Herbal medicines from the industry in the unified health system: challenge faced by medical professionals

Abstract The World Health Organization recognized the use of herbal medicines as a therapeutic resource and its application in the primary attention to heath. The begin of this expansion was in 2006, with the National Policy on Integrative and Complementary practices of the Unified Health System (SUS). This research aimed to evaluate the questionnaires applied to doctors, who may have prescribed industrialized herbal medicines and to identify the difficulties involved with the implementation of this therapy as an integrative and complementary practice. It is a quantitative, observational and transversal study conducted in the municipality of Pinhais/Brazil. The questionnaire applied had as themes the experience of personal use of industrialized herbal medicines, improvement after their use. Forty-four individuals from four different nationalities: Brazilian (88.64%), Cuban (6.82%), Mexican (2.27%) and Argentinian (2.27%), ages between 25 and 69 years, mainly male sex (54.55%) answered the questionnaire. According to the study, the doctors consider herbal medicines an alternative to the conventional treatment and these medical professionals have already prescribed some industrialized herbal medications. Despite the difficulties faced by medical doctors with the prescription of herbs, it is possible to define strategies to assist these professionals, such as the incentive the actions by the governments.

Inhibition of α-glucosidase, pancreatic lipase, and antioxidant property of Myrcia hatschbachii D. Legrand containing gallic and ellagic acids / Inhibición de la α-glucosidasa, la lipasa pancreática y la propiedad antioxidante de Myrcia hatschbachii D. Legrand que contiene ácidos gálico y elágico

Several species of the Myrcia genus have been used in folk medicine to treat diabetes. Therefore, the aim of this work was to investigate the inhibitory activity of α-glucosidase and pancreatic lipase in the crude extract (EBF) and in the ethyl acetate fraction (FFA) of Myrcia hatschbachii, as well as to identify isolated phenolic compounds and to evaluate the antioxidant property and preliminary in vitro toxicity against Artemia salina. EBF (IC50: 3.21 µg/mL) and FFA (IC50: 1.14 µg/mL) showed inhibitory activity superior to acarbose (IC50: 193.65 µg/mL). In addition, they showed inhibitory effects of pancreatic lipase (IC50: 556.58 µg/mL for EBF and 532.68 µg/mL for FFA), antioxidant potential, absence of preliminary toxicity and presence of gallic andellagic acids in FFA. The relevant results in the inhibition of α-glucosidase and pancreatic lipase motivate new studies for the development of herbal medicines that assist in the treatment of diabetic patients.

Varias especies del género Myrcia se han utilizado en la medicina popular para tratar la diabetes. Por lo tanto, el objetivo de este trabajo fue investigar la actividad inhibitoria de la α-glucosidasa y la lipasa pancreática en el extracto crudo (EBF) y en la fracción de acetato de etilo (FFA) de Myrcia hatschbachii, así como identificar compuestos fenólicos aislados y evaluar la propiedad antioxidante y toxicidad in vitro preliminar contra Artemia salina. EBF (IC50: 3.21 µg/mL) y FFA (IC50: 1.14 µg/mL) mostraron una actividad inhibitoria superior a la acarbosa (IC50: 193.65 µg/mL). Además, mostraron efectos inhibitorios de la lipasa pancreática (IC50: 556.58 µg/mL para EBF y 532.68 µg/mL para FFA), potencial antioxidante, ausencia de toxicidad preliminar y presencia de ácidos gálico y elágico en FFA. Los resultados relevantes en la inhibición de la α-glucosidasa y la lipasa pancreática motivan nuevos estudios para el desarrollo de medicamentos a base de hierbas que ayudan en el tratamiento de pacientes diabéticos.

Componentes químicos del aceite esencial de Ocotea paranaensis (Lauraceae) y sus propiedades antioxidantes, anticancer y antimicrobianas / Chemical constituents of Ocotea paranaensis (Lauraceae) essential oil and their antioxidant, anticancer and antimicrobial properties

