Comercialização de Plantas Medicinais no Município de Arapiraca-AL / Medicinal Plants commercialization in the city of Arapiraca-AL

RESUMO O comércio de plantas medicinais em feiras livres faz parte da cultura de muitas cidades da região Nordeste do Brasil. Objetivou-se com esta pesquisa verificar a existência de padrões de comercialização de plantas medicinais nas feiras livres do município de Arapiraca-AL. A metodologia incluiu a realização de entrevistas semiestruturadas, aplicadas a vendedores de plantas medicinais, sendo estas gravadas em áudio após assinatura do Termo de Consentimento Livre e Esclarecido, as técnicas da observação direta, “bola de neve” e lista livre. Os informantes indicaram 42 plantas medicinais, tendo Fabaceae com maior destaque em número de espécies. Do total de espécies identificadas, a maior parte é nativa (82%) e o hábito predominante é o arbóreo. Este estudo revelou que a produção e comercialização de plantas medicinais possuem um padrão local, com as plantas adquiridas através de terceiros, não havendo um padrão mínimo de qualidade, sendo necessária a implantação de políticas públicas voltadas a capacitação destes profissionais, agregando valor ao saber popular sobre plantas medicinais.

ABSTRACT The marketing of medicinal plants in street fairs is part of the culture of many cities in the Northeast of Brazil. The aim of this study was to identify the marketing patterns of medicinal plants in Arapiraca-AL city. The methodologies involved semi-structured interviews, givento the merchants of medicinal plants, t after a Free and Clear Consent Form, by which the survey participants were aware of the risks and benefits of it and can stop it if necessary to judge, the interviews were recorded. Snow-ball and free list techniques were also used. The informants indicated 42 species; Fabaceae had the highest number of species. From the total of identified medicinal plants, 80% were native and the predominant habitat was arboreous. This study revealed that the production and marketing of medicinal plants has a local pattern, with the plants being acquired through outsourcing, and there is no minimum quality standard, requiring the implementation of public policies for the training of these professionals, adding value to the common knowledge of medicinal plants.

Reversal of the anticoagulant and anti-hemostatic effect of low molecular weight heparin by direct prothrombin activation

Lopap, found in the bristles of Lonomia obliqua caterpillar, is the first exogenous prothrombin activator that shows serine protease-like activity, independent of prothrombinase components and unique lipocalin reported to interfere with hemostasis mechanisms. To assess the action of an exogenous prothrombin activator reversing the anticoagulant and antihemostatic effect induced by low molecular weight heparin (LMWH), male New Zealand rabbits (N = 20, weighing 3.8-4.0 kg) allocated to 4 groups were anticoagulated with 1800 IU/kg LMWH (iv) over 2 min, followed by iv administration of saline (SG) or recombinant Lopap (rLopap) at 1 µg/kg (LG1) or 10 µg/kg (LG10), 10 min after the injection of LMWH, in a blind manner. Control animals (CG) were treated only with saline. The action of rLopap was assessed in terms of activated partial thromboplastin time (aPTT), prothrombin fragment F1+2, fibrinogen, and ear puncture bleeding time (BT) at 5, 10, 15, 17, 20, 30, 40, 60, and 90 min after initiation of LMWH infusion. LG10 animals showed a decrease of aPTT in more than 50% and BT near to normal baseline. The level of prothrombin fragment F1+2 measured by ELISA had a 6-fold increase with rLopap treatment (10 µg/kg) and was inversely proportional to BT in LMWH-treated animals. Thus, Lopap, obtained in recombinant form using E. coli expression system, was useful in antagonizing the effect of LMWH through direct prothrombin activation, which can be a possible strategy for the reversal of bleeding and anticoagulant events.

Red cell alloimmunization in sickle-cell anaemia patients

This study in King Fahd Hospital of the University, Saudi Arabia, assessed the frequency of alloimmunization to red cell antigens in sickle-cell anaemia patients over 1996-2004 in order to evaluate the risk of alloimmunization and identify the most common alloantibodies. A retrospective analysis of the transfusion history and medical records of 350 patients aged 2 to 75 years who had received at least 1 transfusion found that 48 patients had developed alloantibodies [13.7%]. The most common alloantibodies detected were: anti-E alone [18.8%], nonspecific [12.5%], inconclusive [12.5%], anti-K [10.4%] and anti-c 3 [6.3%]. Some patients had 1 alloantibody, while others more than 1 and even multiple antibodies. Nine patients had a persistent positive direct antiglobulin test

