Effectiveness and safety of biological and target synthetic drugs treatment for psoriatic arthritis: a systematic review with network meta-analysis.

BACKGROUND: Psoriatic arthritis (PA) is a chronic inflammatory systemic arthritis that can result in loss of functional capacity and joint deformation. This systematic review assessed the effectiveness and safety of biological and target synthetic drugs for treating PA. METHODS: We searched for randomized clinical trials (RCTs) that evaluated the use of Adalimumab, Etanercept, Infliximab, Golimumab, Secukinumab, Certolizumab Pegol and Tofacitinib in the main general databases and clinical trial registers databases. The primary outcomes were ACR 50, PsARC, and serious adverse events. Two independent reviewers performed study selection and data extraction. Network meta-analyses were conducted using a random effects model and frequentist approach. The CINeMA software was used to assess the certainty of evidence. RESULTS: We included 33 RCTs (n = 11,034). The results from the network meta-analysis for the ACR 50 at 6-months follow-up showed that all drugs were superior to placebo, with Secukinumab (high certainty of evidence), Infliximab (very low certainty of evidence) and Adalimumab (high certainty of evidence) ranking the highest. Regarding the PsARC (at 6-months follow-up), all drugs, except for Golimumab (very low certainty of evidence), were superior to placebo, with Etanercept (low certainty of evidence), Infliximab (low certainty of evidence) and Certolizumab Pegol (low certainty of evidence) being the most effective drugs. There were no significant differences in the risk of serious adverse events between the drugs and placebo. Golimumab (very low certainty of evidence), Secukinumab (low certainty of evidence), and Adalimumab (very low certainty of evidence) ranked the highest for safety. CONCLUSIONS: In conclusion, based on the balance between efficacy and safety, Secukinumab and Adalimumab may be the preferred options among the evaluated drugs for treating patients with PsA. However, caution is necessary when interpreting the safety findings, as they are supported by evidence of low to very low certainty. Consequently, the balance between benefits and potential risks may change as new safety evaluation studies become available. PROTOCOL REGISTRATION: PROSPERO: CRD42022315577.

Market research to identify and analyze opportunities to produce strategic health technologies in Latin America and the Caribbean

Conducting market research and value chain analysis is crucial for defining a productive investment strategy. In this context, the Pan American Health ORganization contracted IQVIA Solutions do Brasil LTDA and Fundação Instituto de Administração (FIA) to conduct market and value chain studies for biological medicines, chemically synthesized medicines, medical devices, and personal protection equipment. This executive summary presents the context and key conclusions.

An overview of New Psychoactive Substances (NPS) in northeast Brazil: NMR-based identification and analysis of ecstasy tablets by GC-MS.

The actual illicit market for synthetic drugs is characterized by a wide variety of psychoactive substances of different chemical and pharmacological classes, such as amphetamine-type stimulants and new psychoactive substances. The knowledge about its chemical composition, as well as the nature and quantity of the active substances present, is important for emergency care in intoxication cases by these substances and to establish adequate chemical and toxicological analysis procedures in forensic laboratories. The aim of this work was to study the prevalence of amphetamine-type stimulants and new psychoactive substances in the states of Bahia and Sergipe, in the northeast region of Brazil, involving samples of drugs seized by the local police forces from 2014 to 2019. In a total of 121 seized and analyzed samples, in which ecstasy tablets predominated (n = 101), nineteen substances were identified using GC-MS and 1D NMR techniques, comprising classical synthetic drugs and new psychoactive substances (NPS). In order to determine the composition of ecstasy tablets, an analytical method based on GC-MS was applied after validation. Analyzes of 101 ecstasy tablets showed that MDMA was the main substance, being found in 57% of the samples, in amounts between 27.3 and 187.1 mg per tablet. In addition, mixtures of MDMA, MDA, synthetic cathinones and caffeine were observed in 34 samples. These results demonstrate that the variety of substances found and the composition of seized materials in northeast Brazil is similar to other studies carried out previously in other Brazilian regions.

Seguridad de las drogas biológicas y sintéticas dirigidas utilizadas en pacientes con enfermedades reumáticas inmunomediadas. Datos del registro BIOBADASAR 3.0 / Safety of biological and targeted synthetic drugs in patients with immune-mediated rheumatic diseases. Data from the BIOBADASAR 3.0 registry

Introducción: conocer la seguridad de las drogas actualmente disponibles para el tratamiento de las enfermedades reumáticas es muy importante al momento de tomar decisiones terapéuticas objetivas e individualizadas en la consulta médica diaria. Asimismo, datos de la vida real amplían el conocimiento revelado por los ensayos clínicos. Objetivos: describir los eventos adversos (EA) reportados, estimar su frecuencia e identificar los factores relacionados con su desarrollo. Materiales y métodos: se utilizaron datos BIOBADASAR, un registro voluntario y prospectivo de seguimiento de EA de tratamientos biológicos y sintéticos dirigidos en pacientes con enfermedades reumáticas inmunomediadas. Los pacientes son seguidos hasta la muerte, pérdida de seguimiento o retiro del consentimiento informado. Para este análisis se extrajeron datos recopilados hasta el 31 de enero de 2023. Resultados: se incluyó un total de 6253 pacientes, los cuales aportaron 9533 ciclos de tratamiento, incluyendo 3647 (38,3%) ciclos sin drogas modificadoras de la enfermedad biológicas y sintéticas dirigidas (DME-b/sd) y 5886 (61,7%) con DME-b/sd. Dentro de estos últimos, los más utilizados fueron los inhibidores de TNF y abatacept. Se reportaron 5890 EA en un total de 2701 tratamientos (844 y 1857 sin y con DME-b/sd, respectivamente), con una incidencia de 53,9 eventos cada 1000 pacientes/año (IC 95% 51,9-55,9). La misma fue mayor en los ciclos con DME-b/sd (71,1 eventos cada 1000 pacientes/año, IC 95% 70,7-77,5 versus 33,7, IC 95% 31,5-36,1; p<0,001). Las infecciones, particularmente las de la vía aérea superior, fueron los EA más frecuentes en ambos grupos. El 10,9% fue serio y el 1,1% provocó la muerte del paciente. El 18,7% de los ciclos con DME-b/sd fue discontinuado a causa de un EA significativamente mayor a lo reportado en el otro grupo (11,5%; p<0,001). En el análisis ajustado, las DME-b/sd se asociaron a mayor riesgo de presentar al menos un EA (HR 1,82, IC 95% 1,64-1,96). De igual manera, la mayor edad, el mayor tiempo de evolución, el antecedente de enfermedad pulmonar obstructiva crónica, el diagnóstico de lupus eritematoso sistémico y el uso de corticoides se asociaron a mayor riesgo de EA. Conclusiones: la incidencia de EA fue significativamente superior durante los ciclos de tratamientos que incluían DME-b/sd.

