Background: This review examines in vitro techniques for characterizing the pharmacokinetics of medicinal plants, focusing on their role in understanding absorption, distribution, metabolism, and excretion (ADME). The diverse bioactive compounds in medicinal plants highlight the need for robust pharmacokinetic evaluations to ensure their safety and efficacy. Objectives: The objectives were to identify and analyze in vitro techniques applied to medicinal plants’ pharmacokinetics, addressing a gap in the literature. Methods: Studies were included based on predefined eligibility criteria: in vitro pharmacokinetic studies involving medicinal plants, focusing on ADME stages. Ex vivo, in vivo, and in silico studies were excluded, along with reviews. Data were collected from the PubMed, Web of Science, and Scopus databases in June 2024 using Health Sciences Descriptors (DeCS) and their MeSH synonyms. The data extracted included study location, plant species, bioactive compounds, in vitro protocols, and ADME characteristics. Results: The review included 33 studies, with most focusing on metabolism (60%), absorption (25%), or a combination of ADME aspects. Techniques like Caco-2 cells, human liver microsomes, and simulated gastric and intestinal fluids were widely used. Conclusions: The findings highlight methodological heterogeneity, including variability in extract preparation, compound concentrations, and experimental conditions, which limits the comparability and clinical applicability of results. Key limitations include the lack of standardized protocols and physiological relevance in in vitro models, underscoring the need for multidisciplinary approaches and integration with in vivo studies.

Background: Given the impact of the pandemic in Brazil, vaccination is essential to prevent illness and death. Thus, this study sought to compare, after vaccination, the circulation of SARS-CoV-2 and the response to vaccination in the least and most vaccinated municipalities of a Brazilian state during the height of the pandemic when the Omicron variant was dominant. Methods: We tested for the SARS-CoV-2 antigen and confirmed infection using an RT-qPCR and measured IgM and IgG antibodies in fully vaccinated participants from municipalities with higher and lower vaccination rates. Results: We showed that participants from the least vaccinated municipalities were more likely to have detectable IgM antibodies and a positive antigen/RT-qPCR result for SARS-CoV-2 than participants from the most vaccinated municipalities. There were no differences between the vaccines used (BNT162b2, Ad26.COV2.S, AZD1222, and CoronaVac) and antibody production. Conclusions: Our study evaluated municipal vaccination coverage and its effects on mortality, infections, and anti-SARS-CoV-2 antibodies during a critical phase of the pandemic. The results suggest that higher vaccination coverage reduces acute cases and confers higher memory antibody levels against SARS-CoV-2. Even with a full vaccination schedule, individuals living in places with low vaccination rates are more susceptible to infection.

Brazil is a South American country where arboviruses such as dengue, Zika, Chikungunya, and yellow fever are endemic. There are also reports of sporadic outbreaks of viruses such as the Oropouche virus (OROV), which is an Orthobunyavirus¹. Although it has not received much attention, this virus was responsible for more than 7,000 documented cases in the country by July 2024, an eight-fold increase compared to the entire previous year, which saw just over 800 cases². Recently, the first fetal death from the vertical transmission of OROV fever worldwide was documented². The case occurred in the northeastern city of Pernambuco. The mother was 28 years old and was in her 30th week of pregnancy. A second suspected case in the same state that resulted in a miscarriage is being investigated². Health authorities and the general population have overlooked this disease, in a similar manner to the Zika virus prior to the congenital syndrome caused by Zika raising levels of concern². Events like this emphasize the importance of closely monitoring the public health impact of viruses like OROV. In this letter, we draw attention to OROV fever, which has been causing serious consequences in the Brazilian population, characterizing it as a public health problem. In addition to the common symptoms, such as fever, headache, nausea, vomiting, and dizziness, more intense symptoms, such as severe headache, balance dysfunction, and photophobia can occur³. In the most severe cases, neurological damage such as brain inflammation, dizziness, and lethargy can occur, as well as miscarriages and congenital damage such as microcephaly, which are possibly associated with the virus³. Recently, OROV genetic material has been identified in the umbilical cord, brain, liver, kidneys, lungs, heart, and spleen of a fetus exposed to vertical transmission³. This finding promotes a greater understanding of the importance of research on and prevention of this virus.