Platelet aggregation and physiological anticoagulants in sickle-cell disease

During the period January 2002- December 2004, we assessed 30 sickle- cell anaemia patients admitted to hospital in Al Khobar with vaso- occlusive crisis for levels of antithrombin [AT] III, protein C [PC] and protein S [PS]. We also did platelet aggregation studies. Steady state levels were assessed during follow- up and compared with 36 adult controls. Levels of PC, PS and AT III in the group were significantly higher than in those in vaso- occlusive crisis and those in steady state control [P < 0.001]. There was a statistically significant difference between controls and patients for all platelet factors except adrenaline. There was no significant difference between the levels of PC, PS, aggregation AT III and platelet aggregation variables in patients in the steady state and in vaso- occlusive crisi

Impaired cerebral autoregulation and 6-month outcome in children with severe traumatic brain injury: preliminary findings.

The objective of this study was to describe the incidence of impaired cerebral autoregulation and to describe the relationship between impaired cerebral autoregulation and outcome after severe pediatric traumatic brain injury (TBI). We prospectively examined cerebral autoregulation in 28 children

Understanding helicases as a means of virus control.

Helicases are promising antiviral drug targets because their enzymatic activities are essential for viral genome replication, transcription, and translation. Numerous potent inhibitors of helicases encoded by herpes simplex virus, severe acute respiratory syndrome coronavirus, hepatitis C virus, Japanese encephalitis virus, West Nile virus, and human papillomavirus have been recently reported in the scientific literature. Some inhibitors have also been shown to decrease viral replication in cell culture and animal models. This review discusses recent progress in understanding the structure and function of viral helicases to help clarify how these potential antiviral compounds function and to facilitate the design of better inhibitors. The above helicases and all related viral proteins are classified here based on their evolutionary and functional similarities, and the key mechanistic features of each group are noted. All helicases share a common motor function fueled by ATP hydrolysis, but differ in exactly how the motor moves the protein and its cargo on a nucleic acid chain. The helicase inhibitors discussed here influence rates of helicase-catalyzed DNA (or RNA) unwinding by preventing ATP hydrolysis, nucleic acid binding, nucleic acid release, or by disrupting the interaction of a helicase with a required cofactor.

Cerebral autoregulation in children during sevoflurane anaesthesia.

INTRODUCTION: Little is known about cerebral autoregulation in children. The aim of this study was to examine cerebral autoregulation in children. METHODS: Cerebral autoregulation testing was performed during less than 1 MAC sevoflurane anaesthesia in children (from 6 months to 14 yr) and in adults (18-41 yr). Mean middle cerebral artery flow velocities (V(MCA)) were measured using transcranial Doppler ultrasonography. Mean arterial pressure (MAP) was increased to whichever was greater: 20% above baseline or (i) 80 mm Hg for less than 9 yr, (ii) 90 mm Hg for 9-14 yr, and (iii) 100 mm Hg for adults. Cerebral autoregulation was considered intact if the autoregulatory index was > or =0.4. RESULTS: There were 13 subjects less than 2 yr old (Group 1), 13 subjects 2-5 yr (Group II), 14 subjects 6-9 yr (Group III), 12 subjects 10-14 yr (Group IV), and 12 adults (Group V; control group). All subjects had an autoregulatory index > or =0.4. There was no difference in autoregulatory index between children in Groups I-IV or between children and adults. DISCUSSION: We found no age-related differences in autoregulatory capacity during low-dose sevoflurane anaesthesia. We report no differences in autoregulatory capacity between children and adults.

Dynamic cerebral autoregulation in healthy adolescents.

BACKGROUND: : There is little information on the limits of cerebral autoregulation and the autoregulatory capacity in children. The aim of this study was to compare dynamic cerebral autoregulation between healthy adolescents and adults. METHODS: : Seventeen healthy volunteers 12-17 years (n = 8) and 25-45 years (n = 9) were enrolled in this study. Bilateral mean middle cerebral artery flow velocities (Vmca; (cm/s)) were measured using transcranial Doppler ultrasonography (TCD). Mean arterial blood pressure (MAP) and end-tidal carbon dioxide were measured continuously during dynamic cerebral autoregulation studies. Blood pressure cuffs were placed around both thighs and inflated to 30 mmHg above the systolic blood pressure for 3 min and then rapidly deflated, resulting in transient systemic hypotension. The change of Vmca to change in MAP constitutes the autoregulatory response, and the speed of this response was quantified using computer model parameter estimation. The dynamic autoregulatory index (ARI) was averaged between the two sides. RESULTS: : Adolescents had significantly lower ARI (3.9 +/- 2.1 vs. 5.3 +/- 0.8; P=0.05), and higher Vmca (75.2 +/- 15.2 vs. 57.6 +/- 15.0; P<0.001) than adults. CONCLUSION: : The autoregulatory index is physiologically lower in normal adolescents 12-17 years of age than in adults.