Introduction: knowing the efficacy and safety of the drugs currently available for the treatment of rheumatic diseases is very important when making objective and individualized therapeutic decisions in daily medical consultation. Likewise, real-life data extends the knowledge revealed by clinical trials. Objectives: to describe the reported adverse events (AEs), estimate their frequency and identify factors associated to them. Materials and methods: BIOBADASAR data were used, which is a voluntary, prospective follow-up registry of AEs of biological and synthetic treatments in patients with immune-mediated rheumatic diseases. Patients are followed until death, loss of followup, or withdrawal of informed consent. To carry out this analysis, the data collected up to January 31, 2023 was extracted. Results: a total of 6253 patients were included, who contributed with 9533 treatment periods, including 3647 (38.3%) periods without b/ts-DMARDs and 5886 (61.7%) with b/ts-DMARDs. Among the latter, the most used were TNF inhibitors and abatacept. A total of 5890 AEs were reported in a total of 2701 treatments (844 and 1857 without and with b/ts-DMARDs, respectively), with an incidence of 53.9 events per 1000 patients/ year (95% CI 51.9-55.9). It was higher during the periods with b/ts-DMARDs (71.1 events per 1000 patients/year, 95% CI 70.7-77.5 vs 33.7, 95% CI 31.5-36.1, p<0.001). Infections, particularly those of the upper respiratory tract, were the most frequent AEs in both groups. 10.9% were severe and 1.1% were associated with the death of the patient. 18.7% of the periods with b/ts-DMARDs were discontinued due to an AE, significantly higher than that reported in the other group (11.5%; p<0.001). In the adjusted analysis, b/ts-DMARDs were associated with a higher risk of presenting at least one AE (HR 1.82, 95% CI 1.64-1.96). Similarly, older age, longer evolution time, history of chronic obstructive pulmonary disease, diagnosis of systemic lupus erythematosus, and use of corticosteroids were associated with a higher risk of AE. Conclusions: the incidence of AEs was significantly higher during those treatment periods that included DME-b/sd.

Antioxidant, Antidiabetic and Lipid Profiling of Spermadicyton Suaveolens in Streptozotocin (STZ) Induced Diabetic Rats

ABSTRACT Diabetes is a life-threatening disease, and currently available synthetic medicines for treating diabetes are associated with various side effects. Therefore, there is an unmet need to develop herbal remedies against diabetes as an alternative to synthetic medicines. Although local healers use the roots of Spermadicyton suaveolens (SS) to manage diabetes, there is negligible research to validate its antidiabetic properties. The present investigation aims to the assess the antioxidant, antidiabetic, and antihyperlipidemic potential of the ethanolic extract of S. Suaveolen's roots (EESS) on streptozotocin (STZ) induced diabetic rats. The extract was screened for in vitro antioxidant and antidiabetic activity. The in vivo antidiabetic potential of EESS (at 200 and 400 mg/kg) was studied on STZ-induced diabetic rats for 20 days. The EESS displayed significant (p<0.05) antidiabetic and antioxidant properties. The administration of 200 mg/kg and 400 mg/kg EESS in STZ-induced diabetic rats significantly reduced hyperglycemia, and restored antioxidant enzymes and lipid profile-a high density lipoprotein (HDL) increased by the administration of a single dose of streptozotocin. Thus, EESS could be a promising herbal medicine in the treatment of diabetes and hyperlipidemia

Atividade de alcaloides inibidores da acetilcolinesterase no tratamento da doença de Alzheimer: uma revisão sistemática / Activity of Acetylcholinesterase inhibitor Alkaloids in the treatment of Alzheimer's Disease: a systematic review

Objetivo: descrever a atividade de inibição da enzima acetilcolinesterase (AChE), por meio de ativos extraídos de alcaloides naturais. Metodologia: este estudo se configura como uma revisão sistemática da literatura, no período de janeiro de 2015 a setembro de 2021, nas bases de dados PUBMED, LILACS e SCIENCE DIRECT, com os descritores Acetylcholinesterase; Alzheimer; Alkaloids. As informações obtidas foram tabuladas para avaliação dos alcaloides inibidores da acetilcolinesterase. Resultados: de 563 artigos encontrados, 17 foram utilizados. Dois deles relataram a atividade de alcaloides inibidores da AChE por meio de ensaios clínicos, enquanto os demais a realizaram por testes in vitro. De 160 substâncias estudadas, 48 apresentaram atividade anticolinesterásica, as quais foram avaliadas de acordo com a sua concentração inibitória média (IC50). Discussão: a eficiência dos alcaloides como inibidores da AChE, provavelmente está relacionada com sua carga positiva no pH do organismo e sua boa biodisponibilidade, tendo como consequência uma atividade duradoura in vivo, em comparação com os medicamentos sintéticos. Conclusão: no presente estudo, foi possível observar uma grande diversidade de substâncias alcalóidicas antiAChE. Contudo, torna-se necessária a realização de mais ensaios in vivo e in vitro para a constatação efetiva da atividade dessas moléculas.

