Anti-secretory, anti-inflammatory and anti-Helicobacter pylori activities of several fractions isolated from Piper carpunya Ruiz & Pav.

ETHNOPHARMACOLOGICAL RELEVANCE: The leaves of Piper carpunya Ruiz & Pav. (syn Piper lenticellosum C.D.C.) (Piperaceae), are widely used in folk medicine in tropical and subtropical countries of South America as an anti-inflammatory, anti-ulcer, anti-diarrheal and anti-parasitical remedy as well as an ailment for skin irritations. AIMS OF THE STUDY: To study the anti-inflammatory, anti-secretory and anti-Helicobacter pylori activities of different fractions isolated from an ethanolic extract of the leaves of Piper carpunya, in order to provide evidence for the use of this plant as an anti-ulcer remedy. Moreover, to isolate the main compounds of the extract and relate their biological activity to the experimental results obtained with the fractions. MATERIALS AND METHODS: Sixteen fractions were obtained from the ethanolic extract (F I-XVI) and 16 pure compounds were isolated and identified from these fractions. We studied the effects of the fractions (0.1-400microg/mL) on the release of myeloperoxidase (MPO) enzyme from rat peritoneal leukocytes, on rabbit gastric microsomal H(+), K(+)-ATPase activity and anti-Helicobacter pylori anti-microbial activity using the microdilution method (MM). The main compounds contained in the fractions were isolated and identified by (1)H- and (13)C NMR spectra analysis and comparison with the literature data. RESULTS: Eight fractions showed inhibition of MPO enzyme (F I-IV, X, XII, XIV and XV). The highest inhibition was observed with F XIV (50microg/mL, 60.9%, p<0.001). F X and XII were the most active ones, inhibiting the gastric H(+), K(+)-ATPase activity with IC(50) values equal to 22.3microg/mL and 28.1microg/mL, respectively. All fractions, except F XV, presented detectable anti-Helicobacter pylori activity, with a diameter of inhibition zones ranging from 11mm up to 50mm. The best anti-Helicobacter pylori activity was obtained with F III and V. Both fractions killed Helicobacter pylori with lowest concentration values, about 6.25mug/mL. Sixteen pure compounds were isolated, five of them are flavonoids that possess strong anti-oxidant and free radical scavenging activity, e.g. vitexin, isovitexin, and rhamnopyranosylvitexin. Terpenoids like sitosterol, stigmasterol and phytol, which have shown gastroprotective activity, and dihydrochalcones, like asebogenin, with anti-bacterial activity, were also isolated. Furthermore, the rare neolignan 1, that is a DNA polymerase beta lyase inhibitor, and (6S, 9S)-roseoside, that shows strong anti-bacterial activity, were isolated, for the first time, from the genus Piper. CONCLUSIONS: We suggest that the flavonoids isolated from F I and II (vitexin, isovitexin, rhamnopyranosylvitexin and isoembigenin) contribute to the anti-MPO activity, as well as to their anti-Helicobacter pylori activity. These flavonoids may also be responsible for the important inhibition of H(+), K(+)-ATPase activity. Also the phytosterols and phytol obtained from F XIV and XV could be involved in these gastroprotective activities. These results encourage us to continue phytochemical studies on these fractions in order to obtain full scientific validation for this species.

The aerial parts of Guazuma ulmifolia Lam. protect against NSAID-induced gastric lesions.

Guazuma ulmifolia Lam., a member of the Sterculiaceae family, is used in folk medicine because of its antioxidant, antimicrobial and antihypertensive properties. Most of the research work carried out on this plant has focused on the bark because of its high concentration of antioxidant proanthocyanidins. The flowers and leaves of Guazuma ulmifolia, though less studied, are also used as a remedy for different conditions, such as kidney and gastrointestinal diseases, fever and diabetes. The aim of this study was to assess the gastroprotective effects of an aqueous suspension of the ethanolic extract from leaves and flowers of Guazuma ulmifolia in a model of acute gastric ulcer induced by diclofenac as ulcerogenic agent, using the proton pump inhibitor omeprazole as a protection reference. Therefore, the extract was administered two times orally to three groups of Wistar rats at doses of 500, 250 and 125mg/kg, with a 24-h interval between doses. Diclofenac (100mg/kg) was given 1h after the last administration of the extract. Pretreatment with Guazuma ulmifolia or omeprazole decreased the ulcerated area in a dose-dependent way. Myeloperoxidase activity as a marker of neutrophil infiltration was slightly reduced in vivo, whereas in vitro, anti-inflammatory activity was clearly inhibited in a dose-dependent way. The lowest doses of the extract significantly decreased the levels of lipoperoxides, and superoxide dismuthase activity increased to a similar extent as with omeprazole (P<0.001). Examination of glutathione metabolism reflected a significant rise in glutathione peroxidase activity at the highest dose of Guazuma ulmifolia. Finally, there was a faint elevation in prostaglandin E(2) levels with all doses, though the depletion induced by diclofenac could not be reverted. We conclude that the aerial parts of Guazuma ulmifolia protect gastric mucosa against the injurious effect of NSAIDs mainly by anti-inflammatory and radical-scavenging mechanisms.

