Mapping community pharmacy services in Brazil: a scoping review

Abstract The delivery of clinical pharmacy services has been growing in Brazilian community pharmacies, and it is necessary to have a comprehensive understanding of the topic. This scoping review aimed to provide an overview of Brazilian studies about clinical pharmacy services in community pharmacies. Original research articles, with no restriction of time, study design, or patient's health condition, were included. Searches were conducted in PubMed, Scopus, Web of Science, Scielo, and Lilacs. Two reviewers conducted the screening, full-text reading, and data extraction independently. ROB and ROBINS-I were used for the assessment of quality. Charts and tables were built to summarise the data. Seventy-two articles were included. A diversity of study designs, number of participants, terms used, and outcomes was found. São Paulo and Sergipe States had the highest number of studies (n=10). Pharmacists' interventions were not fully reported in 65% of studies, and most studies presented an unclear risk of bias. Studies were very diverse, impairing the comparisons between the results and hindering their reproducibility. This review suggests using guidelines and checklists for better structuration of pharmacists' interventions as well as reporting results and measuring fidelity in future research.

Estudo da eficácia de encapsulação da Cinarizina em cubossomos não-iônicos: caracterização estrutural e citotóxica / Study of the encapsulation efficacy of Cinnarizine in non-ionic cubosomes: structural and cytotoxic characterization

Os cubossomos são partículas nanoestruturadas em forma de bicamada lipídica, bicontínuas e altamente curvadas, as quais devem ser estabilizadas por um polímero não-iônico, neste caso o Pluronic® F-127. Podem ser compostos por alguns tipos de lipídios específicos que possuem a capacidade de se auto associar em estruturas cúbicas quando estão em excesso de água, como o fitantriol (PHY) e a monoleína (GMO). Devido a sua estrutura única, cubossomos possuem um grande potencial para serem considerados como sistemas drug delivery. Os sistemas drug delivery são amplamente utilizados na pesquisa farmacêutica e em contextos clínicos para aumentar a eficácia de compostos utilizados para diagnóstico e de fármacos. No caso da cinarizina (CNZ), fármaco já aprovado para o tratamento de náuseas, vômitos e vertigens causadas pela doença de Ménière, existem inúmeros efeitos colaterais associados a sua baixa solubilidade. Desta forma, a encapsulação em cubossomos se torna uma abordagem promissora para resolver os problemas de atividade farmacológica relacionados ao fármaco. Neste trabalho, realizamos uma caracterização biofísica da interação da CNZ em cubossomos (contendo PHY ou myverol, MYV, sendo este composto por 80% de GMO). As técnicas biofísicas utilizadas foram: espalhamento de raios-X em baixos ângulos (SAXS), espalhamento dinâmico de luz (DLS), microscopia eletrônica de transmissão (TEM), crio microscopia eletrônica de transmissão (Crio-TEM), análise de rastreamento de nanopartículas (NTA) e potencial zeta. A cromatografia líquida de alta eficiência (HPLC) foi realizada para verificar a porcentagem de eficiência de encapsulação (%EE) da CNZ nos cubossomos, enquanto que a citotoxicidade foi avaliada em eritrócitos através da análise da atividade hemolítica. Inicialmente, a influência de diferentes solventes (acetona, clorofórmio, etanol e octano) nas propriedades estruturais de cubossomos de PHY foi investigada, a fim de se minimizar os efeitos do solvente utilizados para a encapsulação da CNZ. Para amostras com acetona, descobriu-se que apenas altas concentrações tiveram influência na estrutura cristalográfica das nanopartículas, sendo o resultado foi totalmente reversível após 24h. O etanol fez com que o parâmetro de rede aumentasse de 10-15%. O clorofórmio e o octano tiveram efeitos diferentes sobre cubossomos de PHY em comparação com a acetona e o etanol; ambos induziram uma transição cúbico-hexagonal-micelar. Posteriormente, constatamos que as nanopartículas de PHY e MYV apresentaram diferentes estruturas cristalográficas, sendo elas Pn3m e Im3m, respectivamente. Devido a problemas com a baixa solubilidade de CNZ em PHY os estudos para esse lipídio foram suspensos. Nos testes para cubossomos de MYV ao incorporar a CNZ foi observado uma alteração da estrutura cúbica de Im3m para Pn3m e os valores dos parâmetros de rede se alteraram de acordo com a estrutura cristalina encontrada, porém os valores não apresentaram diferenças significativas de tamanho quando se trata da mesma estrutura, sugerindo que a CNZ não interferiu no parâmetro de rede. Os tamanhos das nanopartículas apresentaram uma população monodispersa com ~200 nm. DLS mostrou uma interferência da CNZ no tamanho dos cubossomos, variando de forma diretamente proporcional a concentração de CNZ na amostra, enquanto as técnicas de NTA e microscopia apresentaram nanopartículas de tamanhos bastante variados, mas independente da interferência da CNZ. A encapsulação de CNZ também foi dosada por HLPC em cubossomos de MYV, obtendo um limite superior de 0,6 mg/mL. A atividade citotóxica dos cubossomos foi testada em eritrócitos, revelando uma taxa de hemólise bastante inferior em cubossomos com CNZ em relação a cubossomos puros. Acreditamos que os cubossomos podem sim ser utilizados como sistemas carreadores de CNZ