Objective: describe the activity of the enzyme Acetylcholinesterase (AChE) through natural actives extracted from alkaloids. Methodology: this study is a systematic literature review, from January 2015 to September 2021, in the PUBMED, LILACS, and SCIENCE DIRECT databases, with the descriptors Acetylcholinesterase; Alzheimer's; Alkaloids. The information obtained was tabulated for the evaluation of Acetylcholinesterase inhibitor alkaloids. Results: of 563 articles found, 17 were used. Two of them reported the activity of AChE-inhibiting Alkaloids through clinical trials, while the others performed it through in vitro tests. Of 160 substances studied, 48 showed anticholinesterase activity, which was evaluated according to their mean inhibitory concentration (IC50). Discussion: the efficiency of Alkaloids as AChE inhibitors is probably related to their positive charge on the body's pH and their good bioavailability, resulting in a long-lasting activity in vivo compared to synthetic drugs. Conclusion: in the present study, it was possible to observe a great diversity of antiAChE alkaloid substances. However, it is necessary to carry out more in vivo and in vitro tests to verify the effective activity of these molecules.

Remdesivir para el tratamiento de pacientes con COVID-19: (3 de junio de 2022) / Remdesivir for the treatment of patients with COVID-19: (June 3, 2022)

INTRODUCCIÓN: El remdesivir fue evaluado originalmente en ensayos clínicos para abordar el brote de virus del ébola en 2014.(13) Con la demostración de que remdesivir poseía una amplia actividad contra otros virus de ARN, incluidos los coronavirus, múltiples grupos evaluaron su actividad antiviral in vitro como in vivo en otras indicaciones. Posteriormente, se confirmó su actividad antiviral contra los coronavirus zoonóticos MERS, así como los coronavirus humanos circulantes HCoV-OC43 y HCoV-229E, agentes causantes del resfriado común.(14) Recientemente, también ha demostrado su actividad in vitro frente al SARS-CoV-2.(15) En un modelo de macaco Rhesus con infección por SARS-CoV-2 donde el tratamiento con remdesivir se inició poco después de la inoculación, los animales tratados con este fármaco presentaron niveles de virus más bajos en los pulmones y menos daño pulmonar respecto a los animales de control. Aunque este modelo animal no representa la enfermedad grave observada en algunos pacientes con COVID-19, se tomaron estos hallazgos como una posibilidad biológica para iniciar estudios clínicos con este fármaco antiviral en pacientes con COVID-19. OBJETIVO: El objetivo del presente informe es evaluar parámetros de eficacia, seguridad, conveniencia y recomendaciones disponibles acerca del empleo de remdesivir para el tratamiento de pacientes con COVID-19 en Argentina. MÉTODOS: Efectos en la Salud: Teniendo en cuenta la velocidad con la que la información relacionada a la pandemia aparece y se modifica, se desarrolló un protocolo sustentado en proyectos que resume activamente la evidencia científica a medida que la misma se hace disponible. Con este fin se utilizó la plataforma L- ove de Epistemonikos https://app.iloveevidence.com/topics para identificar revisiones sistemáticas "vivas". Se seleccionaron aquellas con una calidad metodológica apropiada evaluada a través de la herramienta AMSTAR-2, y que a su vez llevaran un proceso de actualización frecuente. De cada una de las revisiones sistemáticas identificadas se extractaron los efectos de la intervención sobre los desenlaces priorizados como importantes o críticos y la certeza en dichos efectos. Para la priorización de los desenlaces se adoptó una perspectiva desde el paciente considerando sus potenciales preferencias. La selección se realizó por consenso entre los autores y supervisores del informe considerando los resultados de múltiples ejercicios de priorización publicados, realizados en el marco del desarrollo de distintas guías de práctica clínica. Implementación: Este dominio contempla dos subdominios: la existencia de barreras y facilitadores en nuestro contexto para la implementación de la tecnología evaluada no consideradas en los otros dominios analizados, y los costos comparativos en relación con otras intervenciones similares. Con el objetivo de emitir un juicio de valor sobre la magnitud de dichos costos, en pacientes hospitalizados se utilizó como comparador al tratamiento con dexametasona, que ha demostrado ser una intervención accesible y de beneficios importantes en el contexto analizado. Recomendaciones: Para la identificación de recomendaciones sustentadas en evidencia y actualizadas, se utilizó la plataforma COVID recmap. Se seleccionaron aquellas guías con rigor metodológico apropiado según la herramienta AGREE II (> 70%) y se incorporaron sus recomendaciones al informe. RESULTADOS: Se identificaron tres revisiones sistemáticas que cumplieron con los criterios de inclusión del presente informe y reportaron resultados: Las revisiones sistemáticas identificadas incluyeron 12 estudios aleatorizados para remdesivir en COVID19 que aleatorizaron un total de 9869 pacientes. Los resultados de 12 ECCA, incluyendo los resultados finales del ensayo SOLIDARITY, muestran que, en pacientes hospitalizados con COVID-19 y enfermedad de moderada a crítica, el remdesivir probablemente reduce la mortalidad y la necesidad de ventilación mecánica invasiva, y podría mejorar el tiempo de resolución de los síntomas. La certeza de la evidencia fue clasificada como moderada debido a la imprecisión. En pacientes con enfermedad leve de comienzo reciente, el remdesivir podría reducir las hospitalizaciones, pero la certeza de la evidencia es baja también por imprecisión. Adicionalmente, existe información sobre la efectividad in vitro de remdesivir frente a las diferentes variantes de SARS-CoV-2. Esta información se encuentra disponible en OpenData Portal, que condensa lo reportado por conjunto priorizado de publicaciones (preprints y artículos revisados por pares). resultados muestran que remdesivir podría tener una efectividad similar frente a las nuevas variantes del SARS-CoV-2, incluida Omicrón y subvariantes (B.1.1.529; BA.1.1; BA.1; BA.1 [+Q493K]; BA.2; B.1.1.529 [+F694Y] en comparación de las variantes predominantes al momento de realizarse los estudios. CONCLUSIONES: El cuerpo de la evidencia disponible, muestra que en pacientes con enfermedad leve o de reciente comienzo y factores de riesgo para progresión a enfermedad severa, remdesivir podría disminuir las hospitalizaciones y podría aumentar la velocidad para la mejoría clínica y resolución de los sintomas. Sin embargo, la magnitud de la reducción solo resulta importante (mayor a 1%) para pacientes sin esquema de vacunación completo o con riesgo de respuesta inmune inapropriada. En pacientes hospitalizados con enfermedad severa en cambio, el remdesivir probablemente reduce la mortalidad y la necesidad de ventilación mecánica invasiva y podría mejorar el tiempo de resolución de los síntomas, sin aumentar los eventos adversos sérios. A pesar que remdesivir se encuentra autorizado para su comercialización en Argentina, existen algunas situaciones que podrían constituir barreras para el acceso. La vía de administración endovenosa podría no ser aceptada en personas con enfermedad leve. Además, el costo del tratamiento es muy elevado y existe una extensa población objetivo para la aplicación de este tratamiento, que podrían constituir también barreras de acceso. Las guías sugieren el tratamiento con remdesivir condicionado a aquellos pacientes no graves con mayor riesgo de hospitalización. También sugieren en forma condicional utilizar remdesivir en pacientes hospitalizados que requieren oxígeno y recomiendan fuertemente no utilizar en adultos hospitalizados con COVID-19 que requieran ventilación no invasiva o invasiva. En el contexto de América Latina y el Caribe, se sugirió que cada país debe evaluar la decisión de su uso con base en los recursos disponibles, la factibilidad de su implementación, el acceso, los factores específicos del paciente (p. ej., la duración de los síntomas, el funcionamiento renal, las interacciones farmacológicas), la cobertura de vacunación y la forma de administración. También, es importante que se determine la capacidad de los servicios para poder administrar los medicamentos y considerar el tiempo adecuado para su uso.