Actuación del farmacéutico comunitario ante el paciente automedicado / No disponible

La automedicación responsable es una práctica aceptada por las instituciones y la industria sanitarias. Sinembargo, debe ser controlada por profesionales cualificados ya que puede implicar riesgos si el paciente no tiene una formación sanitaria adecuada.Objetivos: Valorar la actuación del farmacéutico comunitario ante la demanda de consejo o indicaciónfarmacéutica para una determinada dolencia, así como de medicamentos sin prescripción médica. Cuantificarlas patologías más prevalentes que son motivo de consulta en la farmacia comunitaria; promover eluso racional del medicamento controlando, en la medida de lo posible, la automedicación; y confirmar si laindicación y la dispensación farmacéutica son plataforma para el seguimiento farmacoterapéutico.Método: Estudio descriptivo sobre pacientes que acuden a la oficina de farmacia siguiendo un protocolosistemático de información de estos pacientes y registrando la actuación del farmacéutico en cada caso.Resultados: El protocolo se aplicó a 185 pacientes que solicitaron el servicio de indicación farmacéutica y177 pacientes que solicitaron un medicamento concreto. La edad del 59% de los pacientes estaba en un rangode 15-40 años, el 90% no tenía alergia a ningún medicamento, ni historia de patologías anteriores y el 85% de las consultas fue de procesos banales. Al 60% de los individuos incluidos en el estudio se le indicó o dispensó una especialidad publicitaria y al 15,75% se les derivó a otros servicios sanitarios.Conclusiones: El farmacéutico es identificado, por un grupo importante de pacientes, como el primereslabón en la cadena sanitaria para resolver problemas de salud «menores», que al experimentar mejoríade forma perceptible no requieren la visita al médico de atención primaria. En estos casos, el farmacéuticopuede realizar un importante papel en el uso racional del medicamento. Además, el registro sistemático delas actuaciones sirve de base para iniciar el seguimien-to farmacoterapéutico en aquellos pacientes en los quese detecte esta necesidad

Responsible self-medication is a practice commonly accepted by sanitary institutions and pharmaceuticalindustry. However, due to its inherent risks when the patient lacks an adequate sanitary education, it has tobe supervised by qualified professionals.Objectives: To evaluate the role of the community pharmacist faced with patient’s need for counseling orpharmaceutical indication for a specific malady, as well as dispensing drugs without medical prescription.To quantify the most prevalent pathologies that people ask about in the community pharmacy; to encouragethe rational drug use by means of controlling, if possible, self-medication; and to assess if indication and pharmaceutical dispensation are a good platform for pharmacotherapy follow-up.Method: Descriptive study on patients who visit the community pharmacy, following a systematic informationprotocol and recording the intervention of the pharmacist in each case.Results: The protocol was applied to 185 patients who requested pharmaceutical indication and to 177patients who demanded a specific drug. The age range of 59% of the patients was 15-40 years, 90% did notsuffer from any drug allergies, nor did they have a history of former pathologies and 85% of the consultations were about banal processes. Sixty per cent of the subjects included in the study received indication or dispensation of an «over the counter» drug and 15.75% of the patients were diverted to other sanitary services.Conclusions: An important number of patients consider that the pharmacist is the first link of the healthsystem in order to solve «minor» problems, and as they experience a substantial improvement, it is not necessaryfor them to visit the primary care doctor. In these cases, the pharmacist may play a paramount role inpromoting rational drug use. Moreover, the systematic recording of the pharmacist’s interventions is a firststep for pharmacotherapy follow-up in those patients where the need is detected (AU)

