70, 80 e 90% (v/v); e quatro técnicas de impregnação diferentes ( A -vidro, B -papel, C -copo e D -FHB). A impregnação foi validada através da uniformidade de dose por conteúdo, sendo o minoxidil a substância quantificada. Como os resultados da uniformidade de dose por conteúdo não demonstraram distribuição normal, utilizaram-se o One way ANOVA e um modelo estatístico não paramétrico para sua avaliação. Considerando-se a média, o desvio padrão (DP), a variância individual de cada grupo e os gráficos de análise de componentes principais (ACP), observou-se que a impregnação que utilizou o glóbulo nº5, a concentração para impregnação de 5% (v/p), graduação alcoólica de 70% (v/v) e técnica “A” apresentou a melhor uniformidade de dose. Quanto à secagem, verificou-se a necessidade do uso de uma fonte de calor.

Nanostructured delivery system for zinc phthalocyanine: preparation, characterization, and phototoxicity study against human lung adenocarcinoma A549 cells.

In this study, zinc phthalocyanine (ZnPc) was loaded onto poly-ɛ-caprolactone (PCL) nanoparticles (NPs) using a solvent emulsification-evaporation method. The process yield and encapsulation efficiency were 74.2% ± 1.2% and 67.1% ± 0.9%, respectively. The NPs had a mean diameter of 187.4 ± 2.1 nm, narrow distribution size with a polydispersity index of 0.096 ± 0.004, zeta potential of -4.85 ± 0.21 mV, and spherical shape. ZnPc has sustained release, following Higuchi's kinetics. The photobiological activity of the ZnPc-loaded NPs was evaluated on human lung adenocarcinoma A549 cells. Cells were incubated with free ZnPc or ZnPc-loaded NPs for 4 h and then washed with phosphate-buffered saline. Culture medium was added to the wells containing the cells. Finally, the cells were exposed to red light (660 nm) with a light dose of 100 J/cm(2). The cellular viability was determined after 24 h of incubation. ZnPc-loaded NPs and free photosensitizer eliminated about 95.9% ± 1.8% and 28.7% ± 2.2% of A549 cells, respectively. The phototoxicity was time dependent up to 4 h and concentration dependent at 0-5 µg ZnPc. The cells viability decreased with the increase of the light dose in the range of 10-100 J/cm(2). Intense lysis was observed in the cells incubated with the ZnPcloaded NPs and irradiated with red light. ZnPc-loaded PCL NPs are the release systems that promise photodynamic therapy use.