La composición química del aceite esencial obtenido de las ramas de Ocotea paranaensis se estudió por cromatografía de gases/espectrometría de masas (CG/MS). Se identificaron veintisiete compuestos, que comprenden el 94,82% de los componentes totales. El aceite se caracterizó por una concentración relativamente alta de sesquiterpenos (62,96%), sesquiterpenos oxigenados (33,33%) y diterpeno (3,70%). En cuanto a los compuestos principales, se destacaron Z-nerolidol (19,16%), germacreno D (12,92%) y α-bulnesene (8,47%), que correspondieron al 40,55% de las sustancias encontradas. El aceite esencial analizado de Ocotea paranaensis tiene una buena acción reductora de fosfomolibdeno y es moderadamente tóxico para la Artemia salina (LC50 = 147,91 µg/mL). Mostró potencial hemolítico y actividad moderada contra Staphylococcus aureus (concentración inhibitoria mínima MIC = 250 µg/mL) y Pseudomonas aeruginosa (MIC = 500 µg/mL). No se observaron resultados satisfactorios de citotoxicidad en el linaje H460 y HeLa.

The chemical composition of the essential oil obtained from the branches of Ocotea paranaensis was studied by gas chromatography/mass spectrometry (GC/MS). Twenty-seven compounds, comprising 94.82% of the total components, were identified. The oil showed relatively high concentration of sesquiterpenes (62.96%), oxygenated sesquiterpenes (33.33%), and diterpene (3.70%). Regarding the major compounds, Z-nerolidol (19.16%), germacrene D (12.92%) and α-bulnesene (8.47%) could be highlighted, which corresponded to 40.55% of the substances that were found. The essential oil from Ocotea paranaensis has phosphomolybdenum reducing action and is moderately toxic to the Artemia salina (LC50 = 147.91 µg/mL). It showed haemolytic potential and moderate activity against Staphylococcus aureus, (minimum inhibitory concentration MIC = 250 µg/mL) and Pseudomonas aeruginosa (MIC = 500 µg/mL). No satisfactory cytotoxicity results were observed in lineage H460 and HeLa.

Biomarkers of cardio-renal syndrome in uremic myocardiopathy animal model / Biomarcadores de síndrome cardiorrenal em modelo animal de miocardiopatia urêmica

ABSTRACT Introduction: Cardio-renal syndrome subtype 4 (CRS4) is a condition of primary chronic kidney disease that leads to reduction of cardiac function, ventricular hypertrophy, and risk of cardiovascular events. Objective: Our aim was to understand the mechanisms involved on the onset of CRS4. Methods: We used the nephrectomy 5/6 (CKD) animal model and compared to control (SHAM). Serum biomarkers were analyzed at baseline, 4, and 8 weeks. After euthanasia, histology and immunohistochemistry were performed in the myocardium. Results: Troponin I (TnI) was increased at 4 weeks (W) and 8W, but nt-proBNP showed no difference. The greater diameter of cardiomyocytes indicated left ventricular hypertrophy and the highest levels of TNF-α were found at 4W declining in 8W while fibrosis was more intense in 8W. Angiotensin expression showed an increase at 8W. Conclusions: TnI seems to reflect cardiac injury as a consequence of the CKD however nt-proBNP did not change because it reflects stretching. TNF-α characterized an inflammatory peak and fibrosis increased over time in a process connecting heart and kidneys. The angiotensin showed increased activity of the renin-angiotensin axis and corroborates the hypothesis that the inflammatory process and its involvement with CRS4. Therefore, this animal study reinforces the need for renin-angiotensin blockade strategies and the control of CKD to avoid the development of CRS4.

RESUMO Introdução: A síndrome cardiorrenal (SCR) tipo 4 é uma afecção da doença renal crônica primária que leva a redução da função cardíaca, hipertrofia ventricular e risco de eventos cardiovasculares. Objetivo: O objetivo do presente estudo foi compreender os mecanismos envolvidos no surgimento da SCR tipo 4. Métodos: Um modelo animal de nefrectomia 5/6 (DRC) foi comparado a animais de controle (Placebo). Biomarcadores séricos foram analisados no início do estudo e com quatro e oito semanas de estudo. Após eutanásia, foram realizados exames histológicos e de imunoistoquímica no tecido miocárdico. Resultados: Troponina I (TnI) estava aumentada nas semanas quatro (S4) e oito (S8), mas o NT-proBNP não apresentou diferenças. O diâmetro maior dos cardiomiócitos indicava hipertrofia ventricular esquerda. Os níveis mais elevados de TNF-α foram identificados na S4 com redução na S8, enquanto fibrose foi mais intensa na S8. A expressão de angiotensina mostrou elevação na S8. Conclusões: TnI parece sugerir lesões cardíacas em consequência da DRC, porém o NT-proBNP não sofreu alterações por refletir alongamento. O TNF-α evidenciou um pico inflamatório e a fibrose aumentou ao longo do tempo devido ao processo de conexão entre rins e coração. A angiotensina mostrou aumento da atividade do eixo renina-angiotensina, corroborando a hipótese do processo inflamatório e seu envolvimento com SCR tipo 4. Portanto, o presente estudo em modelo animal reforça a necessidade de em adotar estratégias com bloqueadores de renina-angiotensina e controle da DRC para evitar o desenvolvimento de SCR tipo 4.