Cubosomes are nanostructured particles in the form of a lipid bilayer, bicontinuous and highly curved, which must be stabilized by a non-ionic polymer, in this case Pluronic® F-127. They can be composed of some types of specific lipids that have the ability to self-associate in cubic structures when they are in excess of water, such as phytantriol (PHY) and monolein (GMO). Due to their unique structure, cubosomes have a great potential to be considered as drug delivery systems. Drug delivery systems are widely used in pharmaceutical research and clinical settings to increase the efficacy of compounds used for diagnostics and drugs. In the case of cinnarizine (CNZ), a drug already approved for the treatment of nausea, vomiting and vertigo caused by Ménière's disease, there are numerous side effects associated with its low solubility. Thus, cubosomal encapsulation becomes a promising approach to solve drug-related problems of pharmacological activity. In this work, we performed a biophysical characterization of the CNZ interaction in cubosomes (containing PHY or myverol, MYV, which is composed of 80% GMO). The biophysical techniques used were: low angle X-ray scattering (SAXS), dynamic light scattering (DLS), transmission electron microscopy (TEM), cryo transmission electron microscopy (Crio-TEM), nanoparticle tracking analysis (NTA) and zeta potential. High performance liquid chromatography (HPLC) was performed to verify the percentage of encapsulation efficiency (%EE) of CNZ in cubosomes, while cytotoxicity was evaluated in erythrocytes by analyzing the hemolytic activity. Initially, the influence of different solvents (acetone, chloroform, ethanol and octane) on the structural properties of PHY cubosomes was investigated in order to minimize the effects of the solvent used for the encapsulation of CNZ. For samples with acetone, it was found that only high concentrations had an influence on the crystallographic structure of the nanoparticles, with the result being fully reversible after 24h. Ethanol caused the network parameter to increase by 10-15%. Chloroform and octane had different effects on PHY cubosomes compared to acetone and ethanol; both induced a cubic-hexagonal-micellar transition. Later, we found that PHY and MYV nanoparticles presented different crystallographic structures, being Pn3m and Im3m, respectively. Due to problems with the low solubility of CNZ in PHY, studies for this lipid were suspended. In the tests for MYV cubosomes when incorporating CNZ, a change in the cubic structure from Im3m to Pn3m was observed and t he lattice parameters changed according to the crystal structure found, but the differences observed were not significant when it comes to the same structure, suggesting that the CNZ did not interfere with the network parameter. The nanoparticle sizes showed a monodisperse population with ~200 nm. DLS showed an interference of CNZ in the size of the cubosomes, varying directly proportionally to the concentration of CNZ in the sample, while NTA and microscopy techniques showed nanoparticles of widely varying sizes, but independent of CNZ interference. CNZ encapsulation was also dosed by HLPC in MYV cubosomes, obtaining an upper limit of 0.6 mg/ml. The cytotoxic activity of cubosomes was tested in erythrocytes, revealing a much lower rate of hemolysis in cubosomes with CNZ compared to pure cubosomes. We believe that cubosomes can indeed be used as CNZ carrier systems

Progress in pharmaceutical research for cerebral resuscitation after cardiac arrest / 中华危重病急救医学

With the popularization of cardiopulmonary resuscitation (CPR) technology, the success rate of restoration of spontaneous circulation (ROSC) is gradually improved, and the survival rate and neurological outcome of patients with cardiac arrest are improved. Currently, therapeutic methods for cerebral resuscitation after cardiac arrest are limited. In addition to mild hypothermia for clinical application, the majority of drugs remain in the animal experimental stage. Finding effective brain protection drugs has become a hot spot in the field of brain resuscitation research. This article will review the pharmaceutical progress of research for cerebral resuscitation after cardiac arrest, so that we can study the brain protection mechanism of these drugs better and more targeted.