Application of Homogeneous Liquid-Liquid Microextraction With Switchable Hydrophilicity Solvents to the Determination of MDMA, MDA and NBOMes in Postmortem Blood Samples.

Synthetic drugs for recreational purposes are in constant evolution, and their consumption promotes a significant increase in intoxication cases, resulting in damaging public health. The development of analytical methodologies to confirm the consumption of illicit drugs in biological matrices is required for the control of these substances. This work exploited the development of an extraction method based on homogenous liquid-liquid microextraction with switchable hydrophilicity solvent (SHS) as extraction phase for the determination of the synthetic drugs 3,4-methylenedioxymethamphetamine, 3,4-methylenedioxyamphetamine and N-methoxybenzyl-methoxyphenylethylamine derivates (25B, 25C and 25I) in postmortem blood, followed by liquid chromatography coupled to mass spectrometry in tandem. The optimized sample preparation conditions consisted of using 250 µL of ZnSO4 10% and 50 µL of NaOH 1 mol/L in the protein precipitation step; N,N-dimethylcyclohexylamine was used as SHS, 650 µL of a mixture of SHS:HCl 6 mol/L (1:1 v/v), 500 µL of whole blood, 500 µL of NaOH 10 mol/L and 1 min of extraction time. The proposed method was validated, providing determination coefficients higher than 0.99 for all analytes; limit of detection and limit of quantitation ranged from 0.1 to 10 ng/mL; intra-run precision from 2.16% to 9.19%; inter-run precision from 2.39% to 9.59%; bias from 93.57% to 115.71% and matrix effects from 28.94% to 51.54%. The developed method was successfully applied to four authentic postmortem blood samples from synthetic drugs users, and it was found to be reliable with good selectivity.

Acanthoscurria gomesiana spider-derived synthetic mygalin in the dorsal raphe nucleus modulates acute and chronic pain.

Mygalin, a diacylspermidine that is naturally found in the hemolymph of the spider Acanthoscurria gomesiana, is of interest for development as a potential analgesic. Previous studies have shown that acylpolyamines modulate glutamatergic receptors with the potential to alter pain pathways. This study aimed to evaluate the effects of mygalin on acute and chronic pain in rodents. For evaluation of acute pain, Wistar rats were subjected to tail-flick and hot-plate nociceptive tests. For the evaluation of chronic neuropathic pain, a partial ligation of the sciatic nerve was performed and, 21 days later, animals were examined in hot-plate, tail-flick, acetone, and von Frey tests. Either Mygalin or vehicle was microinjected in the dorsal raphe nucleus (DRN) before the tests. Another group was pretreated with selective antagonists of glutamate receptors (LY 235959, MK-801, CNQX, and NBQX). Mygalin decreases nociceptive thresholds on both acute and chronic neuropathic pain models in all the tests performed. The lowest dose of mygalin yielded the most effective nociception, showing an increase of 63% of the nociceptive threshold of animals with neuropathic chronic pain. In conclusion, mygalin microinjection in the DRN results in antinociceptive effect in models of neuropathic pain, suggesting that acylpolyamines and their derivatives, such as this diacylspermidine, could be pursued for the treatment of neuropathic pain and development of selective analgesics.

Variable Data Independent Acquisition and Data Mining Exploring Feature-Based Molecular Networking Analysis for Untargeted Screening of Synthetic Cannabinoids in Oral Fluid.

