Design and Characterization of an Ethosomal Gel Encapsulating Rosehip Extract.

Rising environmental awareness drives green consumers to purchase sustainable cosmetics based on natural bioactive compounds. The aim of this study was to deliver Rosa canina L. extract as a botanical ingredient in an anti-aging gel using an eco-friendly approach. Rosehip extract was first characterized in terms of its antioxidant activity through a DPPH assay and ROS reduction test and then encapsulated in ethosomal vesicles with different percentages of ethanol. All formulations were characterized in terms of size, polydispersity, zeta potential, and entrapment efficiency. Release and skin penetration/permeation data were obtained through in vitro studies, and cell viability was assessed using an MTT assay on WS1 fibroblasts. Finally, ethosomes were incorporated in hyaluronic gels (1% or 2% w/v) to facilitate skin application, and rheological properties were studied. Rosehip extract (1 mg/mL) revealed a high antioxidant activity and was successfully encapsulated in ethosomes containing 30% ethanol, having small sizes (225.4 ± 7.0 nm), low polydispersity (0.26 ± 0.02), and good entrapment efficiency (93.41 ± 5.30%). This formulation incorporated in a hyaluronic gel 1% w/v showed an optimal pH for skin application (5.6 ± 0.2), good spreadability, and stability over 60 days at 4 °C. Considering sustainable ingredients and eco-friendly manufacturing technology, the ethosomal gel of rosehip extract could be an innovative and green anti-aging skincare product.

Comparison of the Role of Different Levels of Religiousness and Spirituality in Controversial Ethical Issues and Clinical Practice among Brazilian Resident Physicians: Results from the Multicenter SBRAMER Study.

This study compares clinical practice and objections to controversial ethical issues among 836 Brazilian resident physicians according to levels of religiousness/spirituality. Residents with low religiousness/spirituality (s/r) believed less in the influence of spirituality on clinical practice, were less comfortable addressing this issue, tended to listen less carefully and try to change the subject more than other groups. Residents with high spirituality and low religiousness (S/r) inquired more about religious/spiritual issues, while those with high religiousness/spirituality (S/R) were more supportive and reported fewer barriers to addressing these issues. Concerning ethical issues (e.g., physician-assisted suicide, withdrawal of life support, abortion), S/R had more objections than others.

Religiosity and Spirituality of Resident Physicians and Implications for Clinical Practice-the SBRAMER Multicenter Study.

OBJECTIVES: To assess the attitudes, knowledge, and experiences of Brazilian resident physicians regarding religiosity/spirituality (R/S), factors associated with addressing this issue, and its influence on clinical practice. METHODS: We report results of the multicenter "Spirituality in Brazilian Medical Residents" (SBRAMER) study involving 7 Brazilian university centers. The Network for Research Spirituality and Health (NERSH) scale (collecting sociodemographic data, opinions about the R/S-health interface, and respondents' R/S characteristics) and the Duke Religion Index were self-administered. Logistic regression models were constructed to determine those factors associated with residents' opinions on spirituality in clinical practice. RESULTS: The sample comprised 879 resident physicians (53.5% of total) from all years of residency with 71.6% from clinical specialties. In general, the residents considered themselves spiritual and religious, despite not regularly attending religious services. Most participants believed R/S had an important influence on patient health (75.2%) and that it was appropriate to discuss these beliefs in clinical encounters with patients (77.1%), although this was not done in routine clinical practice (14.4%). The main barriers to discussing R/S were maintaining professional neutrality (31.4%), concern about offending patients (29.1%), and insufficient time (26.2%). Factors including female gender, clinical specialty (e.g., internal medicine, family medicine, psychiatry) as opposed to surgical specialty (e.g., surgery, obstetrics/gynecology, orthopedics), having had formal training on R/S, and higher levels of R/S were associated with greater discussion of and more positive opinions about R/S. CONCLUSION: Brazilian resident physicians held that religious and spiritual beliefs can influence health, and deemed it appropriate for physicians to discuss this issue. However, lack of training was one of the main obstacles to addressing R/S issues in clinical practice. Educators should draw on these data to conduct interventions and produce content on the subject in residency programs.

Novel and Modified Neutrophil Elastase Inhibitor Loaded in Topical Formulations for Psoriasis Management.