Modificación de la calidad de vida de pacientes polimedicados mediante atención farmacéutica / No disponible

Fundamento. Determinar si las actividades de seguimiento farmacoterapéutico a pacientes crónicos polimedicados,como parte de la atención farmacéutica realizada por farmacéuticos comunitarios, modifica las distintas dimensiones de la calidad de vida percibida. Métodos. 110 pacientes polimedicados fueron aleatorizados ofertándosele a la mitad el seguimiento farmacotera-péutico en la farmacia comunitaria, y a la otra mitad atención habitual. La oferta de seguimiento farmacoterapéutico se hizo en 8 farmacias de la provincia de Sevilla durante 6 meses, cuyos titulares son farmacéuticos específicamente entrenados en actividades de atención farmacéutica. La variable resultado principal es la calidad de vida percibida, medida según el cuestionario SF-36 (versión española). La evaluación se hizo por investigadores independientes.Resultados. A los 6 meses, no se observan diferencias estadísticamente significativas en ninguno de los ochocomponentes de la calidad de vida (función física, rol físico, dolor corporal, salud general, vitalidad, funciónsocial, rol emocional y salud mental). Comparativamente con los valores nacionales de referencia, los pacientescrónicos polimedicados tienden a manifestar peor calidad de vida que la media nacional de referencia,especialmente las mujeres en las dimensiones de rol físico, dolor corporal, vitalidad, función social y saludmental (p<0,05).Conclusiones. La calidad de vida de los pacientes polimedicados es peor que la media nacional. El seguimiento farmacoterapéutico desde las oficinas de farmacia no demuestra mejoría

Objective. To determine whether pharmacotherapeutic follow-up activities in chronic patients on multidrugtherapy, as part of the pharmaceutical care provided by community pharmacists, modifies the dimensionsof perceived quality of life.Methods. The study involved 110 patients on multidrug therapy. Half of them were randomized to undergopharmacotherapeutic follow-up in the community pharmacy and the other half to regular care. The offer ofpharmatherapeutic follow-up involved eight pharmacies in the province of Seville over a six-month period.The proprietors were pharmacists specifically trained in pharmaceutical care activities. The main outcomevariable was the perceived quality of life, measured according to the Spanish version of the SF-36 questionnaire. The evaluation was carried out by independent investigators.Results. After six months of study, no statistically significant differences were observed in any of the eightquality of life components (physical functioning, physical role, bodily pain, general health, vitality, social functioning, emotional role and mental health). When compared with the national reference values, chronicpatients on multidrug therapy tended to present a lower quality of life than the national average. The mostmarked differences were found in women with respect to physical role, bodily pain, vitality, social functioningand mental health (p<0.05).Conclusions. The quality of life in patients on multidrug therapy is lower than the national average. Pharmacotherapeutic follow-up carried out in pharmacies is not associated with an improvement

Pharmaceutical care: past, present and future.

Since the concept of Pharmaceutical Care was introduced from United States about twenty years ago, this initiative has become a dominant form of practice for thousands of pharmacists around the world. Currently, pharmaceutical care is understood as the pharmacists' compromise to obtain the maximum benefit from the pharmacological treatments of the patients, being therefore responsible of monitoring their pharmacotherapy. As the profession has moved from a product orientation (dispensing medications) to a patient focus, clinical training requirements have expanded. This is a slow but ongoing process, which started from a philosophical point of view, in order to transform the concept of Pharmacy from commodity-based, mercantile operations into a clinical profession in the community pharmacies. Since its introduction, there has been an ample debate on the definition of pharmaceutical care due to differences in Pharmacy systems and in health care structure among the different countries. Moreover, several implementation barriers exist, which are attributable to problems in education, skills, resources and environment. Indeed, an awareness of the problem resulting from the use of medicines exists and numerous studies reflect that drug use control is necessary since there is an important relationship between morbidity / mortality and pharmacotherapy. Thus, it is possible to evaluate the benefits of pharmaceutical care on patients' health and ultimately on society. Many studies have been conducted, which show that the provision of pharmaceutical care has its value in common pathologies such as diabetes, hypertension, asthma, hyperlipidemia, chronic pain, rheumatic diseases or psychiatric disorders, as well as in polymedicated patients. A large amount of data is currently being published in biomedical journals, in an effort to establish the clinical, economic and humanistic viability of pharmaceutical care. Thus, the aim of this review is to study the evolution of this practice from its beginning until nowadays. Furthermore, we have analyzed a number of implementation programs performed in countries of Europe, the United States and Latin America, focusing on clinical, economical and humanistic outcomes, and also, on the current concept of drug therapy problems (DTP) considered as failures in drug therapy. We conclude that the positive outcomes obtained with different programs of pharmaceutical care are making a beneficial change in patients' health but still more research projects should be conducted to support this change.

