Introduction: Vancomycin and piperacillin-tazobactam are widely prescribed in the therapy of septic shock of critically ill ICU patients, including major burns with infections caused by susceptible Gram-positive and Gram-negative nosocomial bacteria. Therapeutic drug serum monitoring and cultures were essential to combat these infections. Therefore, combating the development of resistance is a relevant first-line tool to ensure the maintenance of these antibiotics in the therapeutic arsenal, especially in tertiary public hospitals with high demand for care for these septic patients with high-risk mortality admitted to Intensive Care Units. Subject: Aim of the study was investigated by an open label clinical protocol in major burns during the first septic shock, after 72 hours of ICU admission to evaluate pharmacodynamics based on pharmacokinetics, that could affect the coverage of vancomycin, 1-hr. intermittent infusion, in a combined therapy with piperacillin-tazobactam by 3-hrs.-extended infusion in a dose prescribed in a creatinine clearance dependence, against susceptible pathogens. Methods: The primary endpoint was the pharmacodynamics target based on microbiology of the isolate susceptible strains obtained from cultures, and on drug serum monitoring that was realized by two Sets of blood sampling for antibiotics serum measurements by TDM, twice a week, to reach the target recommended for both ATBs, with dose prescribed based on a renal function dependence. The recommended target for vancomycin by 1hr. intermittent infusion was considered against Gram-positive susceptible strains; while for piperacillin-tazobactam by 3hrs.-extended infusion was chosen against Gram-negative strains. The primary outcome was to evaluate the combined therapy prescribed to patients, considering vancomycin and piperacillin/tazobactam dose prescribed in Set 1 at TDM1 vs Set 2 at TDM 2, adjusted or maintained dose. Results: Coverage strategy was based on the prediction index (AUCss0-24/MIC, ratio) for vancomycin effectiveness related to target attainment. In addition, coverage related to piperacillin-tazobactam was based on the prediction index of drug effectiveness (%f T>MIC) based on target attainment. It is important to highlight that each antibiotic coverage was monitored at the first septic shock, in the early stage in patients with high variability of renal clearance as acute kidney injury (AKI, n=10), renal function preserved or vasopressor requirements (n=22). PK-changes impacted coverage of both ATBs related to renal function dependence by each antibiotic investigated, and dose adjustment was done in real time for each patient. Conclusion: Combined therapy of septic shock with vancomycin-piperacillin/tazobactam against nosocomial pathogens by PK/PD approach was done twice a week based on cultures, ATBs serum levels to guarantee the target attainment in a short period for all patients. Then, this strategy has been applied in the last ten years in the clinical protocols of our hospital, especially in the ICU of Burned Unit, to guarantee the individualized therapy by antimicrobial coverage, that contributes for combating the mutant´s selection of Enterobacteriaceae. and to prevent the development of bacterial resistance resulting in death on ICU by selection of MDR pathogens.
Pulmonary tuberculosis (TB), caused by Mycobacterium tuberculosis, remains a major global health challenge. The increasing incidence of multidrug-resistant TB (MDR-TB) necessitates the exploration of alternative therapeutic options. Artemisia afra and Artemisia annua are two medicinal plants used historically in traditional medicine to treat various ailments, including respiratory diseases. Researchers have discovered that extracts found in the two plants, such as artemisinin and certain flavonoids and flavones, have significant anti- TB effects. This review evaluates the potential of Artemisia Afra and Artemisia Annua in treating pulmonary tuberculosis, focusing on their pharmacological properties, preclinical, clinical studies, and their potential integration into TB treatment regimens.
Recurrent spontaneous abortion (RSA), defined as the loss of three or more fetuses during the first trimester of pregnancy, is a significant reproductive health issue. The Human Leukocyte Antigen (HLA)-G, a non-classical major histocompatibility complex (MHC) class I molecule, plays a crucial role in maternal-fetal immune tolerance. This study investigates the relationship between HLA-G alleles and RSA across various populations globally. Allelic frequencies were analyzed using data from the Anthony Nolan and Allele Frequencies databases, focusing on populations with genetic ties to Colombia due to historical migration patterns. Results indicate that the HLA-G01:01 allele is most prevalent in Denmark, Germany, Portugal, and the United States, with frequencies of 56.7%, 87.47%, 77.19%, and 79.8%, respectively. Conversely, the HLA-G01:03 and HLA-G01:05N alleles are the least frequent, with HLA-G01:05N particularly associated with RSA. The study underscores the importance of HLA-G in pregnancy outcomes and suggests that genetic screening for specific HLA-G alleles in women with a history of RSA could provide insights into the risk factors and mechanisms underlying recurrent pregnancy loss.
This study comprehensively investigated three Moringa species in Madagascar Moringa drouhardii, M. hildebrandtii and M. oleifera. Recognizing the significant nutritional and medicinal potential of M. oleifera, this research aimed to expand our understanding of the endemic Malagasy species. A multi-faceted approach was employed, encompassing phytochemical screening, macronutrient and micronutrient analyses, and acute toxicity assessments. Results demonstrated that the leaves of all three species possess significant nutritional value, with high protein content, particularly in M. oleifera. They are also rich in essential minerals such as potassium, magnesium, and phosphorus, while supplementation with calcium-rich foods is recommended. Phytochemical analysis revealed the presence of various bioactive compounds, including alkaloids, tannins, flavonoids, and saponins, suggesting potential health-promoting properties. Acute toxicity studies in animal models did not reveal any significant adverse effects, indicating the potential safety of Moringa leaf consumption. To fully characterize the nutritional composition of these species, further in-depth studies, including detailed amino acid and vitamin analyses, are warranted. To promote the sustainable utilization of these valuable resources, a multi-pronged approach is necessary. This includes public awareness campaigns, the development of value-added products, the establishment of a nursery for the conservation and propagation of endemic species, and the promotion of sustainable cultivation and harvesting practices. This research provides a foundation for the sustainable utilization of these underutilized Malagasy resources, promoting both human health and environmental sustainability.
The present work proposed to research the labels of some industrialized and compounded herbal medicines, authorized for commercialization by ANVISA. It assessed the agreement with the rules recommended in the current national legislation. 150 labels of herbal medicines composed of 42 medicinal plants, acquired in the months of August and September 2017 in Belo Horizonte, were analyzed. The analysis was made as to the presence of items according to the Resolution of the Collegiate Board nº26, of May 13, 2014. The result confirmed that many labels were in disagreement with the legislation. Of the 150 samples, 58 were inadequately packaged and only 21 samples presented important information as contraindications. None of the phytotherapics analyzed in this work had, on their labels, information about the adverse effects of medicines. When making a comparison with the previous studies, it appears that there has been an improvement in the labeling of herbal medicines. However, they still require regulatory actions, as they fail to provide important information about the correct and safe use of these medicinal plants.