Human neutrophil elastase (HNE) is a serine protease that degrades matrix proteins. An excess of HNE may trigger several pathological conditions, such as psoriasis. In this work, we aimed to synthesize, characterize and formulate new HNE inhibitors with a 4-oxo-ß-lactam scaffold with less toxicity, as well as therapeutic index in a psoriasis context. HNE inhibitors with 4-oxo-ß-lactam scaffolds were synthesized and characterized by NMR, FTIR, melting point, mass spectrometry and elemental analysis. In vitro cytotoxicity and serine protease assays were performed. The compound with the highest cell viability (AAN-16) was selected to be incorporated in an emulsion (AAN-16 E) and in a microemulsion (AAN-16 ME). Formulations were characterized in terms of organoleptic properties, pH, rheology, droplet size distribution, in vitro drug release and in vivo psoriatic activity. All compounds were successfully synthesized according to analytical methodology, with good yields. Both formulations presented suitable physicochemical properties. AAN-16 E presented the most promising therapeutic effects in a murine model of psoriasis. Overall, new HNE inhibitors were synthesized with high and selective activity and incorporated into topical emulsions with potential to treat psoriasis.

Fragaria vesca L. Extract: A Promising Cosmetic Ingredient with Antioxidant Properties.

Fragaria vesca L. (F. vesca), popularly known as wild strawberry, is a plant from the Rosaceae family, found in temperate and subtropical areas of the northern hemisphere. F. vesca leaves have been shown to have antiseptic, emollient, and dermatological protection properties, due to the presence of bioactive compounds, such as flavonoids, phenolic acids, ellagitannins, and proanthocyanidins. In this study, a F. vesca extract was obtained by an optimized extraction process, and was characterized by HPLC, ROS scavenging activity, cytotoxicity assays in HaCaT cells, and tyrosinase inhibitory activity determination. The most active extract was then incorporated in a hydrogel with hydroxyethylcellulose at 2% (w/w), which was characterized at the physicochemical, stability, cytotoxicity, and ROS scavenging activity levels to evaluate its quality, safety, and efficacy. In vivo studies, human repeat insult patch testing, and an assay to determine their antioxidant efficacy, were also performed. The results showed that the Fragaria vesca extracts had antioxidant activity and that the F. vesca extract-based hydrogel exhibited cutaneous compatibility, acceptability and antioxidant efficacy, being stable, and suitable for topical application.

Exposure assessment in one central hospital: A multi-approach protocol to achieve an accurate risk characterization.

The bioburden in a Hospital building originates not only from patients, visitors and staff, but is also disseminated by several indoor hospital characteristics and outdoor environmental sources. This study intends to assess the exposure to bioburden in one central Hospital with a multi-approach protocol using active and passive sampling methods. The microbial contamination was also characterized through molecular tools for toxigenic species, antifungal resistance and mycotoxins and endotoxins profile. Two cytotoxicity assays (MTT and resazurin) were conducted with two cell lines (Calu-3 and THP-1), and in vitro pro-inflammatory potential was assessed in THP-1 cell line. Out of the 15 sampling locations 33.3% did not comply with Portuguese legislation regarding bacterial contamination, whereas concerning fungal contamination 60% presented I/O > 1. Toxigenic fungal species were observed in 27% of the sampled rooms (4 out of 15) and qPCR analysis successfully amplified DNA from the Aspergillus sections Flavi and Fumigati, although mycotoxins were not detected. Growth of distinct fungal species was observed on Sabouraud dextrose agar with triazole drugs, such as Aspergillus section Versicolores on 1 mg/L VORI. The highest concentrations of endotoxins were found in settled dust samples and ranged from 5.72 to 23.0 EU.mg-1. While a considerable cytotoxic effect (cell viability < 30%) was observed in one HVAC filter sample with Calu-3 cell line, it was not observed with THP-1 cell line. In air samples a medium cytotoxic effect (61-68% cell viability) was observed in 3 out of 15 samples. The cytokine responses produced a more potent average cell response (46.8 ± 12.3 ρg/mL IL-1ß; 90.8 ± 58.5 ρg/mL TNF-α) on passive samples than air samples (25.5 ± 5.2 ρg/mL IL-1ß and of 19.4 ± 5.2 ρg/mL TNF-α). A multi-approach regarding parameters to assess, sampling and analysis methods should be followed to characterize the biorburden in the Hospital indoor environment. This study supports the importance of considering exposure to complex mixtures in indoor environments.

Starch-Based Pickering Emulsions as Platforms for Topical Antibiotic Delivery: In Vitro and In Vivo Studies.

The present study investigated a new approach to treat superficial skin infections by topical application of minocycline hydrochloride (MH) formulated in a novel starch-based Pickering emulsion (ASt-emulsions). The emulsions were fully characterized in terms of efficacy, as well as in vitro release and permeation studies. The emulsions provided a prolonged MH release, always above its minimum inhibitory concentration against Staphylococcus aureus, although the drug did not permeate through the entire skin layer. The in vitro antibacterial activity of MHASt-emulsions against S. aureus was confirmed and their therapeutic efficacy was assessed using an in vitro skin-adapted agar diffusion test. In vivo antibacterial activity, evaluated using the tape-stripping infection model in mice, showed the topical administration of MH was effective against superficial infections caused by S. aureus. This study supports the potential of ASt-emulsions as promising platforms for topical antibiotic delivery, contributing to a new perspective on the treatment of superficial bacterial infections.