Structural process and implementation programs of pharmaceutical care in different countries.

Pharmaceutical care started in the nineties in the United States and has rapidly extended in many other countries. Although there are different trends, such as clinical pharmacy services, cognitive services, medication management, medication review, they all share the same philosophy and objectives, namely "the responsible provision of drug therapy for the purpose of achieving definite outcomes that improve a patient's quality of life". To attain these objectives, a pharmaceutical care process has to be followed point-by-point in order to detect possible medication-related problems. Furthermore, pharmacists have to work together with patients, and ultimately with physicians to establish a care plan. This methodology requires basic skills of documentation and communication and therefore, it is important to establish implementation programs aimed at community-, hospital-, and consultant pharmacists, and to consider PC as a basic element of University teaching programs and postgraduate studies. Moreover, there are still barriers that hinder the provision of this service and have to be overcome. In this article, we have revised the implementation process and the existing projects in many countries and we conclude that despite the enormous amount of work, there is still much to be done from sides of Administration and pharmacists themselves.

Evidence for protective and antioxidant properties of rutin, a natural flavone, against ethanol induced gastric lesions.

This study was designed to determine the ulcer-protecting effects of rutin, a natural flavone, against gastric lesions induced by 50% ethanol, the experimental model related to lesion pathogenesis with production of reactive species. The possible involvement of sulphydryl compounds (SH), neutrophil infiltration, and the capacity of this flavone to restrain the oxidative process produced in the gastric tissue were also investigated. The levels of thiobarbituric acid (TBA, as index of lipid peroxidation), the myeloperoxidase activity (MPO, as a marker of neutrophil infiltration), the content of mucosal sulphydryls (SH) groups and the activity of glutathione peroxidase (GSH-Px, an important antioxidant enzyme) were determined. Pretreatment with the highest dose of rutin (200 mg/kg), 120 min before 50% ethanol, resulted in the most effective necrosis prevention. TBA reactive substances in the gastric mucosa, were increased by ethanol injury, and this increase was inhibited by the administration of 200 mg/kg of rutin. However, the flavonoid was not able to modify the ethanol-induced neutrophil infiltrate expressed as myeloperoxidase activity. Exposure of the gastric mucosa to 50% ethanol induced a significant diminution in gastric non-protein SH content; this parameter also was not modified by the treatment with rutin. GSH-Px activity decreased in the gastric mucosa after ethanol-treatment. In contrast, rutin at all tested doses induced a significant increase in this enzymatic activity, higher than in control group. These results suggest that the gastroprotective effect of rutin in this experimental model appears through an anti-lipoperoxidant effect, and also by enhancement of the anti-oxidant enzymatic (GSH-Px) activity.

[Rational use of non-steroidal anti-inflammatory drugs in primary care]. / Uso racional de antiinflamatorios no esteroides en atención primaria.

OBJECTIVE: To quantify the consumption of non-steroidal anti-inflammatory drugs (NSAIDs) charged to the Andalusian Health Service and other health bodies, with a view to finding prescription quality and the pharmaceutical cost generated in the province of Sevilla in 1996. SETTING: The 759 pharmacies in the province of Seville. PARTICIPANTS: Beneficiaries of the Andalusian Health Service (pensioners and non-pensioners) and other health bodies. MEASUREMENTS AND RESULTS: The overall quantitative consumption indicators of the entire therapeutic group, and the dose per inhabitant per day (DID) of the systemic active principles which were significantly most prescribed, were determined. 3967487 NSAID prescriptions were dispensed, at a pharmaceutical cost of 2369, 483, 257 pesetas. Naproxen and Piroxicam were the active principles most used in terms of their DIDs. Of the population groups analysed, it is essentially the pensioners group which consumes these drugs. CONCLUSIONS: Seville province's NSAID use profile is inadequate, since the main drugs prescribed are those associated with high incidences of undesirable side-effects.