The influence of inhaled nitric oxide on cerebral blood flow and metabolism in a child with traumatic brain injury.

IMPLICATIONS: The effects of inhaled nitric oxide (INO) on cerebrovascular hemodynamics are not well established. We report no adverse cerebral effects with INO therapy in a child with traumatic brain injury.

Cerebral autoregulation before and after blood transfusion in a child.

The authors present the case of an anemic 22-month-old child undergoing lower extremity surgery in whom the lower limit of cerebral autoregulation was shifted to the right.

Coagulopathy predicts poor outcome following head injury in children less than 16 years of age.

The authors examined the relationship between fibrin degradation products (FDP) and outcome in children with isolated head injury by reviewing the records of 69 children who met the following criteria: (1) less than 16 years of age; (2) diagnosis of isolated head injury and (3) FDP levels. Outcome was evaluated using the following Glasgow Outcome Scale (GOS): 1 = death; 2 = vegetative state; 3 = functionally impaired; 4 = minimal dysfunction; 5 = premorbid level of functioning. Poor outcome was defined as GOS 1-3. Twenty-nine of 33 patients with FDP > 1000 (g/mL had GOS scores < 4 compared to 4/36 patients (11%) with FDP < 1000 microg/mL (Fisher's Exact Probability Test P < .0001). When stratified by GCS, no other prognosticator of outcome was needed when GCS was < 7 and > 12. In patients with GCS 7-12, however, 4/6 with FDP >1000 microg/mL had a poor outcome and all 12 patients with FDP < 1000 microg/mL had a good outcome (P = .004). The authors conclude that FDP > 1000 microg/mL predicts poor outcome in children with isolated head injury. Fibrin degradation products are a strong independent prognosticator of outcome in children when GCS is between 7 and 12.

Cerebrospinal fluid signal intensity increase on FLAIR MR images in patients under general anesthesia: the role of supplemental O2.

PURPOSE: To determine whether increased cerebrospinal fluid (CSF) signal intensity is seen on fluid-attenuated inversion recovery (FLAIR) magnetic resonance (MR) images in patients under general anesthesia and to investigate the cause of these changes. MATERIALS AND METHODS: MR images from nine examinations performed in eight patients under general anesthesia were reviewed retrospectively. In phantom experiments, T1 measurements obtained with several inhaled anesthetic agents and propofol dissolved in saline were compared with those obtained with either 100% O2 or room air. To confirm phantom experiment results, a healthy volunteer underwent sequential FLAIR imaging while breathing high-flow 100% O2. RESULTS: Of the nine examinations performed with patients under general anesthesia, eight had resultant images that showed increased CSF signal intensity within the basal cisterns and sulci over the cerebral convexities. Anesthetic phantom measurements showed T1 shortening only when the agent was administered with high concentrations of oxygen. In the healthy volunteer, images obtained before and during administration of 100% O2 demonstrated increased CSF signal intensity after O2 administration; this was identical to the changes observed in patients under anesthesia. CONCLUSION: The paramagnetic effects of supplemental O2 administration result in shortened CSF T1. Radiologists should be aware of this phenomenon to avoid attributing increased CSF signal intensity on FLAIR images to abnormal CSF properties such as hemorrhage or elevated protein content.

Standards of neuroanesthesia.

Currently there are no published standards of neuroanesthesia. However, consensus guidelines based on physiological considerations, published literature, clinical experience and expert opinions do exist. Four areas of the practice of neuroanesthesia: premedication, intraoperative algorithms, emergency algorithms, and postoperative care of the neurosurgical patient will be reviewed.

Managing mature cystic teratomas of the ovary.