Design and Characterization of a New Quercus Suber-Based Pickering Emulsion for Topical Application.

Quercus Suber Bark from Quercus suber L. is a natural, renewable and biodegradable biomaterial with multifunctional proprieties. In this study, we used it as solid particles to stabilize a Pickering emulsion. The main goal was to produce an optimized topical formulation using biocompatible organic particles as stabilizers of the emulsion instead of the common surfactants, whilst benefiting from Quercus suber L. proprieties. In this work, a Quality by Design (QbD) approach was successfully applied to the production of this emulsion. A screening design was conducted, identifying the critical variables of the formula and process, affecting the critical quality attributes of the emulsion (droplet size distribution). The optimization of the production was made through the establishment of the design space. The stability was also investigated during 30 days, demonstrating that Quercus Suber Bark-stabilized emulsions are stable since the droplet size distribution lowers. In vitro studies were performed to assess antioxidant and antiaging efficacy, which revealed that the formulation had indeed antioxidant proprieties. A physicochemical characterization demonstrated that the formulation presents a shear-thinning fluid, ideal for topical administration. The in vivo compatibility study confirmed that the final formulation is not skin irritant, being safe for human use. A sensorial analysis was also performed, using a simple sensory questionnaire, revealing very positive results. Thus, the use of Quercus Suber Bark particles as a multifunctional solid ingredient contributed to achieve a stable, effective and innovative Pickering emulsion with a meaningful synergistic protection against oxidative stress.

Approaching Spirituality Using the Patient-Centered Clinical Method.

Although the scientific literature already suggests the importance of spiritual care in clinical practice, this topic has been apart from the routine of many practitioners, and many physicians still have difficulties in how to carry out such approaches in the clinical setting. This article reflects on the importance of spirituality in the health-disease process and provides an approach to the biopsychosocial-spiritual care in the practice of primary care. In addition, the aim of the authors is to propose a spiritual approach based on the patient-centered clinical method. This method has been used for clinical communication and can be powerful for exploring spiritual history. Thus, using a fictional case scenario as a practical example, the authors guide readers to understand the patient-centered approach they propose.

Useful In Vitro Techniques to Evaluate the Mucoadhesive Properties of Hyaluronic Acid-Based Ocular Delivery Systems.

Polymer-based eye drops are the most used drug delivery system to treat dry eye disease (DED). Therefore, the mucoadhesion between the polymer and the ocular mucin is crucial to ensure the efficacy of the treatment. In this context, the present study aimed to evaluate the potential use of in vitro methods to study the mucoadhesion of eye drop solutions and, specifically to evaluate the efficacy of two hyaluronic acid-based formulations (HA), HA 0.15% and 0.30% (w/v) to treat DED. Rheology methods and zeta potential determination were used to study the mucoadhesive properties of both eye drop solutions. All results indicated that interactions occurred between the mucin and the HA, being stronger with HA 0.30%, due to the physical entanglements and hydrogen bounding. In vitro tests on ARPE-19 cell line were performed using a 2D and a 3D dry eye model and the results have shown that pre-treated cells with HA showed a morphology more similar to the hydrated cells in both products, with a high survival rate. The in vitro techniques used in this study have been shown to be suitable to evaluate and predict mucoadhesive properties and the efficacy of the eye drops on relief or treatment of DED. The results obtained from these methods may help in inferring possible in vivo effects.

Spirituality, Religiosity, Quality of Life and Mental Health Among Pantaneiros: A Study Involving a Vulnerable Population in Pantanal Wetlands, Brazil.

This study aims to investigate the relationship between spirituality, religiosity (S/R), mental health and quality of life in a vulnerable population in the Pantanal wetlands of Brazil. A total of 129 individuals were interviewed. We examined mental health (Hospital Anxiety and Depression Scale), quality of life (SF-12), spirituality (self-spirituality rating scale), religiosity (DUREL) and R/S opinions. Individuals had high levels of spirituality, non-organizational and intrinsic religiosity, but low levels of religious attendance. Most participants said they would like to have their faith addressed by a health professional and that this approach would strengthen their trust on the doctors. Higher levels of spirituality were associated with less anxiety (ß = - 0.236, p < 0.01) and depressive symptoms (ß = - 0.398, p < 0.001); higher levels of non-organizational religiosity were associated with less anxiety (ß = - 0.250, p < 0.01) and depressive symptoms (ß = - 0.351, p < 0.001); and higher levels of intrinsic religiosity were associated with less depressive symptoms (ß = - 0.315, p < 0.001). Quality of life was not associated with any religious/spiritual measures.