Teoría de colas aplicada al estudio del sistema de servicio de una farmacia / Queueing theory applied to the study of the service system of a pharmacy

Con frecuencia las instituciones que brindan servicios deben tomar decisiones respecto al caudal de clientes que reciben, así como la capacidad de servicio con que cuentan. Sin embargo, a diario se presenta un fenómeno común y cotidiano: las colas o líneas de espera, las que se generan cuando la demanda excede a la oferta. En este contexto aparece la teoría de colas, la cual no resuelve el problema, pero ofrece información para tomar decisiones, sobre la base de la predicción de algunas características sobre la cola y el sistema de servicio. Un escenario evidente en el sector salud, donde se generan constantemente líneas de espera son las farmacias. En la Farmacia Hospitalaria Principal de Santiago de Cuba, se modeló la venta de medicamentos desde este enfoque, al no contar con otras herramientas que con su aplicación apoyaran la toma de decisiones. Por ello el objetivo del trabajo es determinar desde el enfoque de la teoría de colas, las variables y medidas de rendimiento del sistema de servicio de dicha Farmacia, para la toma de decisiones a corto y mediano plazo, en función de ofrecer un mayor y mejor servicio. Como resultado se determinó que, para el sistema de servicio actual, existe una alta probabilidad de que se generen colas, y que los clientes permanezcan en ella por más de 5 minutos; recomendando garantizar la disponibilidad de los dependientes, reducir el número de clientes en la cola, hacer más amena la estancia en ella, así como valorar y evaluar su rediseño(AU)

Often the institutions that provide services must make decisions regarding the number of clients they receive, as well as the service capacity they have. However, there is a daily and everyday phenomenon: queues or waiting lines, which are generated when demand exceeds supply. In this context, queueing theory appears, which does not solve the problem, but provides information needed to make decisions, based on the prediction of some characteristics about the queue and the service system. A clear context in the health branch, where there are constantly waiting lines are pharmacies. In the Municipal Community Pharmacy of Santiago de Cuba, the sale of medicinal products was modeled from this approach, since there are no other applied tools that support decision making. Therefore, the objective of the work is to determine from the approach of queueing theory, the variables and measures of performance of the service system of the said Pharmacy, for the decision making in the short and medium term, in function of offering a greater and better service. As a result, it was determined that, for the current service system, there is a high probability that queues will be generated, and that customers will stay in it for more than 5 minutes; recommending to guarantee the availability of dependents, reduce the number of clients in the queue, make the stay in it more enjoyable, as well as assess and evaluate its redesign(AU)

Nanopreparations for better drug delivery

Nanomedicines are a recent development to face medical and pharmaceutical challenges because nanoparticles have unique properties. They are very small in size and are easy to handle. One more advantage is that they are not harmful for the human body. Poorly soluble drugs have serious problems with their delivery and dosage forms. Formulation strategies by means of nanocarrier systems, such as polymeric micelles, can resolve the trouble. Micelles from PEG-diacyllipids, e.g. PEG-PE, are of special attention. On the other hand, the layer-by-layer [LbL] technique can be useful to set up stable nanocolloids of low solubility. In some cases, the use of nanopreparations is the only way to fulfill medical requirements. Thus, for the blood group CT imaging, one has to prepare long-circulating contrast-loaded nanoparticles. In other cases, poor stability of potential drugs creates a problem, such as with siRNA, and the use of nanocarriers may present a solution e.g. Polymeric micelles having a hydrophobic derivative of siRNA. We will discuss the preparation, properties, and anti-cancer activity of drug-loaded PEG-PE micelles and LbL nanoparticles and other [approaches] for making "undeliverable" substances deliverable. Injectable, implantable, topical delivery of active compounds, oral drug delivery system and many other methods have been improved by nanotechnology