Use of industrialized herbal medicines by patients attended at the basic health units in the County of Pinhais, Paraná, Brazil / Uso de medicamentos fitoterápicos industrializados por pacientes atendidos en unidades básicas de salud en el municipio de Pinhais, Paraná, Brasil

The present article studied the use of industrialized phytotherapies by patients attended at the basic health units in Pinhais county, located in the metropolitan region of Curitiba, Paraná, Brazil. This is a quantitative, observational and cross-sectional study that was conducted by semi-structured questionnaire interviews that were used as a data collection instrument. The population sample consisted of 267 patients from basic health care organizations. Regardless of gender or age, 56.2% of the interviewed participants reported using industrialized herbal medicines, of which 21.3% acquired their drugs from drugstores from around the county. Patients reported positive results using industrialized herbal medicines (89.33%), of whom women were predominant, making up (80%) (p<0.05). Among the drugs used by all the patients, "guaco" syrup was the most frequent (34%). The present study demonstrates the good acceptance by patients of treatments that involve integrative practices, such as herbal medicine, but when a drug has a vegetal origin, the idea that these products do not cause adverse effects persists.

El presente articulo se estudio el uso de hierbas medicinales procesadas por pacientes tratados en unidades básicas de salud del município de Pinhais, en la región metropolitana de Curitiba, Paraná, Brasil. Se trata de un estudio cuantitativo, observacional y transversal, realizado por medio de entrevistas que utilizan como instrumento de recolección de datos un cuestionario semi-estructurado. La población de la muestra consistió en 267 pacientes de atención básica a la salud. Independiente del sexo o de la edad, 56.2% de los entrevistados relató hacer uso de fitoterápicos industrializados, siendo que de los 21.3% hizo la adquisición en las farmacias de las unidades de salud del municipio. Los pacientes reportaron resultados positivos con el tratamiento realizado con fitoterápicos industrializados (89.33%). Entre ellos predominan las mujeres (80%) (p<0.05). Entre los medicamentos citados por los pacientes, el jarabe de guaco se mostró el más frecuente (34%). El presente estudio demuestra la buena aceptación por parte de los pacientes en realizar tratamientos que implican prácticas integrativas como la fitoterapia, pero, por poseer origen vegetal, todavía existe la idea de que estos productos no tienen la capacidad de causar efectos adversos.

Brazilian panorama about the registration and use of herbal medicines / Panorama brasileño en cuanto al registro y el uso de las hierbas medicinales

It was evaluated the Brazilian panorama regarding the registration and use of phytotherapics. A descriptive study about herbal medicines was carried out using the Pubmed and Portal Capes databases, and online data from the National Health Surveillance Agency (ANVISA). Of the 114-plant species described in the list of Brazilian Common Denomination (CBD), 67 have at least one formulation registered by ANVISA, with emphasis on Ginkgo biloba L. Fifteen different pharmaceutical forms were observed, the most common being tablets. There are 22 different indications, laxative was the most cited. Publications in the field of herbal medicine have increased significantly in the last 2 decades.

Se evaluó el panorama brasileño sobre el registro y uso de fitoterápicos. Se realizó un estudio descriptivo de las hierbas medicinales utilizando las bases de datos Pubmed y Portal Capes, así como datos en línea de la Agencia Nacional de Vigilancia Sanitaria (ANVISA). De las 114 especies de plantas descritas en la lista de Denominación Común Brasileña (CBD), 67 tienen al menos una formulación registrada por ANVISA, con énfasis en Ginkgo biloba L. Se observaron 15 formas farmacéuticas diferentes, siendo las más comunes las tabletas. Hay 22 indicaciones diferentes, laxante fue el más citado. Las publicaciones en el campo de la medicina herbal han aumentado significativamente en las últimas 2 décadas.