Effect of an educational intervention in "spirituality and health" on knowledge, attitudes, and skills of students in health-related areas: A controlled randomized trial.

BACKGROUND: To date there have been no randomized studies that assess whether "Spirituality and Health" (S/H) programs are, indeed, effective, or not. We sought to evaluate if an intervention in teaching S/H fosters competence changes in healthcare students. METHODS: A randomized controlled trial was carried out. Students were randomized into two groups: an Intervention Group (a theoretical-practical course in S/H) and a control group (waiting list). Students' S/H knowledge, attitudes, and skills (through a simulated patient) were assessed. RESULTS: A total of 49 students were evaluated. Students in the intervention group received higher scores on knowledge tests, felt more comfortable and prepared to talk about religious/spiritual beliefs with patients, more readily recognized importance of hospital chaplains, and more frequently held the opinion that addressing spirituality is important. Furthermore, a breaking down of S/H barriers was identified. Students also demonstrated more ability in obtaining a patient's spiritual history when compared to the control group. CONCLUSIONS: There were some differences on knowledge, attitudes, and spiritual history skills between students who participated in the S/H teaching strategy and students who have not been exposed to the theme. These results might foster discussion for the development of new educational strategies about the subject.

Learning from Listening: Helping Healthcare Students to Understand Spiritual Assessment in Clinical Practice.

We aim to evaluate the perceptions of healthcare students while taking a spiritual history (SH). Fifty students were trained on how to take a SH, interviewed inpatients and answered a questionnaire concerning their perceptions. A total of 362 patients were interviewed: 60.1% of students felt comfortable taking a SH, 85.1% believed the patient liked the approach, and 72.1% believed more benefits could come with a follow-up. When students felt more comfortable, they tended to believe the patient: liked the approach (p < 0.01), felt better (p < 0.01) and more motivated (p < 0.01). Spirituality/health educational strategies may be a valid strategy to prepare future health professionals to face spiritual issues in health scenarios.

Mediumship: review of quantitatives studies published in the 21st century

Abstract Background Mediumship can be defined as the alleged ability to communicate with deceased persons. The last decade has been particularly productive for this field of research and the study of mediumship can help the understanding of the human mind-brain relationship and provide objective data to the scientific community and to the general population. Objective The aim of this review is to summarize and discuss the results found on recent studies investigating mediumship. Furthermore, we aim to discuss the psychophysiology underlying mediumship and future perspectives for this study topic. Methods A literature search for articles in English, Portuguese and Spanish published from January 2000 up to June 2015 was conducted using three electronic databases (PubMed, Lilacs and Web of Science). Review articles, qualitative studies and studies investigating altered states of consciousness caused by psychoactive substances were excluded. The original search returned 150 articles, but the application of exclusion criteria resulted in the inclusion of 19 articles for final analysis. Results The general findings were: (1) an association of mediumship with good mental health, predominantly in experienced mediums, (2) heterogeneous findings regarding the ability of mediums to provide accurate information what may be due to different study methodologies and (3) incipient studies assessing physiological correlations during mediumistic communications (i.e. hypoactivation of brain regions responsible for cognitive processing and writing planning during psychography compared to a control task; electroencephalographic (EEG) changes and a slight predominance of the sympathetic nervous system). Discussion There is a paucity of empirical data available in this controversial research field. New studies employing rigorous design (e.g.triple-blind protocols to test accuracy of mediumistic communications), and sensitive methods are required.

Approaches to tuberculosis mucosal vaccine development using nanoparticles and microparticles: a review.

Next-generation vaccines for tuberculosis should be designed to prevent the infection and to achieve sterile eradication of Mycobacterium tuberculosis. Mucosal vaccination is a needle-free vaccine strategy that provides protective immunity against pathogenic bacteria and viruses in both mucosal and systemic compartments, being a promising alternative to current tuberculosis vaccines. Micro and nanoparticles have shown great potential as delivery systems for mucosal vaccines. In this review, the immunological principles underlying mucosal vaccine development will be discussed, and the application of mucosal adjuvants and delivery systems to the enhancement of protective immune responses at mucosal surfaces will be reviewed, in particular those envisioned for oral and nasal routes of administration. An overview of the essential vaccine candidates for tuberculosis in clinical trials will be provided, with special emphasis on the potential different antigens and immunization regimens.