Novel psychoactive substances (NPS) are constantly emerging in the drug market, and synthetic cannabinoids (SCs) are included in this NPS family. Forensic laboratories often struggle with these continually emerging SCs, forcing them to develop an untargeted workflow to incorporate these psychoactive drugs in their procedures. Usually, forensic laboratories select analytical methods based on targeted mass spectrometry (MS) technologies for strictly tracking already known NPS. The appropriate way to tackle unknown substances is to develop pipelines for untargeted analysis that include LC-HRMS analytical methods and data analysis. Once established, this strategy would allow drug testing laboratories to be always one step ahead of the new trends concerning the "designer drugs" market. To address this challenge an untargeted workflow based on mass spectrometry data acquisition and data analysis was developed to detect SCs in oral fluid (OF) samples at a low concentration range. The samples were extracted by mixed-mode solid-phase extraction and analyzed by Liquid Chromatography - High-Resolution Mass Spectrometry (LC-HRMS). Tandem mass spectra (MS2) were recorded performing a variable isolation width across a mass range of all theoretical precursor ions (vDIA) after the chromatographic separation. After raw data processing with the MSDial software, the deconvoluted features were sent to GNPS for Feature-Based Molecular Networking (FBMN) construction for nontargeted data mining. The FBMN analysis created a unique integrated network for most of the SCs assessed in the OF at a low level (20 ng/mL). These results demonstrate the potential of an untargeted approach to detect different derivatives of SCs at trace levels for forensic applications.

Avaliação do uso da Profilaxia Pré-Exposição ao HIV: coorte retrospectiva / Evaluation of the use of pre-exposure HIV prophylaxis: retrospective cohort / Evaluación del uso de profilaxis pre-exposición al VIH: cohorte retrospectiva

Objetivo: Identificar o perfil da população que buscou a Profilaxia Pré-Exposição ao HIV (PrEP) no Paraná e, entre os usuários da PrEP, avaliar modificações nos comportamentos de risco de adquirir infecções sexualmente transmissíveis (IST's), além de alterações nos exames laboratoriais de monitoramento. Métodos: Coorte retrospectiva com dados secundários obtidos do Sistema de Controle Logístico de Medicamentos acessados em 2018 e 2019. Investigou-se o perfil sociodemográfico da população que buscou a PrEP, de forma a correlacioná-lo aos segmentos prioritários para o uso do medicamento profilático. Entre os usuários, avaliaram-se dados comportamentais, testes diagnósticos para IST's, funções renal e hepática referentes a diferentes momentos no decorrer do uso. Os resultados comparados deram-se por meio dos testes Wilcoxon e Exato de Fisher. Resultados: 255 pessoas buscaram a PrEP. Predominaram-se o sexo masculino (92,28%), homossexuais (78,04%), de 20 a 39 anos (83,53%), brancos (71,76%), com 12 ou mais anos de estudo (74,90%). Para uso da PrEP elegeram-se 188 pessoas. Entre estas, durante o uso, observou-se aumento de práticas sexuais sem preservativo (p=0,012), diminuição no número de parceiros e do consumo de álcool (p=0,001), aumento da atividade de enzimas hepáticas ALT/AST (p=0,018), sem diferença no diagnóstico do HIV e outras IST's. Conclusão: Homens que fazem sexo com homens predominaram na busca pela profilaxia. Entre os usuários da PrEP, apesar do aumento de práticas sexuais desprotegidas, não houve aumento do diagnóstico de IST's no período do estudo. O medicamento da PrEP demonstrou bom perfil de segurança nos exames laboratoriais de seguimento.

Objective: To identify the profile of the population that sought HIV Pre-Exposure Prophylaxis (PrEP) in Paraná; and assess, among PrEP users, changes in risk behaviors for acquiring sexually transmitted infections (STIs) as well as changes in monitoring laboratory tests. Methods: Retrospective cohort with secondary data obtained from the Drug Logistics Control System accessed in 2018 and 2019. The sociodemographic profile of the population that sought PrEP was investigated to correlate it with priority segments for the use of prophylactic medication. Among users, behavioral data, diagnostic tests for STIs, kidney, and liver functions were evaluated at different times during use. The results were compared using the Wilcoxon and Fisher's Exact tests. Results: 255 people sought PrEP. Males predominated (92.28%), homosexuals (78.04%), from 20 to 39 years old (83.53%),white people (71.76%), with 12 or more years of schooling (74.90%). For the use of PrEP, 188 people were elected. Among them, during the usage, was noticed an increase in sexual practices without a condom (p=0.012), a decrease in the number of partners and alcohol consumption (p=0.001), an increase in the activity of liver enzymes ALT/AST (p=0.018), with no difference in the diagnosis of HIV and other STI's. Conclusion: Men who have sex with men predominated in the search for prophylaxis. Among PrEP users, despite the increase in unprotected sexual practices, there was no increase in the diagnosis of STIs during the study period; PrEP drugs showed a good safety profile in follow-up laboratory tests.

Objetivo: Identificar el perfil de la población que fue en busca de la Profilaxis pre-exposición al VIH (PrEP) en Paraná y, de entre los usuarios de la PrEP, evaluar los cambios de conducta de riesgo para tener infecciones de transmisión sexual (ITS) además de las alteraciones de las pruebas de laboratorios para el monitoreo. Métodos: Cohorte retrospectiva con datos secundarios del Sistema de Control Logístico de Medicamentos con acceso en 2018 y 2019. Se investigó el perfil sociodemográfico de la población que fue en busca de la PrEP, para correlacionarlo con los segmentos prioritarios para el uso del medicamento profiláctico. De los usuarios se ha evaluado los datos comportamentales, las pruebas de diagnósticos para las ITS, las funciones renales y hepática referente a distintos momentos durante el uso. Los resultados comparados se han dado a través de las pruebas de Wilcoxon y el Exacta de Fisher. Resultados: 255 personas han buscado la PrEP. Hubo el predominio para el sexo masculino (92,28%), homosexuales (78,04%), entre los 20 y 39 años (83,53%), blancos (71,76%), con 12 o más años de estudio (74,90%). Se há elegido 188 personas para el uso de la PrEP. De entre ellas, durante el uso, se observó el aumento de las prácticas sexuales sin condón (p=0,012), la disminución del número de compañeros y del consumo del alcohol (p=0,001), el aumento de la actividad de enzimas hepáticas ALT/AST (p=0,018), sin diferencia en el diagnóstico del VIH y de otras ITS. Conclusión: Los hombres que tienen sexo con hombres prevalecieron para la búsqueda de la profilaxis. De entre los usuarios de la PrEP, a pesar del aumento de las prácticas sexuales sin protección no hubo el aumento del diagnóstico de ITS en el período del estudio. El medicamento de la PrEP demostró un perfil bueno de seguridad en las pruebas de laboratorios de seguimiento.