Background: Diabetes Mellitus (DM) is an important chronic disease that occurs worldwide. Aims: This study aims to investigate how the use of the FreeStyle^® Libre system in Unified Health System (SUS) patients impacts diabetes parameters in patients who receive education on proper insulin administration and the use of the continuous monitoring device, as well as how this affects patients without any concomitant multidisciplinary support in Sergipe, Brazil. Methods: We conducted a prospective randomized study in a diabetes clinic in Sergipe, Brazil, using the flash method FreeStyle^® Libre (Abbott). The participants were divided into two groups: one receiving diabetes education on CGM (continuous glucose monitoring), while the other did not. Before the intervention, the patient’s treatment motivation and quality of life were assessed using a questionnaire, and baseline levels of glycated hemoglobin were measured using high-performance liquid chromatography (HPLC) and the point of care Alere^TM Afinion with boronate fixation. We compared first- and second-phase data with respect to glycated hemoglobin, mean interstitial blood glucose, time on and above target for hypoglycemic and hyperglycemic events, and mean hypoglycemic duration. Results: In group A, which received the diabetes education intervention, there was a significant reduction in average HbA1c levels from 8.6% to 7.9% after 3 months (p = 0.001). However, there was no significant difference in average glycemic values. Time above target decreased significantly from 50.62% to 29.43% (p = 0.0001), while time below target decreased from 22.90% to 20.21% (p = 0.002). There was no significant change in the number of hypoglycemic events, but the duration of hypoglycemia decreased significantly from 130.35 min to 121.18 min after 3 months (p = 0.0001). In Group B, there was no significant difference in mean HbA1c levels before (7.07%) and after (7.28%) sensor installation. This group maintained lower HbA1c levels compared to the other group. Average blood glucose levels also remained similar before (148.37 mg/dL) and after (154.65 mg/dL) the intervention. Although the time above the target glucose level increased significantly from 35.94% to 48.17%, the time at target decreased from 50.40% to 37.97%. No significant changes were observed in the time below target, the number of hypoglycemic events, or the duration of hypoglycemia. Conclusions: Our findings indicate that utilizing continuous glucose monitoring technology can enhance glycemic control, particularly in motivated, educated, low-income patients dependent on the SUS. To achieve positive results with FreeStyle Libre, it is imperative to allocate resources for multidisciplinary support.

Since their discovery, rubella and measles have been treated with concern due to the infectivity and mortality of these diseases in non-immunized or immunocompromised individuals (Kaplan et al. 1992). These vaccines are still part of the vaccination schedule of the Brazilian population. Since 2019 the Brazilian Ministry of Health has reported the increase of rubella and measles cases in the country (Makarenko et al. 2022 MAKARENKO C, SAN PEDRO A, PAIVA NS, SANTOS JPC, MEDRONHO RA & GIBSON G. 2022. Ressurgimento do sarampo no Brasil: análise da epidemia de 2019 no estado de São Paulo. Rev Saúde Pública 56: 50. ). From 2017 to 2019, DataSUS indicated a 99.8% increase in confirmed measles cases. Rubella, last reported in Brazil in an imported case in 2014, was suspected of at least 660 cases in the country in 2022. Despite 23 years of a vigorous vaccination schedule, the return of these infections is occurring and the main reason involves individuals who have not adhered or had no access to vaccination.

Background: The disposal of plastic material has been gaining negative attention due to its impact on the environment and people’s health. Insulin pens used by people living with diabetes are disposed of through landfills or incineration, negatively impacting the environment and generating costs for the state. Methods: In an attempt to reduce the disposal of plastic in the environment and reduce disposal costs, the “Insulinadiamor” project was created, which uses handicrafts as a means of re-socializing women deprived of their liberty. In this project, female inmates in the state of Sergipe turn insulin pens into ballpoint pens. Results: During the year 2022, 2000 insulin pens were transformed into ballpoint pens. We estimate a loss of around USD 37,150.28 for the state due to the inappropriate use of medicines, which was reflected in the return of complete insulins. In addition, by avoiding landfill or incineration of the plastic content collected, we contributed to an estimated saving of almost USD 603.91 for the state and more than 80 kg of CO₂-equivalent emissions. Conclusions: This project brings a sustainable and transformative approach involving financial savings, rehabilitation of inmates, and contribution to the environment. It also raises the importance of creating more sustainable initiatives to reduce plastic waste in the health sector and other areas.