Mature cystic teratomas (MCT), commonly called dermoid cysts, are the most common benign germ cell tumors of the ovary in women of reproductive age. Future fertility is of major concern among these women; therefore, the surgical management must focus on preserving ovarian tissue and minimizing adhesion formation. Patients requiring surgery should be appropriately counseled about the risks and benefits of laparoscopy and laparotomy, the risks of intraoperative MCT spillage and adhesion formation. In addition, the risks of recurrence and malignant transformation should be discussed. The parents of children with MCTs have the same concerns as older women and a similar discussion should take place. The goal of this article is to review these issues and provide the physician with the information to counsel their patients preoperatively.

Rocuronium versus succinylcholine-atracurium for tracheal intubation and maintenance relaxation during propofol anesthesia.

STUDY OBJECTIVES: To compare the onset and offset time (clinical duration), and intubating conditions obtained with rocuronium bromide 0.6 mg/kg and succinylcholine 1.0 mg/kg after induction with propofol and fentanyl; and to compare rocuronium with atracurium for maintenance during propofol anesthesia. DESIGN: Prospective, open-label, parallel group comparative, randomized study. SETTING: Operating rooms of a university hospital. PATIENTS: 30 ASA physical status I and II adult patients scheduled for elective surgeries with general anesthesia. INTERVENTIONS: Patients premedicated with midazolam 2 mg were anesthetized with fentanyl 2 microg/kg followed by propofol 2.5 mg/kg and muscle relaxants. Group 1 (n = 15) received succinylcholine 1.5 mg/kg and Group 2 (n = 16) received rocuronium bromide 0.6 mg/kg. Intubation was performed 60 seconds after the administration of muscle relaxant. Patients in Group 1 received atracurium and patients in Group 2 received rocuronium for maintenance if required. MEASUREMENTS: The ease of intubation was scored using a scale of 1 to 4. Onset and offset time monitored with evoked twitch response of the adductor pollicis were recorded. MAIN RESULTS: Intubation was successful in all patients and there was no difference in scores between the two groups. Although onset time was shorter with succinylcholine than with rocuronium, neuromuscular blockade was successfully antagonized in both groups, and the recovery profile was not different between the two groups. CONCLUSIONS: Rocuronium bromide at a dose of 0.6 mg/kg, when used with propofol and fentanyl for induction, provides intubating conditions similar to succinylcholine 1.0 mg/kg at 1 minute. The actual onset time and offset time, however, are significantly longer with rocuronium. There was no difference between atracurium and rocuronium as a maintenance drug. Rocuronium is suitable for surgical procedures greater than 30 minutes, eliminating the need for an additional relaxant to succinylcholine.

Graded hypercapnia and cerebral autoregulation during sevoflurane or propofol anesthesia.

BACKGROUND: Hypercapnia abolishes cerebral autoregulation, but little is known about the interaction between hypercapnia and autoregulation during general anesthesia. With normocapnia, sevoflurane (up to 1.5 minimum alveolar concentration) and propofol do not impair cerebral autoregulation. This study aimed to document the level of hypercapnia required to impair cerebral autoregulation during propofol or sevoflurane anesthesia. METHODS: Eight healthy subjects received a remifentanil infusion and were anesthetized with propofol (140 microg. kg-1. min-1) and sevoflurane (1.0-1.1% end tidal) in a randomized crossover study. Ventilation was adjusted to achieve incremental increases in arterial carbon dioxide partial pressure (Paco2) until autoregulation was impaired. Cerebral autoregulation was tested by increasing the mean arterial pressure (MAP) from 80 to 100 mmHg with phenylephrine while measuring middle cerebral artery flow velocity by transcranial Doppler. The autoregulation index, which has a value ranging from 0 to 1, representing absent to perfect autoregulation, was calculated, and an autoregulation index of 0.4 or less represented significantly impaired autoregulation. RESULTS: The threshold Paco2 to significantly impair cerebral autoregulation ranged from 50 to 66 mmHg. The threshold averaged 56 +/- 4 mmHg (mean +/- SD) during sevoflurane anesthesia and 61 +/- 4 mmHg during propofol anesthesia (P = 0.03). Carbon dioxide reactivity measured at a MAP of 100 mmHg was 30% greater than that at a MAP of 80 mmHg. CONCLUSIONS: Even mild hypercapnia can significantly impair cerebral autoregulation during general anesthesia. There is a significant difference between propofol anesthesia and sevoflurane anesthesia with respect to the effect of hypercapnia on cerebral autoregulation. This difference occurs at clinically relevant levels of Paco2. When inducing hypercapnia, carbon dioxide reactivity is significantly affected by the MAP.