Antidiabetic activities of alkaloids isolated from medicinal plants

Diabetes mellitus is a metabolic disorder affecting a great part of population around the world. It is the fifth leading death causing disease in the world and its cases are increasing day by day. Traditional medicine is thought to have promising future in the treatment of diabetes mellitus. In contrast to synthetic drugs phytochemicals are considered to be free from side effects. As one of the main class of natural products, alkaloids and their derivatives have been widely used as sources of pharmacological agents against a variety of medical problems. Many studies confirmed the role of alkaloids in the management of diabetes and numerous alkaloids isolated from different medicinal plants were found active against diabetes. Like other natural products, alkaloids regulate glucose metabolism either by inhibiting or inducing multiple candidate proteins including AMP-activated protein kinase, glucose transporters, glycogen synthase kinase-3, sterol regulatory element-binding proteins 1, glucokinase, glucose-6-phosphatase, acetyl-CoA carboxylase among the others. A comprehensive review of alkaloids reported in the literature with anti-diabetic activities and their target enzymes is conducted, with the aim to help in exploring the use of alkaloids as anti-diabetic agents. Future work should focus on rigorous clinical studies of the alkaloids, their development and relevant drug targets.

Latest Updates in Dengue Fever Therapeutics: Natural, Marine and Synthetic Drugs.

In this paper, we review the history of Dengue, the mechanism of infection, the molecular characteristics and components of Dengue, the mechanism of entry to the target cells, cyclization of the genome and replication process, as well as translation of the proteins for virus assembly. The major emphasis of this work is on natural products and plant extracts, which were used for as palliative or adjuvant treatment of Dengue. This review article also summarizes the latest findings in regards to the marine products as effective drugs to target different symptoms of Dengue. Furthermore, an update on synthetic drugs for treating Dengue is provided in this review. As a novel alternative, we describe monoclonal antibody therapy for Dengue management and treatment.

Sample Mining and Data Mining: Combined Real-Time and Retrospective Approaches for the Identification of Emerging Novel Psychoactive Substances.

Novel psychoactive substances (NPS) are synthetic drugs that pose serious public health and safety concerns. A multitude of NPS have been identified in the United States, often implicated in forensic investigations. The most common and effective manner for identifying NPS is by use of mass spectrometry and the true utility lies within nontargeted acquisition techniques. During this study, a liquid chromatography quadrupole time-of-flight mass spectrometry (LC-QTOF-MS) assay was developed, validated, and implemented for forensic toxicology testing. A SCIEX TripleTOF™ 5600 + with SWATH® acquisition was used. Resulting data were compared against an extensive library database containing more than 800 compounds. The LC-QTOF-MS assay was applied to the reanalysis of biological sample extracts to discover emergent NPS. More than 3,000 sample extracts were analyzed, and more than 20 emerging NPS were detected for the first time. Among these were isopropyl-U-47700, 3,4-methylenedioxy-U-47700, fluorofuranylfentanyl, N-methyl norfentanyl, 2F-deschloroketamine, 3,4-methylenedioxy-alpha-PHP, eutylone, and N-ethyl hexedrone.

An Insight into the Discovery of Potent Antifilarial Leads Against Lymphatic Filariasis.

BACKGROUND AND OBJECTIVES: Lymphatic filariasis is a neglected tropical disease caused by infection with filarial worms that are transmitted through mosquito bites. Globally, 120 million people are infected, with nearly 40 million people disfigured and disabled by complications such as severe swelling of the legs (elephantiasis) or scrotum (hydrocele). Current treatments (ivermectin, diethylcarbamazine) have limited effects on adult parasites and produce side effects; therefore, there is an urgent to search for new antifilarial agents. Numerous studies on the antifilarial activity of pure molecules have been reported accross the recent literature. The present study describes the current standings of potent antifilarial compounds against lymphatic filariasis. METHODS: A literature search was conducted for naturally occurring and synthetic antifilarial compounds by referencing textbooks and scientific databases (SciFinder, PubMed, Science Direct, Wiley, ACS, SciELO, Google Scholar, and Springer, among others) from their inception until September 2019. RESULTS: Numerous compounds have been reported to exhibit antifilarial acitivity in adult and microfilariae forms of the parasites responsible for lymphatic filariasis. In silico studies of active antifilarial compounds (ligands) showed molecular interactions over the protein targets (trehalose-6-phosphate phosphatase, thymidylate synthase, among others) of lymphatic filariasis, and supported the in vitro results. CONCLUSION: With reference to in vitro antifilarial studies, there is evidence that natural and synthetic products can serve as basic scaffolds for the development of antifilarial agents. The optimization of the most potent antifilarial compounds can be further performed, followed by their in vivo studies.

Recomendação nº 042, de 11 de outubro de 2019: recomenda ao Governador do Estado de São Paulo, à Assembleia Legislativa do Estado de São Paulo, e ao Ministério Público Estadual de São Paulo, que a FURP não seja desestatizada / Recommendation No. 042, of October 11, 2019: recommends to the Governor of the State of São Paulo, to the Legislative Assembly of the State of São Paulo, and to the State Prosecutor's Office of São Paulo, that FURP not be privatized

Recomenda ao Governador do Estado de São Paulo, à Assembleia Legislativa do Estado de São Paulo, e ao Ministério Público Estadual de São Paulo, que: I - A FURP não seja desestatizada; II - Sejam apuradas as responsabilidades e tomadas as medidas cabíveis em razão dos problemas financeiros que atingem a FURP; III - Os interesses privados não se sobreponham ao interesse público; IV - Seja realizada uma revisão do processo contratual entre a FURP e a CPM, com celeridade, para que se restabeleça o equilíbrio econômico-financeiro da Fundação; e V - Se garanta a diferença fundamental de natureza jurídica das complexas atividades entre a Fundação e a Concessionária.

4F-MDMB-BINACA: A New Synthetic Cannabinoid Widely Implicated in Forensic Casework.

This is the first report regarding the characterization of the new synthetic cannabinoid 4F-MDMB-BINACA. 4F-MDMB-BINACA was first analytically confirmed in seized drug material using gas chromatography-mass spectrometry (GC-MS), liquid chromatography-quadrupole time-of-flight mass spectrometry (LC-QTOF), and nuclear magnetic resonance (NMR) spectroscopy. Subsequent to this characterization, 4F-MDMB-BINACA was detected in biological specimens collected as part of forensically relevant casework, including medicolegal death investigations and drug impaired driving investigations, from a variety of regions in the United States. Further analysis of biological specimens resulted in the identification of the metabolites 4F-MDMB-BINACA 3,3-dimethylbutanoic acid and 4-OH-MDMB-BINACA. 4F-MDMB-BINACA is appearing with increasing frequency as a contributory factor in deaths, creating morbidity and mortality risks for drug users. Laboratories must be aware of its presence and impact, incorporating 4F-MDMB-BINACA into workflows for detection and confirmation.

Causes of synthetic disease-modifying drug discontinuation in rheumatoid arthritis: Data from a large real-life cohort.

The treatment of rheumatoid arthritis (RA) has evolved rapidly in recent years. Nonetheless, conventional synthetic disease-modifying drugs (csDMARDs) remain the gold standard for RA treatment. The treatment for RA is expensive and this has a negative impact on public health. Given the low cost of csDMARDs compared to those of other treatment strategies, it is important to manage this type of treatment properly. Information on the duration of use of each drug and the reasons for their discontinuation is relevant to medical practitioners as it could improve the information available regarding side effects and their proper management. Moreover, data from clinical practice in the population can provide health care managers with information for resource allocation and optimization of csDMARD use with a consequent cost reduction in the treatment of RA. In this cross-sectional study, we aimed to describe the use of csDMARDs in public health services in Brazil, emphasizing on the duration of use and reasons for discontinuation of each drug. This study is a part of the REAL, a multicenter project that evaluated Brazilian patients with RA from eleven rheumatology services from August to October 2015. Patients were examined clinically, and an analysis of complementary exams and medical records was performed. A total of 1125 patients were included. 98.5% were women with a median age of 55.6 years. 36% and 90.84% patients were using biological disease-modifying drugs (bDMARDs) and csDMARDs, respectively. The duration of use and doses of each medication and the causes of suspension were analyzed. Most of the patients analyzed in this study were using csDMARDs for prolonged periods and methotrexate showed the longest duration of use. Interruption indexes due to ineffectiveness and side effects were analyzed. The knowledge of common adverse effects may alert attending physicians to the proper management of effective and low-cost therapeutic groups.

Life-Threatening Bleeding and Deaths from Synthetic Cannabinoids.

'Fake weed' containing rat poison raises alarm.

Secuquinumabe para o tratamento da artrite psoriásica em pacientes adultos com resposta inadequada a medicamentos modificadores do curso da doença sintéticos ou biológicos da classe anti-TNF / Secuquinumab for the treatment of psoriatic arthritis in adult patients with inadequate response to synthetic or biological anti-TNF class disease course modifying drugs

CONTEXTO: A artrite psoriásica (AP) é uma artrite inflamatória crônica, autoimune, que acomete entre 0,06 e 0,25% da população. O tratamento envolve medidas não farmacológicas e o uso de anti-inflamatórios não esteroidais (AINEs), glicocorticoides e medicamentos modificadores do curso da doenças (MMCD) sintéticos e biológicos, segundo o tipo de acometimento predominate (AP periférica ou axial). Os medicamentos biológicos são indicados em caso de falha ao tratamento prévio com os AINES e MMCD sintéticos (AP periférica) ou AINES (AP axial), constituindo a última linha de tratamento da doença. TECNOLOGIA: SECUQUINUMABE (COSENTYX®). PERGUNTA: Secuquinumabe é eficaz e seguro para o tratamento da artrite psoriásica ativa, quando a resposta à terapia prévia com medicamentos modificadores do curso da doença (MMCD), sintéticos ou biológicos, for inadequada? EVIDÊNCIAS CIENTÍFICAS: Foram incluídos três ensaios clínicos e quatro revisões sistemáticas de comparação direta de secuquinumabe contra placebo e indireta com relação aos demais biológicos disponíveis no SUS. Comparações indiretas demonstraram eficácia equivalente entre secuquinumabe e os medicamentos anti-TNF disponíveis no SUS, porém estes estudos apresentaram baixa qualidade metodológica. Dados dos ensaios clínicos randomizados FUTURE 1 e FUTURE 2 demonstraram que secuquinumabe 150 mg é eficaz em 24 semanas, comparado a placebo, para os desfechos de AP periféricos (ACR20, ACR50, ACR 70, DAS28 e entesite), de pele (PASI75, PASI 90), e para redução da progressão radiográfica. Para pacientes com falha ao anti-TNF, apenas sequinumabe 300 mg foi mais eficaz que placebo (FUTURE II). Para pacientes com psoríase e artrite psoriásica concomitante, sequinumabe 300 mg foi mais eficaz que placebo e que etanercepte (ERASURE e FIXTURE). Com relação aos resultados de segurança, as taxas de eventos adversos, eventos adversos sérios e descontinuação por eventos adversos foram semelhantes entre os grupos secuquinumabe e placebo até 16 semanas de acompanhamento, porém a ocorrência de infecções ou infestações foi maior entre pacientes que receberam secuquinumabe. Ao final de 104 semanas, 84,5% dos pacientes que utilizaram secuquinumabe relataram pelo menos um evento adverso, sendo a ocorrência de infecções ou infestações os mais comuns. AVALIAÇÃO ECONÔMICA: A análise de custo minização sugere que secuquinumabe na dose de 150 mg é mais barato em comparação com os medicamentos anti-TNF disponíveis no SUS em todos os cenários propostos. Secuquinumabe 300 mg é mais caro que adalimumabe, etanercepte e golimumabe no primeiro ano de uso e mais caro que golimumabe a partir do segundo ano. Esta análise foi sensível à redução de 10% no preço de aquisição dos medicamentos disponíveis no SUS, favorecendo os medicamentos já incorporados. AVALIAÇÃO DE IMPACTO ORÇAMENTÁRIO: A análise de impacto orçamentário apresentada sugere economia de até R$ 60 milhões de reais com a incorporação de secuquinumabe em cinco anos, o que representa 4% do total gasto com AP. Entretanto, parâmetros estimados no modelo estão inadequados e podem influenciar o resultado final, tais como: baixo índice de troca entre os medicamentos biológicos; constante e elevado market share para o secuquinumabe; taxa de descontinuação sem troca de 0%. MONITORAMENTO DO HORIZONTE TECNOLÓGICO: Alguns medicamentos estão em fase de desenvolvimento clínico para o tratamento da artrite psoriásica (abatacepte, apremilaste, brodalumabe, guselkumabe, ixequizumabe, tofacitinibe e upadacitinibe). Essas novas tecnologias ainda não tiveram seu registro aprovado pela Anvisa para a AP. CONSIDERAÇÕES FINAIS: Não existem estudos que avaliem o secuquinumabe com outros medicamentos disponíveis pelo SUS por comparação direta. Os ensaios clínicos randomizados FUTURE 1, FUTURE 2, FIXTURE e ERASURE mostraram que secuquinumabe foi melhor do que o placebo para os desfechos de eficácia. Não houve diferenças entre secuquinumabe e placebo para a segurança. A revisão sistemática de comparação indireta relatou que secuquinumabe apresenta eficácia semelhante aos anti-TNF para o desfecho ACR 20. Secuquinumabe 150 mg possui menor custo do que as outras alternativas disponíveis no SUS. O mesmo não ocorre quando a dose de 300 mg é necessária, em casos de falha a um anti-TNF e na presença de psoríase moderada a grave. RECOMENDAÇÃO PRELIMINAR DA CONITEC: A CONITEC, em sua 58ª reunião ordinária, realizada no dia 03 de agosto de 2017, recomendou que a matéria fosse submetida à consulta pública com recomendação inicial favorável à incorporação no SUS do secuquinumabe 150mg para artrite psoriásica moderada a grave com falha terapêutica inicial ao AINE e/ou MMCD sintético e do secuquinumabe 300mg para pacientes com atrite psoriásica com falha terapêutica inicial ao anti-TNF ou para pacientes com psoríase e artrite psoriásica concomitante. Entretanto, a incorporação está condicionada à redução de preço do secuquinumabe 300mg ao menor preço de anti-TNF disponível no SUS, pois considerou-se que o secuquinumabe tem equivalência terapêutica com os medicamentos anti-TNF já disponíveis no SUS. CONSULTA PÚBLICA: Foram recebidas 66 contribuições de experiência ou opinião e 25 contribuições de cunho técnico-científico, onde 95% e 96% concordaram com a recomendação preliminar da CONITEC, respectivamente. Todas as contribuições foram avaliadas quantitativamente e qualitativamente. As contribuições destacaram a importância da incorporação de mais uma opção terapêutica para o tratamento da artrite psoriásica. As contribuições científicas enviadas não apresentaram evidências adicionais sobre a eficácia, efetividade e segurança do secuquinumabe em comparação aos medicamentos disponíveis no SUS. DELIBERAÇÃO FINAL: Os membros da CONITEC presentes na 62ª reunião ordinária da plenária, realizada no dia 07/12/2017, deliberaram por unanimidade recomendar a incorporação de secuquinumabe para o tratamento de artrite psoriásica em pacientes adultos com resposta inadequada a medicamentos modificadores do curso da doença sintéticos ou biológicos da classe anti-TNF. Foi assinado o Registro de Deliberação nº 317/2017 (Retificado e substituído pelo Registro de deliberação n° 402/2018). Todavia os membros da CONITEC presentes na 73ª reunião ordinária do plenário do dia 05/12/2018, motivados pela necessidade de adequação do texto da deliberação final do dia 07/12/2017 e com base nas informações contidas neste relatório, a fim de refletir a deliberação, recomendaram por unanimidade a incorporação do secuquinumabe para artrite psoríaca em pacientes com doença ativa (moderada a grave) e com falha terapêutica com uso de MMCD-s e de pelo menos 01 anti-TNF, conforme Protocolo Clínico e Diretrizes Terapêuticas. Registro de deliberação n° 402/2018. DECISÃO: (Portaria revogada): Incorporar o secuquinumabe para o tratamento de artrite psoriásica em pacientes adultos com resposta inadequada a medicamentos modificadores do curso da doença sintéticos ou biológicos da classe anti-TNF no âmbito do Sistema Único de Saúde ­ SUS. Dada pela Portaria nº 3 de 25 de janeiro de 2018, publicada no Diário Oficial da União nº 18, seção 1, página 123. (Portaria vigente): Incorporar o secuquinumabe para o tratamento de artrite psoriásica em pacientes adultos com resposta inadequada a medicamentos modificadores do curso da doença sintéticos e biológicos da classe anti-TNF, mediante Protocolo Clínico e Diretrizes Terapêuticas do Ministério da Saúde, no âmbito do Sistema Único de Saúde - SUS e revoga a Portaria nº 3, de 24 de janeiro de 2018. Dada pela Portaria nº 1 de 21 de janeiro de 2019, publicada no Diário Oficial da União nº 14, seção 1, página 50.